Implementing preoperative bathing with 4% chlorhexidine soap as part of a surgical site infection prevention bundle: a study of knowledge, attitudes, and practices among patients and healthcare personnel
DOI:
https://doi.org/10.15574/PS.2026.1(90).2732Keywords:
surgical site infection (SSI), chlorhexidine bath, healthcare bundles, knowledge, attitudes, practices (KAP)Abstract
Aim - to assess the knowledge, attitudes, and practices of healthcare professionals and patients regarding the implementation of a care bundle for the prevention of surgical site infections (SSI), including the use of pre-operative chlorhexidine bathing.
Materials and methods. Between July and August 2025, a knowledge, attitudes, and practices (KAP) study was conducted among 76 healthcare workers and 161 patients. Aim-specific questionnaires were developed for both groups.
Results. Overall, the intervention was perceived positively. Among healthcare workers, 96.1% believed that the practice either facilitated pre-operative preparation or did not increase workload. Only one patient (0.6%) reported skin dryness or irritation associated with the use of 4% chlorhexidine soap.
Additionally, 92.1% of healthcare workers and 89.4% of patients believed that pre-operative bathing could improve surgery outcomes. However, 35.6% of healthcare workers assumed that patients were not interested in learning about the evidence supporting the procedure.
Conclusions. The positive perception of pre-operative bathing with 4% chlorhexidine supports scaling up of the intervention and continued institutional support. Monitoring SSI incidence rates and using surveillance data may help improve adherence among healthcare personnel and patients to the recommended bathing protocol. The demand for 4% chlorhexidine soap in Ukraine, with the wider implementation of enhanced bathing practices, may encourage domestic manufacturers to produce such soap for use in healthcare facilities.
The authors declare no conflict of interest.
References
Chapman L, Hargett L, Anderson T, Galluzzo J, Zimand P. (2021). Chlorhexidine Gluconate Bathing Program to Reduce Health Care-Associated Infections in Both Critically Ill and Non-Critically Ill Patients. Crit Care Nurse. 41(5): e1-e8. https://doi.org/10.4037/ccn2021340; PMid:34595499
Ching PR. (2024). Care Bundles in Surgical Site Infection Prevention: A Narrative Review. Curr Infect Dis Rep. 26: 163-172. https://doi.org/10.1007/s11908-024-00837-9
Compaoré A, Nikièma J, Kiemdé F, Tinto H, Salami O, Nkeramahame J et al. (2023). What Influences Patients' Adherence to Healthcare Worker Prescription in Primary Healthcare Facilities in Burkina Faso? A Qualitative Account of Barriers and Facilitators. Clin Infect Dis. 77; Suppl 2: S171-S181. https://doi.org/10.1093/cid/ciad347; PMid:37490739 PMCid:PMC10368408
Conradsen S, Vardinghus-Nielsen H, Skirbekk H. (2024). Patient Knowledge and Trust in Health Care. A Theoretical Discussion on the Relationship Between Patients' Knowledge and Their Trust in Health Care Personnel in High Modernity. Health Care Anal. 32(2): 73-87. https://doi.org/10.1007/s10728-023-00467-7; PMid:37807014 PMCid:PMC11133163
George ASH, Shahul A, George AS. (2022). An Overview of Medical Care and the Paternalism Approach: An Evaluation of Current Ethical Theories and Principles of Bioethics in the Light of Physician-Patient Relationships. Partners Universal International Research Journal, 1(4): 31-39. doi: 10.5281/zenodo.7419781.
Isand KG, Saar S, Bahhir A, Graumann K, Kibuspuu L, Meier MA et al. (2025). A Care Bundle to Prevent Surgical Site Infections in Emergency General Surgery: A Prospective Cohort Study. World J Surg. 49(7): 1795-1802. https://doi.org/10.1002/wjs.12657; PMid:40495267
Memorial Sloan Kettering Cancer Center. (2023). How to Shower Using 4% Chlorhexidine Gluconate (CHG) Solution Antiseptic Skin Cleanser. Last updated on August 23, 2023. URL: https://mskcc.org/cancer-care/patient-education/showering-hibiclens.
Sonpar A, Hundal CO, Totté JEE, Wang J, Klein SD, Twyman A et al. (2025). Multimodal strategies for the implementation of infection prevention and control interventions-update of a systematic review for the WHO guidelines on core components of infection prevention and control programmes at the facility level. Clin Microbiol Infect. 31(6): 948-957. https://doi.org/10.1016/j.cmi.2025.01.011; PMid:39863071
Uren HD, Aliieva N, Weinstein E. (2025). Implementing an Infectious Disease and Antimicrobial Stewardship Program to Support the Treatment of Hospital-Acquired Infections in Conflict-Associated Casualties in Ukraine. Prehospital and Disaster Medicine. 40(S1): s46-s47. https://doi.org/10.1017/S1049023X25001281
Vicentini C, Bussolino R, Gastaldo C, Castagnotto M, D'Ancona FP, Zotti CM et al. (2024). Level of implementation of multimodal strategies for infection prevention and control interventions and prevalence of healthcare-associated infections in Northern Italy. Antimicrob Resist Infect Control. 13(1): 39. https://doi.org/10.1186/s13756-024-01398-1; PMid:38605378 PMCid:PMC11010422
Vicentini C, Elhadidy HSMA, Marengo N, Paladini G, Cornio AR, Zotti CM. (2023). Mortality and Case Fatality Rates Associated With Surgical Site Infections: A Retrospective Surveillance Study. Surg Infect (Larchmt). 24(8): 734-740. https://doi.org/10.1089/sur.2023.082; PMid:37669111
Vodianyk A, Diomin E, Husakov A, Havrilov I, Horbachevskyi A, Habicht J. (2025). Healthcare-associated infections and antimicrobial use in Ukrainian acute care hospitals involved in treatment of casualties of war: multi-centre cross-sectional study in 2024. J Hosp Infect. 162: 333-338. https://doi.org/10.1016/j.jhin.2025.05.015; PMid:40484243 PMCid:PMC12351372
Warren BG, Nelson A, Warren DK, Baker MA, Miller C, Habrock T et al. (2021). CDC Prevention Epicenters Program. Impact of preoperative chlorhexidine gluconate (CHG) application methods on preoperative CHG skin concentration. Infect Control Hosp Epidemiol. 42(4): 464-466. https://doi.org/10.1017/ice.2020.448; PMid:32993846 PMCid:PMC8034836
World Health Organization. (2018). Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva. URL: https://iris.who.int/handle/10665/277399.
Yilmaz A, Ateş S, Kosif A. (2022). Chlorhexidine Gluconate for Perioperative Skin Cleansing to Reduce Surgical Site Infection and Bacterial Colonization: A Randomized Controlled Trial. Mediterr J Infect Microb Antimicrob. 11(1): 15-15. https://doi.org/10.4274/mjima.galenos.2022.2021.15
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