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.