Reducing the rate of post-cesarean surgical site infections at Remera Rukoma Hospital: a quality improvement analysis using PDSA and fishbone diagram

Abstract

Surgical site infections (SSIs) following cesarean sections (CS) are a significant global health concern, with varying prevalence rates across regions. At Remera Rukoma Hospital in Rwanda, the CS infection rate was 2.025% from July to December 2023, prompting a quality improvement project to reduce it to 1% by June 2024. The hospital's target of a 1% surgical site infection rate for cesarean sections aligns with World Health Organization standards, positioning it as a potential regional leader in infection control while significantly improving patient safety and maternal health outcomes. 

The project utilized a comprehensive approach, employing the Fishbone diagram to identify root causes across patient, surgical team, and hospital environment factors. Targeted interventions were implemented, including improved pre-operative cleaning, staff training on infection prevention, and enhanced environmental hygiene. Progress was monitored monthly using the Plan-Do-Study- Act cycle. 

The project successfully reduced the average CS infection rate to 0.45% from January to June 2024, with four months achieving 0% infection rates. Key factors in this success included strengthened aseptic practices, optimized antibiotic prophylaxis, and improved teamwork. Continuous monitoring, regular staff education, and data-driven improvement cycles are recommended to sustain these positive outcomes.