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Am J Perinatol 2019; 36(13): 1325-1331
DOI: 10.1055/s-0039-1688822
SMFM Fellowship Series Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Does a Care Bundle Reduce Racial Disparities in Postcesarean Surgical Site Infections?

Tetsuya Kawakita 
1   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
,
Jason G. Umans
1   Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia
2   Department of Medicine, Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia
3   Department of Obstetrics and Gynecology, Georgetown-Howard Universities Center for Clinical and Translational Science, Washington, District of Columbia
› Author Affiliations
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Publication History

13 January 2019

02 April 2019

Publication Date:
14 May 2019 (online)

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Abstract

Objective To examine the effect of a care bundle on racial disparities in surgical site infections (SSIs).

Study Design This was a retrospective cohort study of women undergoing cesarean delivery at ≥23 weeks' gestation. The care bundle included routine antibiotics (both cefazolin and azithromycin), chlorhexidine skin preparation, clippers, vaginal cleansing, placental removal by cord traction, subcutaneous tissue closure, suture skin closure, dressing removal in 24 to 48 hours, and postoperative chlorhexidine soap. Our primary outcome was SSI (superficial incisional, deep incisional, and organ/space) occurring up to 6 weeks. Adjusted odds ratios (aOR) with 95% confidence intervals (95% CI) were calculated, adjusting for predefined covariates.

Results Of 2,696 women, 1,947 were black (1,014 in the preimplementation period and 933 in the postimplementation period) and 749 were nonblack (370 in the preimplementation period and 379 in the postimplementation period). Regardless of race, women in the postimplementation period had lower rates of SSI compared with those in the preimplementation period (black: 2.9 vs. 5.2%, aOR: 0.53 [95% CI: 0.33–0.85]; nonblack: 1.1 vs. 3.5%, aOR: 0.28 [95% CI: 0.09–0.89]). There was no interaction by race (p for interaction = 0.94).

Conclusion The care bundle decreased SSI in both black and nonblack women but did not reduce racial disparities.

Keywords

care bundle - cesarean delivery - racial disparities - surgical site infections

Note

This paper was presented in part as an oral presentation (#54) at the Society for Maternal-Fetal Medicine 39th Annual Pregnancy Meeting, February 11–16, 2019, Las Vegas, NV.