Clean Cut Overview

© Lifebox/Michael McCaskey 2018

What is Clean Cut?

Clean Cut is a six-month quality improvement program for infection prevention practices in operating rooms aimed at reducing surgical infections and saving lives, especially in low-income countries. It was launched in 2016 by Lifebox, a nonprofit organization focused on improving surgical safety worldwide.

Clean Cut focuses on six key steps (processes) to reduce surgical infections:

  1. Appropriate skin preparation of both the surgeon’s hands and the surgical site with proper antiseptic agents
  2. Maintenance of the sterile field by ensuring the sterility of surgical gowns, drapes, and gloves
  3. Confirmation of instrument sterility by the operating team
  4. Appropriate antibiotic selection and timing of administration within one hour prior to surgical incision 
  5. Complete sponge counts before and after every case
  6. Use of the WHO Surgical Safety Checklist to promote teamwork, communication, and a culture of safety in the operating room


Why Clean Cut?

Surgical infection rates in low-income countries are double those reported in high-income countries, causing untold pain and difficulty for patients and straining hospital systems. Lifebox’s Clean Cut program provides hospitals and practitioners in low-resource settings with a clear best-practices solution for reducing surgical site infections (SSIs). While the World Health Organization recently released guidelines to reduce perioperative infections, there have been few best-practice programs to implement changes in low-income countries on a global scale.


How effective is Clean Cut?

The Clean Cut program has shown clear positive impact backed by evidence. In the first major study of its effect, Clean Cut was introduced at five hospitals in Ethiopia in 2016-2018. The introduction of Clean Cut improved compliance with critical infection prevention standards and dramatically reduced the risk of surgical infections. Furthermore, these beneficial outcomes did not require major investments in new infrastructure or resources. While more research is needed to evaluate the best mechanisms for scaling the program, these initial results illustrate the lifesaving potential of this program and support more urgent uptake of Clean Cut in low-resource settings.