The following is a recommendation from the American College of Obstetricians and Gynecologists:

"Patients undergoing cesarean section can be divided into groups at low- and high-risk for postoperative infection. High-risk patients include those who have cesarean deliveries following rupture of the membranes, onset of labor, or both, and patients who undergo emergency procedures for which preoperative cleansing may have been inadequate. While antibiotic prophylaxis is recommended for both groups, the benefits of prophylaxis will be greatest for high-risk patients. A similar narrow-spectrum antimicrobial regime as recommended for patients undergoing hysterectomy provides adequate prophylaxis."

Information for establishing an infection control program at a new ambulatory surgery center can be found on the websites of either the Association for Professionals in Infection Control and Epidemiology (APIC) or the Association of periOperative Nurses (AORN).

In 2002-03, the Centers for Medicare & Medicaid Services (CMS) sponsored a Breakthrough Series College and a Collaborative on preventing surgical infections, facilitated by the Institute for Healthcare Improvement and Qualis Health. The IHI Collaborative model brings together health care professionals and organizations that share a commitment to making a series of rapid changes that produce significant, or "breakthrough," results.

The national Collaborative participants comprised Quality Improvement Organizations (QIOs) and hospital staff from across the nation who are committed to improving the quality of care delivered to patients during surgery. Each QIO selected one hospital in their state or territory with which to partner and to learn the model. Each Collaborative team identified opportunities to prevent surgical infection by rapidly testing and implementing quality improvement cycles (plan, do, study, act) at the pilot hospital.

The Centers for Medicare & Medicaid Services Surgical Infection Prevention (SIP) Project staff has researched this question and found no studies to help guide the decision about redosing for “excessive” blood loss.  In discussions with the SIP national expert panel, the following recommendations were made:

1. Make sure the first dose is adequate, i.e., give enough prophylactic antibiotic to be sure that adequate tissue levels are achieved. In many patients, this will be more than a standard 1 gram dose of a first-generation cephalosporin.
2. Make sure the patient is redosed in the operating room for long cases — there are published studies of operations where cefazolin was used for prophylaxis — redosing this drug at 3 to 4 hours has been shown to reduce infection rates.
3. There is a lack of good data about redosing for blood loss, however, if the case is approaching the half-life of the drug and there is excessive shift in fluid volume, it is reasonable to redose.