Standardizing the Use of Chlorhexidine Gluconate (CHG) Wipes in the Preoperative Area Prior to Colon, Hysterectomy, Total Hip, and Total Knee Surgery: Does Direct Observation Increase Compliance?

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MR Cooper, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA


This paper describes the burden of surgical site infections and Carolinas Healthcare System’s journey to standardize skin preparation prior to surgery, in particular, hip, knee, hysterectomy, and colon surgeries. The literature supports a surgery bundle of care to reduce the likelihood of an infection, but does not provide clear evidence in skin preparation. Even though the evidence may be lacking, physician leaders at Carolinas Healthcare System decided to standardize care that can be standardized and chose skin preparation in the preoperative area to be the first area of focus. Sustaining improvement has been a challenge for CHS. Multiple stakeholders were involved and the project used organizational change strategies to create support. The aim was to standardize skin preparation in one facility, NorthEast, and measure compliance before and after direct observations of the intervention. If the null hypothesis should be rejected, There will be no significant difference between the baseline compliance rate and the observed compliance rate after implementation of direct observations of competency. Significance level=pfuture efforts to standardize care in all CHS facilities would use this model.

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