We are working on a new project (known as PreCiSSIon) to prevent surgical site infections following caesarean birth with the six acute hospitals and maternity units across the West of England. Watch our short explainer video to find out more:

Surgical site infection (SSI) refers to wound infections following invasive surgical procedures. SSI constitutes a major healthcare burden accounting for 14.5% of all hospital-acquired infections in the UK, and an estimated 34-226% increase in associated costs.

What is the problem we’re addressing?

Caesarean birth is one of the most common procedures, with a SSI rate of approximately 16% being reported nationally. However, as reporting is not covered by national surveillance, most hospitals do not know their SSI rates. Data gathered locally (over two years) showed SSI rates after caesarean birth of 12-15%.

SSI has an enormous impact on mothers caring for a newborn baby and scarring caused from SSI can result in increased morbidity associated with future caesarean births.

What are the outcomes we are trying to achieve?

With over 10,000 caesarean births carried out across the region’s six maternity units each year, if the estimated average SSI rate of 15% was reduced by 30%, this would equate to around 450 SSIs being prevented each year.

The collaborative aims to:

  • Reliably collect 30-day patient-reported SSI rates after elective and emergency caesarean birth
  • Implement a new digital system to collect and report the SSI rate
  • Agree an adapted care bundle for caesarean births
  • Implement the care bundle consistently in all West of England hospitals

How will we do this?

The existing World Health Organisation (WHO) SSI bundle, which is part of the Surgical Safety Checklist, is routinely used throughout the NHS. It consists of four evidence-based interventions, which have been shown to independently reduce infection. These are:

  • antibiotics within 1 hour of surgery
  • normothermia – temperature >36 degrees in recovery
  • blood glucose control in known diabetics – glucose in normal range in recovery
  • appropriate hair removal from the surgical site – using clippers, not wet razors.

In addition, our PreCiSSIon bundle consists of:

  • Skin prep with 2% Chlorhexidine with 2 minutes drying time
  • Abdominal wall sheath and skin closure with antimicrobial triclosan coated sutures
  • Use of Alexis wound protector for mothers with a Body Mass Index (BMI) over 45 at time of booking
  • Second dose of antibiotics if more than 1500ml blood loss

Building on the success and learning from our multiple-award winning collaborative to reduce SSI after elective colorectal surgery, the new PreCiSSIon bundle was developed by reviewing literature for additional initiatives shown to reduce SSI.

The PreCiSSIon collaborative uses a quality improvement (QI) methodology and coaching to underpin its approach.

Who are we working with?

We are collaborating with the six acute maternity units across the West of England:

  • Gloucestershire Hospital
  • Great Western Hospital
  • Royal United Hospital
  • Salisbury Hospital
  • Southmead Hospital
  • University Hospitals Bristol and Weston


Contact us

For further information or to get involved, please contact Senior Project Manager, Susie Beresford or Clinical Lead, Lesley Jordan via healthinnowest.transformation@nhs.net.

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The words mother and mothers have been used throughout our website content as this is the way that the majority of those who are pregnant and having a baby will identify. It also includes people whose gender identity does not correspond with their birth sex or who may have a non-binary identity.