Improving Compliance With Surgical Scrubbing and Sterilization Protocols: A Two-Cycle Quality Improvement Project at...

Background Surgical site infections remain a major cause of postoperative morbidity, prolonged hospitalization, increased healthcare costs, and preventable mortality worldwide. Adherence to evidence-based surgical scrubbing, sterilization, and aseptic practices is essential for reducing contamination risks and maintaining patient safety within operating theatres. This quality improvement project aimed to assess compliance with internationally recommended surgical scrubbing and sterilization standards, implement targeted interventions, and evaluate their impact using a closed-loop audit methodology. Methods A prospective closed-loop clinical audit was conducted in the operating theatre complex of Atbara Teaching Hospital, Sudan, using the Plan-Do-Study-Act (PDSA) framework. Twenty-seven evidence-based criteria derived from international infection prevention guidelines were evaluated across five domains: surgical attire, surgical hand hygiene and scrubbing, gowning and gloving, anesthesia-related infection prevention, and sterile field preparation. The first audit cycle was conducted between March and May 2024, followed by a multifaceted intervention consisting of education, audit feedback, visual reminders, and multidisciplinary engagement. A re-audit was subsequently performed between January and May 2025 using the same methodology and assessment criteria. Compliance rates were compared between audit cycles using Pearson's Chi-square test or Fisher's exact test where appropriate. Results A total of 29 surgical procedures were observed during the first audit cycle and 25 during the second cycle. Following implementation of the intervention package, significant improvements were observed across all assessed domains. Compliance with head-cover use increased from 47.7% to 70.7%, surgical scrubbing before gowning or gloving improved from 50.0% to 88.2%, correct gowning procedures increased from 44.4% to 91.3%, anesthesiologist hand hygiene improved from 22.2% to 69.6%, and adherence to the correct sequence for opening sterile items increased from 44.4% to 95.7%. All evaluated domains demonstrated statistically significant improvements following the intervention (p<0.05). Conclusion Implementation of a multifaceted quality improvement intervention was associated with substantial improvements in compliance with surgical scrubbing, sterilization, and infection prevention standards within the operating theatre. These findings support the effectiveness of structured clinical audit, audit feedback, and targeted educational strategies in improving adherence to evidence-based perioperative infection prevention practices, which may contribute to improved patient safety in surgical settings.