Date of Graduation

Spring 5-20-2022

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


MSN project

First Advisor

Lisa Brozda


Problem: Surgical site infections (SSIs) occur in 3-15% of cesarean sections, making SSIs one of the most common hospital-acquired infections (HAIs). Surgical site infections (SSIs) have increased within a Labor & Delivery (L&D) unit in a large California teaching hospital for the past three years, affecting reimbursement and creating a range of adverse outcomes for patients. Performance of consistent and thorough hand hygiene practices is key to preventing infection, yet the unit’s hand hygiene compliance of 66.7% is well below the facility’s target goal of 90%. Based on recommendations from the organization’s Infection Prevention & Control (IPC) specialist, the aim of the quality improvement project is to increase compliance in nurses by five percent and physicians by ten percent through re-education of operating room (OR) staff by the end of May 2022.

Context: The unit contains 13 patient rooms and three ORs managed by a total of 220 staff members, including registered nurses, technicians, physicians, and anesthesiologists. The facility has one of the nation’s top neonatology units and is central to the Bay Area’s largest healthcare enterprise. The patient population is mostly from the San Mateo and Santa Clara counties, with a diverse set of demographics.

Interventions: Through Plan Do Study Act (PDSA) cycles and application of Lewin’s Change Model, the quality improvement project uses a series of pre- and post-intervention audits to evaluate the effect of hand hygiene re-education on staff behavior. The “Save Lives and Sanitize” campaign aims to standardize hand hygiene education, remind staff of hand hygiene policies, and emphasize current hand hygiene and SSI data. Education was delivered through change of shift report, staff meetings, Local Improvement Team (LIT) meetings, Shared Governance meetings, and emails to all staff.

Measures: Outcome measures include hand hygiene compliance rates during pre- and post-intervention audits, staff survey results, and monthly SSI counts. It should be noted that SSI analysis is delayed, as SSIs can occur up to 30 days after cesarean sections. Quality measures are frequently discussed in staff, LIT, and Shared Governance meetings.

Results: The “Save Lives and Sanitize” project ultimately produced an 8.9% increase in hand hygiene compliance amongst all staff roles. Obstetric (OB) nurses displayed a 28.57% improvement in compliance, surpassing the project’s goal of increasing compliance by five percent. However, OB physician compliance decreased by 4.37% and did not meet the goal of this project. The staff survey generated 63 responses, most of which were completed by OB nurses and anesthesia staff. Surgical site infection (SSI) data from March and April are not available yet but are expected to decrease as only one SSI occurred through all of January and February 2022.

Conclusions: Practicing proper hand hygiene is essential to decreasing the occurrence of post-cesarean SSIs, as supported by evidence-based research. However, inconsistent hand hygiene education between various healthcare roles contributes to vastly different compliance rates and conflict within the unit. Notable barriers to the project’s implementation consist of lack of buy-in from OB providers and presence of Hawthorne bias.