Hands-on training for preoperative skin preparation improves compliance with manufacturer instructions for use.

Surgical site infections (SSIs) drive morbidity and costs. In 2022, our SSI rate rose to a National Surgical Quality Improvement Program (NSQIP) rating of "needs improvement." We implemented a program to improve pre-operative skin preparation compliance.One-time hands-on training session for surgical residents and operating room nurses emphasizing chlorhexidine gluconate and isopropyl alcohol (CHG/IPA) compliance. Compliance was directly observed from August 2022 to November 2023 (N ​= ​1032). Institutional SSI incidence was evaluated using NSQIP semiannual reports.Complete compliance improved from 13.3 ​% to 39.4 ​%(p ​< ​0.0001). Adjusted odds of compliance were 3.4-fold higher overall(p ​< ​0.0001), 3.7-fold higher for general surgery(p ​= ​0.0003), and 9.8-fold higher for colorectal surgery(p ​< ​0.0001). Institutional NSQIP SSI ratings improved from "needs improvement" to "as expected," but reverted to "needs improvement."Single hands-on training significantly improved compliance and was associated with improved SSI ratings. However, the effect was not durable, highlighting need for ongoing education and sustained surveillance to achieve lasting improvement.

Duke Scholars

Author Diego Schaps  

Author Sabran Masoud