A Risk-Stratified Peri-Operative Protocol for Reducing Surgical Site Infection after Cesarean Delivery

G. Theodore Talbot, Rose A. Maxwell, Kara M. Griffiths, Hari M. Polenakovik, Michael L. Galloway, Jerome L. Yaklic

Research output: Contribution to journalArticlepeer-review


Background: Surgical site infections (SSI) are multifaceted. Pre-operative, intra-operative, and post-operative factors influence the risk of developing an infection. Our objective was to evaluate the effectiveness of an infection risk-stratification checklist, utilizing known SSI risk factors, and a tailored surgical protocol for SSI prevention in women undergoing cesarean delivery. Patients and Methods: A prospective project to reduce SSI was conducted for women undergoing cesarean delivery on the resident staff service at a midwestern, urban tertiary care hospital. Patients were categorized according to an SSI risk-stratification checklist as high risk or low risk. The low-risk group received the local standard of care (single prophylactic dose of pre-operative intravenous antibiotics and a standard pressure dressing). In the high-risk group, prophylactic antibiotic agents were given pre-operatively and continued for the first 24 hours post-operatively. Additionally, patients at high risk received an absorbent dressing (Mepilex Ag®; Mölnlycke Health Care AB, Gothenburg, Sweden) that was applied in the operating room and worn for one week. Results: The overall rate of SSIs decreased from 6.1% (pre-study rate) to 1.4% after initiation of the protocol, a 77% reduction (p < 0.001). The low- and high-risk groups did not differ in infection rate (0% and 1.4%, respectively; p < 0.59). Both deep incisional and organ/space SSIs decreased after initiation of the protocol (91% and 62% decrease, respectively). Conclusion: Stratifying patients into high- and low-risk groups with tailored peri-operative management strategies reduced overall SSIs. The protocol incorporates known risk factors for SSI in a surgical procedure with high rates of SSI. This approach offers a structured method that can be adopted by other hospital systems for SSI prevention in patients undergoing cesarean delivery.

Original languageEnglish (US)
Pages (from-to)409-414
Number of pages6
JournalSurgical Infections
Issue number4
StatePublished - May 2021
Externally publishedYes


  • cesarean delivery
  • peri-operative care protocol
  • risk-stratification
  • surgical site infection

ASJC Scopus subject areas

  • Surgery
  • Microbiology (medical)
  • Infectious Diseases


Dive into the research topics of 'A Risk-Stratified Peri-Operative Protocol for Reducing Surgical Site Infection after Cesarean Delivery'. Together they form a unique fingerprint.

Cite this