Improving Preoperative Bathing Compliance Through Standardized Protocols and Team Collaboration

At Sinai Hospital and the University of Maryland Medical Center, a team of clinical leaders, Annet Adegboyega, DNP, MSN, BSN, RN, CNOR; Mihyun "Rose" Jang, MSN, MPH, BSN, RN, CNOR; and Renilda Tijones, MSN, BSN, RN, CNOR, identified an issue with low compliance in preoperative bathing among surgical patients. Recognizing the connection between preop hygiene and surgical site infections (SSIs), they launched an initiative to evaluate and improve the process across multiple departments.

To learn more about this study, “Rethinking Preoperative Washing: Necessity and Effectiveness,” which was presented as a poster at the AORN Global Surgical Conference & Expo held April 5 through 8, 2025, in Boston, Massachusetts.

The project began with a literature review comparing the effectiveness of chlorhexidine gluconate (CHG) and antimicrobial soap. Surprisingly, the evidence revealed no significant difference between the two products in reducing SSIs. The team concluded that what mattered most was not which product was used but how consistently and correctly it was applied.

One of the early findings was the absence of standardized protocols. Each unit approached preoperative bathing differently, leading to confusion and gaps in patient care. In response, the clinical outcomes team developed and implemented clear, evidence-based protocols. These were distributed hospital-wide and supported with training to ensure both outpatient and inpatient staff understood the procedures.

“We started doing a literature review on how we can improve our compliance for preoperative, bathing, and surgical patients,” Jang said. “After the literature review, we found that either antimicrobial soap or CSG fat has no significant differences in effectiveness in surgical site infections. So, our evidence-based recommendations are first having standardized protocols.”

To measure success, compliance dashboards were created using Tableau, allowing real-time tracking across units. Monitoring not only highlighted areas of improvement but also reinforced accountability. Equally important was educating nurses about the clinical rationale behind pre-op hygiene. Many inpatient nurses lacked familiarity with its role in infection prevention, and targeted education helped increase engagement.

A core insight from the project was that CHG wipes alone are not the answer. If patients didn’t understand how to use them—or couldn’t afford them—the protocol failed. By recognizing that a regular bath could be just as effective when properly completed, the team emphasized accessibility and patient-centered care.

“So the main takeaway is that it's not really about whether CHG is more significant in reducing SSI, or whether it's a regular path,” Tijones said. “There aren't enough studies out there that provide a direct relationship between CHG and SSI. SSI is always seen as a multifaceted effect of a certain bundle, and CHG is just one of them. So that's really an opportunity there. What we are looking at in this project is really compliance.”

Ultimately, the initiative succeeded through teamwork, communication, and practical solutions—demonstrating that sustainable change in infection prevention depends as much on collaboration as it does on clinical science.

“This was really great working on because we are a team,” Adegboyega said. “One of the main points I want to put out there, or the main point, is that always working as a team. You cannot do it a lot, and change cannot happen with just one person. It's always a team effort, which also includes other patients.”