Ammanuel SG, Edwards CS, Chan AK Are preoperative chlorhexidine gluconate showers associated with a reduction in surgical site infection following craniotomy? A retrospective cohort analysis of 3126 surgical procedures. J Neurosurg. 2021; 135:(6)1889-1897

Berríos-Torres SI, Umscheid CA, Bratzler DW Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017; 152:(8)784-791

Chan AK, Ammanuel SG, Chan AY Chlorhexidine showers are associated with a reduction in surgical site infection following spine surgery: an analysis of 4266 consecutive surgeries. Neurosurgery. 2019; 85:(6)817-826

Chapman L, Hargett L, Anderson T, Galluzzo J, Zimand P Chlorhexidine gluconate bathing program to reduce health care-associated infections in both critically ill and non–critically ill patients. Crit Care Nurse. 2021; 41:(5)e1-e8

Chen Z, Mont MA The utility of chlorhexidine cloth use for the prevention of surgical site infections in total hip arthroplasty and surgical as well as basic science applications: a meta-analysis and systematic review. Orthop Clin North Am. 2023; 54:(1)7-22

Establishing a surgical site infection prevention day. 2023. https// (accessed 24 April 2024)

Chiwera L, Wigglesworth N, McCoskery C, Lucchese G, Newsholme W Reducing adult cardiac surgical site infections and the economic impact of using multidisciplinary collaboration. J Hosp Infect. 2018; 100:(4)428-436

Making shared decision-making a reality. No decision about me without me. 2011. https// (accessed 24 April 2024)

Department of Health. Liberating the NHS: no decision about me, without me. 2012. https// (accessed 24 April 2024)

Dukes KC, Reisinger HS, Schweizer M Examining barriers to implementing a surgical-site infection bundle. Infect Control Hosp Epidemiol. 2024; 45:(1)13-20

Edmiston CE, Leaper D Should preoperative showering or cleansing with chlorhexidine gluconate (CHG) be part of the surgical care bundle to prevent surgical site infection?. J Infect Prev. 2017; 18:(6)311-314

Graham M, Hanson I, Hart J Getting rights right: implementing ‘Martha's Rule’. Journal of Medical Ethics. 2024;

Huang SS, Septimus E, Kleinman K Chlorhexidine versus routine bathing to prevent multidrug-resistant organisms and all-cause bloodstream infections in general medical and surgical units (ABATE Infection trial): a cluster-randomised trial. Lancet. 2019; 393:(10177)1205-1215

Leaper DJ, Tanner J, Kiernan M, Assadian O, Edmiston CE Surgical site infection: poor compliance with guidelines and care bundles. Int Wound J. 2015; 12:(3)357-362

National Institute for Health and Care Excellence. Surgical site infection. Quality standard QS49. 2013. https// (accessed 24 April 2024)

National Institute for Health and Care Excellence. Guys & St Thomas' NHS Foundation Trust. Successful implementation of NICE guidance and quality standard for prevention and treatment of surgical site infection. 2017. https// (accessed 24 April 2024)

National Institute for Health and Care Excellence. Surgical site infections: prevention and treatment. NICE guideline NG125. 2020. https// (accessed 24 April 2024)

SSI Prevention. Let's cut out infection together. 2023. https// (accessed 24 April 2024)

Tanner J, Padley W, Assadian O, Leaper D, Kiernan M, Edmiston C Do surgical care bundles reduce the risk of surgical site infections in patients undergoing colorectal surgery? A systematic review and cohort meta-analysis of 8,515 patients. Surgery. 2015; 158:(1)66-77

Tanner J, Kiernan M, Hilliam R Effectiveness of a care bundle to reduce surgical site infections in patients having open colorectal surgery. Ann R Coll Surg Engl. 2016; 98:(4)270-4

Tipper GA, Chiwera L, Lucas J Reducing surgical site infection in pediatric scoliosis surgery: a multidisciplinary improvement program and prospective 4-year audit. Global Spine J. 2020; 10:(5)633-639

The historical timeline of surgery. 2024. https// (accessed 22 April 2024)

World Health Organization. Global guidelines for the prevention of surgical site infection. 2018. https// (accessed 22 April 2024)

World Health Organization. World Patient Safety Day 2023: Engaging patients for patient safety. ‘Elevate the voice of patients!’. 2023. https// (accessed 22 April 2024)

Surgical site infection prevention bundles: a focus on preoperative skin decolonisation

09 May 2024
Volume 33 · Issue 9

Surgical and preoperative disinfection techniques have evolved over the centuries, from the birth of modern surgery in the early 19th century, to the first use of carbolic acid for disinfecting surgical incisions, helping to prevent surgical site infections in the 1890s, through the discovery of antibiotics in 1928, to the first whole eye and partial face transplant, which was performed in 2023 (Whitlock, 2024). These advances in surgery have led to improved surgical patient outcomes, reduced hospital length of stays and reduced incidences of avoidable infections. Sadly, these advancements are set against a rise in antimicrobial resistance and infectious diseases. This calls for urgent revolutionary strategies to tackle escalating threats to health care and humanity in general.

Published surgical site infection (SSI) guidelines that span the surgical pathway (preoperative skin preparation, appropriate surgical antibiotic prophylaxis, intraoperative practices and postoperative wound care and recovery), are available (Berríos-Torres et al, 2017; World Health Organization (WHO), 2018; National Institute for Health and Care Excellence (NICE), 2020). However, compliance with evidence-based recommendations or bundles has been reported to be poor or actions have not been recorded accurately.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content