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Preparing for Changes in CDC and AORN
Preoperative Skin Cleansing Guidelines

Clorox Healthcare Recommends Skin Cleansing Protocol
Focused on Patient Compliance

Clorox Healthcare Preoperative Skin Cleansing white paper

In 2015 both the Centers for Disease Control and Prevention (CDC) and the Association of periOperative Nurses (AORN) are modifying their preoperative skin cleansing guidelines to be more open to interpretation.

Clorox Healthcare has issued a white paper that provides an evidence-based recommendation for two chlorhexidine gluconate (CHG) showers and includes considerations to improve patient compliance.

Read White Paper

The Impact of Surgical Site Infections (SSIs)

  • SSIs account for an excess of up to $3.5 billion in healthcare expenditures per year,1 not including the additional costs of hospitalization, post-discharge outpatient expenses, and long-term disability care and management.2
  • 55% of SSIs may be prevented with current evidence-based strategies,3 such as the use of chlorhexidine gluconate solution, or soap-and-water bathing prior to surgery.

Understanding Current SSI Prevention Guidelines

The CDC and AORN issue what are considered to be the leading authoritative guidelines on SSI prevention strategies. In 2014 both organizations issued drafts of their intended SSI prevention guidelines:

2014 Recommended Practices


2015 Draft Recommended Practices



“Require patients to shower or bathe with an antiseptic agent on at least the night before the operative day.”4
“Advise patients to shower or bathe (full body) with either soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the operative day.”5


“Patients undergoing open Class I surgical procedures below the chin should have two preoperative showers with chlorhexidine gluconate (CHG) before surgery, when appropriate.”6 
“Patients should bathe or shower
before surgery with either soap or
a skin antiseptic on at least the
night before or the day of surgery.7

Preoperative Skin-Cleansing Protocol Recommendation:
Two Chlorhexidine Gluconate Showers

  • CHG is currently the prevalent practice for preoperative bathing. In a December 2014 study,8 more than 75% of healthcare professionals recommended using CHG liquid
    or wipes.
  • Clinical data supports that SSI prevention and management
    can be enhanced by having two preoperative baths with

Steps to Improved Infection Prevention and Protocol Compliance

  • Studies show that a major factor in patient noncompliance is poor understanding of instructions.
  • Only 6% of infection preventionists, surgical services managers and OR directors are very confident that their patients are properly following their preoperative skin cleaning protocols at home.8
  • Actively engaging patients in infection prevention and arming them with tools and information is key to improving compliance. Some proven strategies include:

• Educate healthcare professionals.

• Provide patients with product.

• Provide patients with clear instructions.

• Implement patient reminder systems.

1. Anderson DJ, Podgorny K, Berrios-Torres SI, et al. “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update” Infection Control and Hospital Epidemiology. 2014; 35 (6): 605-627.

2. Anderson DJ, et al. “Strategies to Prevent Surgical Site Infections in Acute Care Hospitals.” Infection Control and Hospital Epidemiology. (2008); 29: S51-S61.

3. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. “Estimating the Proportion of Healthcare-associated Infections that are Reasonably Preventable and the Related Mortality and Costs.” Infection Control and Hospital Epidemiology. 2011; 32 (2): 101-114.

4. CDC. "Guideline for Prevention of Surgical Site Infection, 1999." Infection Control and Hospital Epidemiology 20, no. 4 (1999): 247-278. Available at:

5. CDC. “Draft CDC Guideline for Prevention of Surgical Site Infections (SSI)” Jan 30, 2014.  Available at:!documentDetail;D=CDC-2014-0003-0002.

6. AORN. “Recommended Practices for Preoperative Patient Skin Antisepsis.” In: Perioperative Standards and Recommended Practices (2012). Denver, CO: AORN, Inc. 445-463.

7. AORN. “Recommended Practices for Preoperative Patient Skin Antisepsis.” In: Preoperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2015. In press. 

8. Kelly Pyrek. “Preoperative Skin Cleansing State of the Industry Report.” Infection Control Today. December 2014.

9. CE Edmiston, Medical College of Wisconsin, Milwaukee, WI, AORN Journal, “Evidence for using Chlorhexidine Gluconate Preoperative Cleansing to Reduce the Risk of Surgical Site Infection.” November 2010; 92(5): 509-518.