FOR IMMEDIATE RELEASE – New study shows Lifebox’s Clean Cut reduces leading cause of mortality and morbidity.

September 23 2020,  Lifebox announces significant results for reducing surgical site infections (SSIs) by nearly half in low-resource hospital systems. A new study published in the British Journal of Surgery reports the results of Clean Cut – a Lifebox program that engages surgical teams to address the causes of SSIs.

Read this release in French or Spanish. 

The study – “Outcomes Following Implementation of Clean Cut, an Adaptive, Multimodal Surgical Infection Prevention Program for Low Resource Settings: A Prospective Quality Improvement Study” – details the impact of Clean Cut in five pilot hospitals in Ethiopia. Using the outcomes of over 2,000 surgical patients, the results show a reduction in the risk of SSIs by 35%. Most importantly, for scalability across low- and middle-income countries, Clean Cut requires no major investments in new infrastructure or resources

“We are very excited and encouraged by our results. Effective implementation of the Surgical Safety Checklist requires coordination and teamwork, and that is what we were able to accomplish through this program. We improved outcomes and reduced postoperative infections without relying on major capital investments. We know that global surgery gets a fraction of global health funding, and here we have a program that slashes infection rates regardless of a hospital’s budget or location. Clean Cut makes surgery demonstrably safer for patients. If we can effectively disseminate and scale this work, it has ramifications for surgical ecosystems worldwide.”  Dr. Thomas G Weiser, Trauma Surgeon and Clean Cut Clinical Lead

SSIs are a leading cause of morbidity and mortality in surgical patients – particularly in low- and middle-income countries (LMICs) – where rates of infection can be nearly twice that of high-income countries such as the USA or UK¹

Clean Cut is a checklist-based program that works to reduce SSIs by improving adherence to six essential perioperative infection prevention practices such as appropriate timing of antibiotics, confirmation of instrument sterility and routine swab counting.

Across the five pilot hospitals, there was a 64% increase in compliance across these six infection prevention standards (from 2.9 to 4.5 out of six) with the maintenance of the sterile field improving by 49% and confirmation of instrument sterility increasing by 50%. As a result, the relative risk of infection dropped by 35% for all surgical patients. When comparing surgical patients with low versus high infection prevention standards, high compliance reduced the risk of infection by 46%.



“This is welcome news for surgical patients in Ethiopia. Like in many low-income countries,  Ethiopian patients suffer disproportionately from surgical infections. Clean Cut is a locally-led and affordable way for surgical teams to make every single patient safer. With the backing of the Federal Ministry of Health, we’re rolling Clean Cut out across Ethiopia to replicate our successes to date.” Dr. Tihitena Negussie, Black Lion Hospital, Addis Ababa, Ethiopia.


With initial support from the GE Foundation’s Safe Surgery 2020 initiative, Clean Cut is now being rolled out in a number of new facilities in Ethiopia with support from the Federal Ministry of Health. With the results demonstrated by the pilot, Lifebox plans to implement Clean Cut in new settings in the coming months.

“The Clean Cut program once again has proven that safety and quality are the pillars of access to safe surgical and anaesthesia care. This system based quality improvement and safety project has shown rates of surgical site infection can be significantly reduced in a developing country, given the right approaches and tools are implemented. National Surgical Obstetric and Anesthesia Plans (NSOAPs) across the region need to consider the value of such a program.” Professor Abebe, Dean and Deputy Vice Chancellor of Academic and Research Affairs at the University of Global Health Equity (UGHE).

¹ Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet Lond Engl. 2011 Jan 15;377(9761):228–41.