Preprocedure Antibiotics Reduce Infection After Cesarean Delivery
A change in policy to give prophylactic antibiotics before incision instead of after cord clamping significantly reduced the risk of surgical-site infections in women undergoing cesarean delivery at a tertiary care hospital.
More than 31% of infants in the United States are delivered by cesarean section, and the rate of surgical-site infection ranges from 1.46 to 3.82 per 100 cesarean deliveries, depending on patient risk factors. Until recently, usual practice was to wait to administer antibiotics until after umbilical cord clamping to avoid masking neonatal sepsis. Practice guidelines issued in 2011, however, recommend giving antibiotics to all women within an hour before cesarean delivery.
Between 2003 and 2010, Barnes-Jewish Hospital in St. Louis implemented several interventions to reduce the risk of postcesarean infection, including the administration of prophylactic antibiotics before incision instead of after delivery, a ban on artificial nails among surgical staff, and streamlined operating room cleaning and disinfection procedures. Researchers used time series analysis to determine the effects of these interventions (after adjusting for secular trends in patient risk factors) on rates of postcesarean surgical-site infection in the eight-year study period.