1246 infection control & hospital epidemiology october 2015, vol. 36, no. 10


table 1. Infection Prevention Practices for Cesarean Delivery Surgeries in 197 Hospitals Response Yes


No 3 (1.5%)


Unknown or conditional 1 ( 0.5% - after cord clamping) NOTE. Data are no. (%) of hospitals.


109 (55.3%) 83 (42.1%) 5 (2.5%)


Preoperative antibiotic use Dosing for obesity Chlorhexidine-based skin antisepsis Vaginal antisepsis 193 (98.0%)


152 (77.2%) 30 (15.2%) 15 (7.6%)


We found that very few academic centers are using povidone- iodine vaginal antisepsis despite the strong evidence favoring this intervention. One limitation of our study is that the nurses we interviewed


may not be familiar with all practices in their units. In order to mitigate this concern, we interviewed only charge nurses, clinical specialists, nurse educators, and nurse managers to select for the more experienced nurses in each unit. Another limitation is that our study assessed recommended standards of care in labor and delivery units and not actual prac- tice. It has been shown that only 57% of women actually receive preoperative prophylactic antibiotics in practice.15 This may be partly related to the emergent nature of some cesarean deliveries. We found significant variability in the practices to prevent


cesarean delivery infections in academic centers across the United States. Additional clinical trials and specific guidelines are needed to better define best practices in this patient population.


acknowledgments


Financial support. None reported. Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.


Cynthia Argani, MD;1 Evie Notis;2


Rachel Moseley, RN, BSN, CWCN, COCN;3 Kerri Huber, RN, MSN, CIC;3 Scott Lifchez, MD;4 Leigh Ann Price, MD;4


Jonathan Zenilman, MD;5 Andrew Satin, MD;1


Trish M. Perl, MD, Msc;5,6 Geetika Sood, MD5


Affiliations: 1. Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland; 2. Brandeis University, Waltham, Massachusetts; 3. Johns Hopkins Bayview Medical Center, Balti- more, Maryland; 4. Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; 5. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; 6. Epidemiology and Infection Prevention, Johns Hopkins Health System, Baltimore, Maryland Address correspondence to Geetika Sood, MD, Center Tower, 3rd Floor,


Johns Hopkins Bayview Medical Center, 5200 Eastern Avenue, Baltimore,MD (Gsood1@jhmi.edu).


Received March 13, 2015; accepted: June 8, 2015; electronically published


July 20, 2015 Infect. Control Hosp. Epidemiol. 2015;36(10):1245–1247 © 2015 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2015/3610-0019. DOI: 10.1017/ice.2015.161


supplementary materials


To view Supplementary Materials for this article, please visit http://dx.doi.org/10.1017/ice.2015.161


references


1. Centers for Disease Control and Prevention. National Vital Statistics System. http://www.cdc.gov/nchs/nvss.htm. Accessed June 24, 2015.


2. Yokoe DS, Christiansen CL, Johnson R, et al. Epidemiology of and surveillance for postpartum infections. Emerg Infect Dis 2001;7:837–841.


3. Smaill FM, Grivell RM. Antibiotic prophylaxis versus no pro- phylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev 2014;10:CD007482.


4. Sun J, Ding M, Liu J, et al. Prophylactic administration of cefazolin prior to skin incision versus antibiotics at cord clamping in preventing postcesarean infectious morbidity: a systematic review and meta-analysis of randomized controlled trials. Gynecol Obstet Invest 2013;75:175–178.


5. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 120: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol 2011;117:1472–1483.


6. Mackeen AD, Packard RE, Ota E, Berghella V, Baxter JK. Timing of intravenous prophylactic antibiotics for preventing post- partum infectious morbidity in women undergoing cesarean delivery. Cochrane Database Syst Rev 2014;12:CD009516.


7. Stitely M, Sweet M, Slain D, et al. Plasma and tissue cefazolin concentrations in obese patients undergoing cesarean delivery and receiving differing pre-operative doses of drug. Surg Infect 2013;14:455–459.


8. Gyte GM, Dou L, Vazquez JC. Different classes of antibiotics given to women routinely for preventing infection at caesarean section. Cochrane Database Syst Rev 2014;11:CD008726.


9. McKibben RA, Pitts SI, Suarez-Cuervo C, Perl TM, Bass EB. Practices to reduce surgical site infections among women undergoing cesarean section: a review [published online May 20, 2015]. Infect Control Hosp Epidemiol. doi:10.1017/ ice.2015.116.


10. Bratzler DW, Dellinger EP, Olsen KM, et al.; American Society of Health-System Pharmacists (ASHP); Infectious Diseases Society of America (IDSA); Surgical Infection Society (SIS); Society for Healthcare Epidemiology of America (SHEA). Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect 2013;14:73–156.


11. Webster J1, Osborne S. Preoperative bathing or showering with skin antiseptics to prevent surgical site infection. Cochrane Database Syst Rev 2012;9:CD004985.


25 (12.7%) 166 (84.3%) 6 (3.0%)


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