Background: Surgical site infections (SSIs) remain a significant concern in Cesarean sections (CS), with evidence-based intraoperative practices playing a central role in prevention. However, adherence to protocols often varies, requiring actions to minimize their impact on patients’ outcomes. Aim: To improve compliance with intraoperative SSI prevention practices during Cesarean deliveries from 80% in August 2024 to 90% by January 2025. Methods: A prospective before-and-after study using the Plan-Do-Study-Act (PDSA) model was conducted from August 2024 to January 2025 in a community hospital. Baseline data were collected 4 weeks prior. A checklist monitored key practices, including hand hygiene, timely administration of antibiotic prophylaxis, glove changes, operating room traffic, and normothermia. Observations were paired with staff education, reminders, and regular feedback to staff and leaders. Compliance and SSI rates were analyzed using descriptive statistics. Results: One hundred and eighty-six procedures were observed (25 baseline, 161 intervention). Overall compliance improved from 52% to 100% by week 9. Surgical hand hygiene compliance increased from 76% to >80%. Compliance with the timely administration of antibiotic prophylaxis improved, particularly in emergency CS. Operating room traffic decreased significantly. Only one SSI occurred during the intervention (0.6%), compared to one during the baseline (4.0%). Conclusion: Targeted quality improvement strategies improved compliance with key intraoperative SSI prevention practices and were associated with reduced infection rates. Education, real-time observation, and feedback were effective in promoting behavior change. Sustained improvement requires routine integration of monitoring into surgical workflows and ongoing analysis of practice adherence indicators.
Gutierrez et al. (Tue,) studied this question.