Variation in obstetric infection prevention and control at caesarean section

Mrs Elizabeth Martin1, Dr Michael Beckmann2, Professor Nicholas Graves1

1Queensland University Of Technology, Kelvin Grove, Australia,

2Mater Health Services, South Brisbane, Australia


Surgical site infections following caesarean section are a preventable problem for women and health services. Unique best-practice infection prevention opportunities exist for the peri-operative and surgical process of caesarean section. Some variation in caesarean section peri-operative and surgical practice is justifiable and desirable when individual patient’s health needs or health preferences are being met. However, clinical practice that varies from the best-practice is unwarranted as it may increase surgical site infection risk. The aim of this study was to identify the extent of unwarranted variation in infection prevention at caesarean section amongst Australian Obstetricians.


Australian Obstetricians were asked in an electronic survey, whether they usually implement 34 peri-operative and surgical strategies that have been evaluated for reducing surgical site infection risk at caesarean section. Adherence to best-practice was analysed descriptively and independent and statistically significant predictors of adherence to best-practice were modelled using binary logistic regression.


Best-practice was fully adhered to amongst only 4.5% of respondents. Respondents most likely to have zero adherence to best-practice were obstetric-trained General Practitioners, Obstetricians practicing in private hospitals, or both private and public hospitals, and those who do not usually use a surgical safety checklist.


Best-practice peri-operative and surgical infection prevention strategies are rarely being implemented at caesarean section. Removing unwarranted variation and improving adherence to evidence-based practice should be a policy goal of maternity health services. Infection Control Practitioners can use this research to target training and resources at Obstetricians most in need of infection prevention support.


Elizabeth is a Health Economist at the Queensland University of Technology, specializing in maternity health services. In her PhD, Elizabeth modelled the cost-effectiveness of adopting an infection prevention bundle for caesarean section. She is passionate about raising the profile of surgical site infections following caesarean section and improving maternity health services in general.

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