Date of Graduation

Spring 5-15-2022

Document Access

Restricted Project/Capstone - USF access only

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions


MSN project

First Advisor

Lisa Brozda


Problem: The national average of surgical site infection (SSI) due to cesarean sections (Csection) is 3-15% (Saeed et al, 2017). The labor and delivery (L&D) unit at the hospital has a much lower average compared to the nation at 1%. However, they are seeing a significant increase over the past four years with 16 in 2019, 18 in 2020, 20 in 2021, and 1 in 2022.

Context: This fast-paced bay area Magnet hospital L&D unit is run by 220 staff members including obstetric (OB) and NICU/Pediatric nurses, OB and NICU/Pediatric physicians, an Anesthesia team, and scrub technicians (techs). The L&D unit is composed of 13 patient rooms and three operating rooms (OR) labeled OR A, B, and C. In 2021, this unit performed 1,494 C-sections.

Interventions: Through Plan Do Study Act (PDSA) cycle the Save Lives and Sanitize Quality Improvement (QI) project implemented pre- and post-intervention audits to increase hand hygiene (HH) compliance in the L&D unit and ultimately decrease SSIs. The education provided emphasized current unit compliance rates, the importance of HH in reducing SSIs, and when to perform proper HH. Education was provided to OB nurses and scrub techs at the change of shift reports, during staff meetings, and by email. Other L&D staff such as NICU/Pediatric nurses, OB and NICU/Pediatric physicians, and the Anesthesia team received education via email. Posters including information on the importance, when, and how to perform proper HH were also placed around the unit.

Measures: A T-test comparing pre-education audits to post-education audits determined the total compliance P-value is 0.05 indicating the results were not significant. However, among OB nurses' compliance, the P-value was 0.01 indicating a significant increase in HH compliance after education. 3

Results: Compliance with HH in the L&D unit increased among all groups with the exception of physicians when comparing pre-education audit data to post-education audit data. HH compliance by all roles increased by 9%. The aim of Save Lives and Sanitize was to increase HH among OB nurses by 5% and physicians by 10%. Obstetric nurses increased hand compliance by 28.6% and physicians decreased by 5%. This QI project was successful with the OB nurses by meeting our aim, but not by physicians who decreased in compliance rates.

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