Institutional protocols for vaginal preparation with antiseptic solution and surgical site infection rate in women undergoing cesarean delivery during labor

Mauricio La Rosa, Victoria Jauk, George Saade, Kim Boggess, Sherri Longo, Erin A.S. Clark, Sean Esplin, Kirsten Cleary, Ronald Wapner, Kellett Letson, Michelle Y. Owens, Sean Blackwell, Jeff M. Szychowski, William W. Andrews, Alan T. Tita

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVE: To evaluate the association of institutional protocols for vaginal preparation with antiseptic solution and the surgical site infection rate in women undergoing cesarean delivery during labor. METHODS: This is a secondary analysis of a multicenter randomized controlled trial of adjunctive azithromycin prophylaxis for cesarean delivery performed in laboring patients with viable pregnancies. The primary outcome for this analysis was the rate of superficial or deep surgical site infection within 6 weeks postpartum, as per Centers for Disease Control and Prevention criteria. Maternal secondary outcomes included a composite of endometritis, wound infection or other infections, postoperative maternal fever, length of hospital stay, and the rates of hospital readmission, unexpected office visits, and emergency department visits. RESULTS: A total of 523 women delivered in institutions with vaginal antisepsis policies before cesarean delivery and 1,490 delivered in institutions without such policies. There was no difference in superficial and deep surgical site infection rates between women with and without vaginal preparation (5.5% vs 4.1%; odds ratio [OR] 1.38, 95% CI 0.87-2.17), even after adjusting for possible confounders (adjusted OR 0.86, 95% CI 0.43-1.73). The lack of significant benefit was noted in all other maternal secondary outcomes. CONCLUSION: Institutional policies for vaginal preparation before cesarean delivery were not associated with lower rates of surgical site infection in women undergoing cesarean delivery during labor. (Obstet Gynecol 2018;132:371-6).

Original languageEnglish (US)
Pages (from-to)371-376
Number of pages6
JournalObstetrics and Gynecology
Volume132
Issue number2
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

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Surgical Wound Infection
Local Anti-Infective Agents
Mothers
Length of Stay
Odds Ratio
Antisepsis
Organizational Policy
Endometritis
Office Visits
Patient Readmission
Azithromycin
Wound Infection
Centers for Disease Control and Prevention (U.S.)
Postpartum Period
Hospital Emergency Service
Fever
Randomized Controlled Trials
Pregnancy
Infection

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Institutional protocols for vaginal preparation with antiseptic solution and surgical site infection rate in women undergoing cesarean delivery during labor. / Rosa, Mauricio La; Jauk, Victoria; Saade, George; Boggess, Kim; Longo, Sherri; Clark, Erin A.S.; Esplin, Sean; Cleary, Kirsten; Wapner, Ronald; Letson, Kellett; Owens, Michelle Y.; Blackwell, Sean; Szychowski, Jeff M.; Andrews, William W.; Tita, Alan T.

In: Obstetrics and Gynecology, Vol. 132, No. 2, 01.01.2018, p. 371-376.

Research output: Contribution to journalArticle

Rosa, ML, Jauk, V, Saade, G, Boggess, K, Longo, S, Clark, EAS, Esplin, S, Cleary, K, Wapner, R, Letson, K, Owens, MY, Blackwell, S, Szychowski, JM, Andrews, WW & Tita, AT 2018, 'Institutional protocols for vaginal preparation with antiseptic solution and surgical site infection rate in women undergoing cesarean delivery during labor', Obstetrics and Gynecology, vol. 132, no. 2, pp. 371-376. https://doi.org/10.1097/AOG.0000000000002745
Rosa, Mauricio La ; Jauk, Victoria ; Saade, George ; Boggess, Kim ; Longo, Sherri ; Clark, Erin A.S. ; Esplin, Sean ; Cleary, Kirsten ; Wapner, Ronald ; Letson, Kellett ; Owens, Michelle Y. ; Blackwell, Sean ; Szychowski, Jeff M. ; Andrews, William W. ; Tita, Alan T. / Institutional protocols for vaginal preparation with antiseptic solution and surgical site infection rate in women undergoing cesarean delivery during labor. In: Obstetrics and Gynecology. 2018 ; Vol. 132, No. 2. pp. 371-376.
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abstract = "OBJECTIVE: To evaluate the association of institutional protocols for vaginal preparation with antiseptic solution and the surgical site infection rate in women undergoing cesarean delivery during labor. METHODS: This is a secondary analysis of a multicenter randomized controlled trial of adjunctive azithromycin prophylaxis for cesarean delivery performed in laboring patients with viable pregnancies. The primary outcome for this analysis was the rate of superficial or deep surgical site infection within 6 weeks postpartum, as per Centers for Disease Control and Prevention criteria. Maternal secondary outcomes included a composite of endometritis, wound infection or other infections, postoperative maternal fever, length of hospital stay, and the rates of hospital readmission, unexpected office visits, and emergency department visits. RESULTS: A total of 523 women delivered in institutions with vaginal antisepsis policies before cesarean delivery and 1,490 delivered in institutions without such policies. There was no difference in superficial and deep surgical site infection rates between women with and without vaginal preparation (5.5{\%} vs 4.1{\%}; odds ratio [OR] 1.38, 95{\%} CI 0.87-2.17), even after adjusting for possible confounders (adjusted OR 0.86, 95{\%} CI 0.43-1.73). The lack of significant benefit was noted in all other maternal secondary outcomes. CONCLUSION: Institutional policies for vaginal preparation before cesarean delivery were not associated with lower rates of surgical site infection in women undergoing cesarean delivery during labor. (Obstet Gynecol 2018;132:371-6).",
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AU - Rosa, Mauricio La

