Highlights
- •Implementing vaginal disinfection in a Dutch hospital is feasible and effective.
- •Vaginal disinfection shows a decline in post cesarean endometritis.
- •Vaginal disinfection shows significant decrease in endometritis for patients with ruptured membranes and in second stage of labor.
- •Vaginal disinfection leads to significantly fewer readmissions and lower costs.
Abstract
Objective
To evaluate the rate of implementation after adding vaginal disinfection to the cesarean
section protocol and its effect on post cesarean infections and hospital readmissions.
Study design
This is an intervention study where two groups were compared. Women the year before
(n = 1384) and one year following (n = 1246) the addition of vaginal disinfection,
with povidone-iodine 1% prior to the cesarean section, to the protocol. Primary outcome
was the rate of implementation. Secondary outcomes were the rates of endometritis,
wound infection and postoperative fever. With the effect expressed in the number of
hospital readmissions.
Results
The implementation rate was 85.6%. Intention-to-treat analysis showed endometritis
rates of 2.0% versus 1.1% (p = 0.07). For women with preoperative ruptured membranes there was a significant decrease
in endometritis, from 3.4% to 1.3% (p = 0.02). Per-protocol analysis showed endometritis rates of 2.0% to 1.0% (p = 0.05). Women with ruptured membranes, 3.4% versus 1.3% (p = 0.02), and women who were in the second stage of labor, 4.7% versus 0.0% (p = 0.01), had a significant decrease in endometritis. For wound infection and postoperative
fever rates were similar.
The decrease of infections had a significant effect on hospital readmissions, 27 versus
10 (p = 0.04).
Conclusion
The implementation of this quality improvement measure shows to be adequate as the
vast majority of women undergoing a cesarean received vaginal disinfection. Vaginal
disinfection showed a declining trend of endometritis and postoperative fever and
for women with broken membranes prior to cesarean section the decrease in endometritis
was significant. These beneficial effects have led to a statistical and clinically
relevant decrease in hospital readmissions and thus cost reduction.
Keywords
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Article info
Publication history
Published online: September 29, 2022
Accepted:
September 26,
2022
Received in revised form:
September 22,
2022
Received:
August 22,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
