How often do surgery patients arrive in the operating room "sufficiently clean" for incision? A survey in a tertiary-care teaching hospital in France.

Aim: The preoperative shower (POS) is strongly recommended in skin preparation before surgery, to remove skin soiling and facilitate the antisepsis of the incision site. The effectiveness of POS to achieve clean skin in routine practice has not been studied in literature. This study aimed to determine how often the operating room (OR) nurse assessed the skin of surgical patients at arrival in the OR as "not adequately clean".

Method: This descriptive survey was carried out in January 2024 in a university hospital in France. An investigator documented patient's age, gender, and body mass index (BMI), the day of surgery, type of surgical procedure, whether it was scheduled or unscheduled, and the site of the site. The patient was asked whether s/he had taken a POS, and its time and place (home or hospital). The OR nurse was asked by the investigator about her assessment of the patient's skin cleanliness (adequate or inadequate), and in case of skin cleanliness deemed unsatisfactory, what decision had been made: proceed as usual, additional skin cleaning in the operating room, postponement of the surgical procedure.

Results: Among the 100 patients included in the study, 18% (95% CI 10.5-25.5%) had a skin cleanliness that was considered unsatisfactory. A scheduled procedure was the sole parameter significantly associated with satisfactory skin cleanliness as compared to unscheduled procedures.

Conclusion: Despite the POS, approximately one-fifth of patients had inadequate skin cleanliness upon arrival in the OR, highlighting an essential area for improvement of preoperative preparation of the surgical field, especially in clean surgery.