AU - Jauk, Victoria

AU - Saade, George

AU - Boggess, Kim

AU - Longo, Sherri

AU - Clark, Erin A.S.

AU - Esplin, Sean

AU - Cleary, Kirsten

AU - Wapner, Ronald

AU - Letson, Kellett

AU - Owens, Michelle Y.

AU - Blackwell, Sean

AU - Szychowski, Jeff M.

AU - Andrews, William W.

AU - Tita, Alan T.

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N2 - OBJECTIVE: To evaluate the association of institutional protocols for vaginal preparation with antiseptic solution and the surgical site infection rate in women undergoing cesarean delivery during labor. METHODS: This is a secondary analysis of a multicenter randomized controlled trial of adjunctive azithromycin prophylaxis for cesarean delivery performed in laboring patients with viable pregnancies. The primary outcome for this analysis was the rate of superficial or deep surgical site infection within 6 weeks postpartum, as per Centers for Disease Control and Prevention criteria. Maternal secondary outcomes included a composite of endometritis, wound infection or other infections, postoperative maternal fever, length of hospital stay, and the rates of hospital readmission, unexpected office visits, and emergency department visits. RESULTS: A total of 523 women delivered in institutions with vaginal antisepsis policies before cesarean delivery and 1,490 delivered in institutions without such policies. There was no difference in superficial and deep surgical site infection rates between women with and without vaginal preparation (5.5% vs 4.1%; odds ratio [OR] 1.38, 95% CI 0.87-2.17), even after adjusting for possible confounders (adjusted OR 0.86, 95% CI 0.43-1.73). The lack of significant benefit was noted in all other maternal secondary outcomes. CONCLUSION: Institutional policies for vaginal preparation before cesarean delivery were not associated with lower rates of surgical site infection in women undergoing cesarean delivery during labor. (Obstet Gynecol 2018;132:371-6).

AB - OBJECTIVE: To evaluate the association of institutional protocols for vaginal preparation with antiseptic solution and the surgical site infection rate in women undergoing cesarean delivery during labor. METHODS: This is a secondary analysis of a multicenter randomized controlled trial of adjunctive azithromycin prophylaxis for cesarean delivery performed in laboring patients with viable pregnancies. The primary outcome for this analysis was the rate of superficial or deep surgical site infection within 6 weeks postpartum, as per Centers for Disease Control and Prevention criteria. Maternal secondary outcomes included a composite of endometritis, wound infection or other infections, postoperative maternal fever, length of hospital stay, and the rates of hospital readmission, unexpected office visits, and emergency department visits. RESULTS: A total of 523 women delivered in institutions with vaginal antisepsis policies before cesarean delivery and 1,490 delivered in institutions without such policies. There was no difference in superficial and deep surgical site infection rates between women with and without vaginal preparation (5.5% vs 4.1%; odds ratio [OR] 1.38, 95% CI 0.87-2.17), even after adjusting for possible confounders (adjusted OR 0.86, 95% CI 0.43-1.73). The lack of significant benefit was noted in all other maternal secondary outcomes. CONCLUSION: Institutional policies for vaginal preparation before cesarean delivery were not associated with lower rates of surgical site infection in women undergoing cesarean delivery during labor. (Obstet Gynecol 2018;132:371-6).

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