Weight and Risk Adjusted Perioperative (WRAP) Bundle for Prevention of Cesarean Delivery Surgical Site Infection: A Quality Improvement Initiative.

OBJECTIVE: Many individual interventions to reduce surgical site infection (SSI) risk after Cesarean delivery (CD) have been identified; however, their collective impact when used as a bundle is not well defined. This quality improvement initiative compared SSI rates before and after the implementation of a weight- and risk-adjusted perioperative (WRAP) bundle, developed to improve CD outcomes. METHODS: The WRAP bundle was designed to standardize care by tailoring evidence-based interventions according to each patient's individual SSI risk category. Risk stratification was based on pre-gravid body mass index (BMI) and the presence of comorbidities associated with increased SSI risk. This quality improvement initiative adopted a before-and-after quasi-experimental design over two years. Post-CD telephone calls by clinical reviewers were made 30-42 days postpartum to identify CD-SSI incidence. RESULTS: A total of 4014 CDs were performed between July 1, 2022, and March 1, 2024, with 1275 before WRAP bundle implementation and 2739 after. Maternal characteristics were comparable between pre- and post-WRAP bundle groups, except for hypertension in pregnancy, which was more prevalent in the post-implementation period (22.1% vs. 17.1%, P = 0.001). Across all BMI categories, a statistically significant reduction in overall CD-SSI incidence from 8.9% to 5.8% (P = 0.007) was observed. In the high-BMI group, the CD-SSI rate decreased from 13.9% to 6.9% (P = 0.03). CONCLUSION: Tailored bundled interventions, such as the WRAP bundle may be effective in reducing the incidence of CD-SSI, particularly among high-risk individuals. Continuous monitoring of post-CD SSI is vital for quality improvement efforts aimed at optimizing postpartum outcomes.