A Randomized Trial Evaluating the Effect of Bundled Preoperative Skin and Vaginal Cleaning Protocols on Surgical Site Infections Following Cesarean Delivery.

BACKGROUND

Surgical site infections (SSIs) following cesarean section (CS) contribute to prolonged hospital stays, increased healthcare costs, maternal morbidity, and psychological stress. Most surgical safety bundles have been shown to reduce SSIs, but the impact of incorporating preoperative skin preparation and vaginal cleaning into these bundles has not been comprehensively assessed in India.

AIM: This study aimed to evaluate the effect of incorporating preoperative skin preparation and vaginal cleaning into standard care bundles for the prevention of SSIs following CS.

METHODS

This randomized controlled trial was conducted at a tertiary care hospital in central India. A total of 170 women undergoing elective or emergency CS were randomly assigned to two groups. In group A, before the CS, parts were prepared by hair clipping instead of shaving. Vaginal cleaning was performed with a 0.25% chlorhexidine solution. Group B received the standard bundle without additional preoperative care and vaginal cleaning. Intraoperative and postoperative care were uniform across groups. The primary outcome was the incidence of SSI within 30 days; secondary outcomes included wound condition at Day 9, microbiological profile, and duration of hospital stay.

RESULTS

The overall SSI incidence was 8.8%. Group A had a lower infection rate (5.9%) than Group B (11.8%) (p = 0.0159). Deep SSIs were markedly reduced in the intervention group, 1 (1.2%) vs. 9 (10.6%). On Day 9, healthy wound healing was seen in 80 (94.1%) of Group A compared to 75 (88.2%) of Group B. Pyrexia, wound gape, and resuturing were more frequent in controls. Culture reports supported reduced colonization in the intervention group. The mean hospital stay was significantly shorter in Group A (9.2 ± 2.6 days) compared with Group B (10.1 ± 1.0 days; p = 0.0133).

CONCLUSION

Addition of preoperative skin preparation and vaginal cleaning to routine surgical bundles significantly decreases SSI rates, particularly deep infections, and reduces the length of stay after CS. These low‑cost, easily adoptable interventions are especially valuable in resource‑limited settings. Wider institutional adoption and regular monitoring are recommended to optimize maternal surgical outcomes.