Initiation of Sterile Vaginal Preps Prior to Cesarean Sections: A Quality Improvement Project

Authors

Diane Gilbertson, HCA HealthcareFollow
Timothy Kremer, HCA HealthcareFollow
Kimberly Udell, HCA HealthcareFollow

Files

Division

North Texas

Hospital

Medical City Arlington

Specialty

Obstetrics & Gynecology

Document Type

Poster

Publication Date

2025

Keywords

cesarean section, vaginal preparations, vaginal preps, gynecologic procedures, quality improvement

Disciplines

Medicine and Health Sciences | Obstetrics and Gynecology | Quality Improvement | Surgical Procedures, Operative

Abstract

OBJECTIVE: Research on patients undergoing routine gynecological procedures with a vaginal preparation has demonstrated a significant reduction in post-operative infections by decreasing the burden of vaginal bacteria. Despite this research, as well as evidence that they reduce postpartum endometritis, especially in labor patients or those with ruptured membranes (Lui), vaginal preparations prior to cesarean section are not standard practice. Prior to the initiation of this quality improvement project, no patients delivering at Medical City Arlington received a vaginal preparation prior to a cesarean delivery. The goal of this quality improvement project is to improve clinical care, patient safety, and healthcare operations in the labor and delivery department. METHODS: The patient population was identified, which included (1) established patients of the clinic and (2) patients who are not assigned to an obstetric provider at Medical City Arlington.” Information was then disseminated to all OBGYN residents, attendings, nurses, and operating room support staff explaining the project. The project was conducted from January to April 2024. RESULTS: The total number of cesarean sections completed during the four-month project was N= 57. The total number of cesarean sections where a vaginal prep was applicable was 86% (n= 49). Of the forty-nine applicable cesarean sections, vaginal preps were performed in 49% of cases. The percentage of applicable cesarean sections where a vaginal prep was performed varied over the four-month period, although the rate ultimately increased from 33% to 70% after 4 months. CONCLUSION: In summary, at this institution, vaginal preps prior to cesarean sections are not routine, but this project demonstrated it is possible to institute this practice. If the initiation of vaginal preps can reproduce past studies in the reduction of postpartum endometritis, it would provide further evidence that obstetricians should adopt the implementation of vaginal preps at the time of cesarean section as the standard of care.

Original Publisher

HCA Healthcare Graduate Medical Education

Recommended Citation

Gilbertson, Diane; Kremer, Timothy; and Udell, Kimberly, "Initiation of Sterile Vaginal Preps Prior to Cesarean Sections: A Quality Improvement Project" (2025). North Texas Research Forum 2025. 91.
https://scholarlycommons.hcahealthcare.com/northtexas2025/91