CheckList Expansion for Antisepsis and iNfection Control in Cesarean Section (CLEAN–CS): a stepped-wedge, cluster-randomized controlled interventional trial to reduce surgical site infections in Ethiopia

Background: Clean Cut is a quality improvement program developed in Ethiopia that aims to strengthen compliance with six standards of perioperative infection prevention: 1. hand and skin antisepsis, 2. instrument sterility, 3. sterile field preparation, 4. prophylactic antibiotics, 5. gauze counting and, 6. the use of the WHO Surgical Safety Checklist. Pilot work improved compliance with these six standards and reduced surgical site infections (SSI) by 35%, but a more rigorous assessment is needed. Intervention: Each cluster underwent baseline assessment followed by Clean Cut implementation, which included process-mapping the six standards, using baseline data to create site-specific systems-level improvements, and delivery of four training workshops on the use of a surgical safety checklist, infection prevention and control practices, instrument reprocessing, and non-technical skills training on operating room teamwork and communication.