Evidence-based interventions to reduce obstetric-related infections at an army training facility.

BACKGROUND: OBJECTIVE: Obstetric-related infections are a major cause of maternal morbidity and mortality worldwide. Our team implemented an evidence-based infection control bundle aimed at reducing obstetric-related infections at our facility. METHODS: A multidisciplinary team at Tripler Army Medical Center developed, implemented, and evaluated an evidence-based maternal safety infection control bundle (MSICB) on labor and delivery aimed at reducing the incidence of surgical site infections (SSI) and chorioamnionitis. Adenosine triphosphate testing of patient care-related surfaces was performed while behavioral and environmental interventions were implemented. Incidence rates for chorioamnionitis, SSI, and endometritis were compared between pre- and during-MSICB implementation using Fisher exact test and Poisson regression, adjusting for year and quarter. The decision science analysts at US Army Medical Command, Fort Sam Houston, Texas responsible for our facility utilized diagnosis-related group and ICD-10 Procedure Coding to determine infection-related costs. RESULTS: Prior to implementation of the MSICB, the rates of chorioamnionitis, SSI, and endometritis in the first half of 2016 were 6.3%, 3.4%, and 0.4%, respectively. After implementation of the MSICB, in the first 6 months of 2017, the rates of chorioamnionitis and SSI decreased to 1.7% and 1.0%, respectively, with no change in the rate of endometritis. The rate was significantly lower after implementation for chorioamnionitis (P < .001), and there was a statistically nonsignificant decrease for SSI (P = .060) and no difference for postpartum endometritis (P = 1.00). These reductions resulted in an estimated net cost savings of $671,218. CONCLUSIONS: A multidisciplinary approach with evidence-based strategies resulted in a significant decrease (P < .001) in chorioamnionitis and a statistically nonsignificant decrease (P = .060) in the SSI rate, which resulted in a significant cost savings for the hospital. There was no change in our postpartum endometritis rate.

Military maternal weight trends and perinatal outcomes.

OBJECTIVE: Obesity is epidemic in the United States and the prevalence is increasing. We sought to determine if the prevalence of obesity in women eligible for health care at military treatment facilities, specifically, active duty (AD) women, is increasing similar to national trends. METHODS: Our retrospective cohort study evaluated selected outcomes in women delivering in 1999 and 2006. Women delivering living, singleton, term, nonanomalous neonates in 1999 and 2006 were eligible. Prepregnancy weight and weight gain during pregnancy were compared between the two populations, and data were stratified by AD status, age, and ethnicity. Obstetric outcomes were evaluated based on body mass index (BMI). RESULTS: There were 1,543 and 1,745 mother-infant pairs available, respectively, for analysis. Prepregnancy BMI for all women evaluated increased significantly from 1999 to 2006 (25.0 vs. 25.6, p < 0.05). Prepregnancy BMI increased significantly for AD women between 1999 and 2006 (24.3 vs. 25.4, p < 0.05). The prevalence of overweight and obese women increased from 1999 to 2006 in the population evaluated (41.2% vs.46.2%, respectively), and this was demonstrated among all ethnicities. Obesity was associated with increased adverse obstetric outcomes. CONCLUSION: We demonstrated increasing maternal obesity in a military population over time and associated adverse perinatal outcomes.