Implementation of a Bundled approach to reduce Surgical site infections with Caesarean Sections in a Rural NSW Referral Hospital. The highs and lows of the project at the half way mark

Mrs Michelle Bolte1Mrs Tracey Walker1

1Hunter New England Local Health District Tamworth Rural Referral Hospital, Tamworth, Nemsc., NSW, Australia


At Tamworth Regional Referral Hospital (TRRH), Clinical Performance Indicators submitted to the Australian Council on Healthcare Standards suggest a 5.7% rate of SSI following caesarean section in the period ending May 2017. This, in the context of a 0.75% infection rate across New South Wales, has prompted a departmental investigation that has recommended the introduction of a Caesarean Infection Prevention (CIP) Bundle to combat this significant obstetric morbidity. The CIP Bundle, designed in collaboration with Infection Prevention ,Wound care Consultant and Hospital Obstetric team at Tamworth Rural Referral Hospital , aimed to combine multiple evidence-based methods into a single package that will significantly impact caesarean associated SSI rates at TRRH. This study aims to validate this approach and encourage the development of similar bundles to reduce SSI rates across specialties.

The CIP bundle included:
*Introduction of standardised approach to pre-operative wash with basic hygiene .
* The use of Chlorhexidine -alcohol pre-operative skin preparations
* Best practice use of prophylaxis antibiotics.
*The application of Negative Pressure Wound therapy for women who are at high risk of SSI.

Data collected at the half way mark shows a 50% reduction in SSIs with women who have caesarean sections . Project completion is December 2018.

The CIP bundle is having an impact on reducing the rate of SSIs for woman following a Caesarean. Factors with compliance of practice was the biggest issue during the study that has required creative and unique approaches to achieve desired outcomes .


Michelle- Clinical Nurse consultant for Infection Prevention Service at Tamworth Rural Referral Hospital. Interests in Infection prevention,wound management and improving systems for patient centred care.

Tracey Walker – OT Educator – Passion in peri-operative education , with strong desire to ensure that all staff have the skills and knowledge to provide excellent patient centre care .

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