242 - Preventing SSIs: Implementation of Preoperative Bathing Protocol and EHR Integration

Description: Preoperative washing is one of the critical preventive measures for reducing surgical site infections (SSIs). In June 2024, an internal audit showed a 0% compliance rate for preoperative chlorhexidine gluconate (CHG) washing (n=10) performed the day before surgery in our organization. To address this gap, a multidisciplinary task force was formed, including a clinical outcomes specialist, an assistant nurse manager, and a nurse educator to conduct a literature review and develop a standardized protocol for the preoperative washing. It was identified that patients' access to chlorhexidine gluconate (CHG) was limited, there was no standardized practice for sending CHG to patients from the clinics before surgery, which varied by specialty services. Furthermore, there was no established method of checking preoperative washing compliance; random audit was performed by the clinical outcome specialist.

The literature review indicated that soap and water are just as effective as CHG when used correctly. This would improve accessibility for patients and increase compliance with perioperative washing. Furthermore, compliance with preoperative bathing remains a significant challenge due to a lack of established preoperative bathing protocols. It is critical to have standardized protocols including antiseptic type, bathing frequency, and targeted areas. A preoperative washing protocol was developed for adult surgical patients, requiring two preoperative washes: one the night before and one the morning of surgery with soap and water or CHG, along with the application of CHG wipes in the preoperative area. In July 2024, an evidence-based tip sheet on SSI prevention, including the preoperative washing protocol, was distributed to staff to support education and awareness. To improve documentation and compliance tracking, electronic health record (EHR) integration was completed in August 2024, enabling inpatient and preoperative units to record preoperative washing in the preoperative checklist documentation. One year after implementation, in June 2025, compliance with the day-before preoperative washing protocol reached 100%, demonstrating the success of interdisciplinary collaboration, evidence-based practice, and technological integration in enhancing patient safety.