Caesarean deliveries and value-based care

Can glove change help reduce the costs and improve the outcomes of caesarean sections?

More and more women are giving birth by caesarean section. The procedure accounted for 21.1% of global births in 2021 and is forecast to reach 29.0% by 2030. In the English NHS the current rate of caesareans is, at 41.4%, much higher than the global average and is increasing steadily every year.

While caesarean sections are generally safe, like any surgery they carry risks – of which surgical site infection (SSI) is the most common. Although most infections are superficial and occur after discharge from hospital, they can still incur significant costs due to extended community midwife visits, GP visits and antibiotic prescribing. Deeper and more severe infections can require extended hospital stays or readmission, increasing the burden on maternity services and workforces that may already be under significant pressure.

One way that maternity services are helping reduce infections is by implementing a ‘bundle’ of evidence-based practices that clinical trials have shown to be effective. These practices can include antibiotic prophylaxis, antiseptic skin preparation and closing the skin with subcutaneous sutures instead of staples.

A less well known but very effective intervention for reducing infections is glove change. A recent systematic review and meta-analysis has demonstrated that obstetric teams that change their gloves after placental delivery and before wound closure can achieve a 59 per cent reduction in the incidence of post-caesarean SSI. In my latest study I’ve collaborated with Health Innovation West of England, Royal United Hospitals Bath NHS Foundation Trust and Mölnlycke Health Care to analyse the impact this could have on the budget and capacity of a typical NHS maternity service and on the English NHS as a whole, if it was adopted as a standard practice.

Our budget impact analysis showed us that:

• a maternity service performing around 1,600 caesareans annually could save over £50,000 a year through reductions in community midwife post-natal visits and hospital readmissions

• local GPs would also see meaningful reductions in the number of appointments and antibiotic prescriptions

• extrapolated across the whole of England, glove change could save the NHS more than £45 million over 5 years and substantially reduce the workloads of community midwives.

Neither the World Health Organization nor NICE – National Institute for Health and Care Excellence presently recommend changing gloves before wound closure. But given that caesarean sections are more expensive and have worse perinatal outcomes than natural births, shouldn’t this now change? Can glove change enable obstetric teams to deliver more value-based care?

That’s a question we’ll be discussing when we present our results at the upcoming Annual Congress of the Surgical Infection Society Europe, taking place in Dublin from 14 – 16 May. Come and join us there or download a copy of our presentation to discover more.

This study was undertaken by Benedict Stanberry, Lesley Jordan, Anne Pullyblank and Judith Hargreaves. It was supported by a financial grant from Mölnlycke Health Care AB.

Preventing Pressure Ulcers in the Emergency Department

Patients needing hospital admission can often spend many hours waiting in the emergency department for an inpatient bed to become available. Yet despite the fact that a significant number of these patients are at high risk of developing pressure ulcers, few EDs have prevention protocols in place.

Over the last year IHLM has, therefore, supported nursing leaders in the emergency department at Karolinska University Hospital in Sweden – which has one of the largest EDs in Europe – who have tried out four simple but effective nurse-led changes that can significantly reduce the incidence of pressure ulcers when integrated into ED workflow:

• early risk assessment – we made sure that patients get a risk assessment the moment paramedics hand them over to the triage nurse

• pressure-relieving equipment – we introduced special mattresses that redistribute pressure around the patient’s body, protecting sensitive tissue areas

• intentional rounding (also called care or comfort rounds) – we ensured individual patients were checked at hourly intervals

• prophylactic dressings and incontinence pads – were made available at every bedside to protect patient’s skin from moisture

We’re pleased to report that these changes led to both measurable improvements in pressure ulcer prevention and increased staff engagement.

Would you like to discover more?  Our recommendations have recently been published in a peer-reviewed article in the journal Emergency Nurse.  It’s an open access article so just click here to download your free copy.

This is just one example of the dozens of quality and safety improvement projects we help our programme members complete each year through expert coaching and mentoring. Click the links to discover more about our upcoming quality improvement and patient safety programmes.