Clean Cut

Clean Cut is a Lifebox Quality Improvement program that helps surgical teams address the causes of Surgical Site Infections (SSIs).

SSIs occur in the part of the body where surgery took place and can lead to serious complications and even death. SSIs are the leading hospital acquired infection in low- and middle-income countries – where rates of infection are more than double that of the USA¹. 

Reducing surgical site infections is one of Lifebox’s three core pillars of Safer Surgery. Clean Cut –  based on the WHO Surgical Safety Checklist – is a three to six month program that works to strengthen a hospital’s perioperative infection prevention practices and save lives.


In Ethiopia, where Lifebox developed and piloted the Clean Cut Program –  this approach has been proven to reduce the relative risk of infection by 35% for all surgical patients. Read the paper published in the British Journal of Surgery here


“The morbidity and mortality following surgical site infection is devastating, especially in a country like ours where resources are limited and we are short on personnel. It is essential that we continue to implement a well-designed system to keep safe surgical practices. Clean Cut guides us towards best practice through intervention methods that will abate the introduction of offending microorganisms into our surgical field.

It makes it clear that it is not only the skill of the OR staff that can save lives, but the adherence to the set forth safety standards as well.”

Dr Assefa Tesfaye,  St Peter’s Specialized Hospital – Addis Ababa, Ethiopia

Clean Cut engages all members of the surgical team and a hospital’s management to map out surgical safety processes and identify where these can be strengthened to improve adherence to six essential perioperative infection prevention practices: 

  • • Appropriate skin preparation of both the surgeon’s hands and the surgical site with proper antiseptic agents
  • • Maintenance of the sterile field by ensuring the integrity and sterility of surgical gowns, drapes, and gloves
  • • Proper confirmation of instrument sterility by the operating team
  • • Appropriate antibiotic administration within one hour prior to surgical incision to optimize prophylaxis
  • • Complete gauze/swab counts before and after every case
  • • Use of the Surgical Safety Checklist to promote teamwork, communication, and a culture of safety in the operating room

Alongside promoting these infection prevention practices the program promotes high quality data collection and builds a strong surgical quality improvement team in the hospital. 

With initial support from the GE Foundation’s Safe Surgery 2020 initiative, Lifebox has worked with a total of eleven hospitals in Ethiopia to implement the Clean Cut Program with the Ethiopian Federal Ministry of Health.

Our original pilot hospital was the Jimma University Specialized Hospital, as well as Black Lion Tertiary Hospital, Menelik II Referral Hospital, St Peter’s Specialized Hospital, and the Fitche General Hospitals. In 2019, three new sites joined the program: Zewditu Memorial Hospital, Gondar University Hospital, and Debark Primary Hospital. Our current Clean Cut work is with teams from Addis Ababa Burn Emergency and Trauma Hospital (AaBET), Gandhi Memorial Hospital and Yekatit Hospital. Follow our Lifebox Fellow, Nichole Starr for updates as we continue our work to make surgery safer.

Across the five pilot hospitals, there was a 64% increase in compliance across the six infection prevention standards, with the maintenance of the sterile field improving by 49% and confirmation of instrument sterility increasing by 50% – both proven measures for reducing surgical site infections and saving lives. As a result, the relative risk of infection dropped by 35% for all surgical patients. When comparing surgical patients with low versus high compliance of infection prevention standards, high compliance reduced the risk of infection by 46%. 

Watch a discussion on the results of Clean Cut by the implementation team in English, French and Spanish and other Clean Cut videos here. Read more about Lifebox’s results here

With Clean Cut in Ethiopia showing significant results in reducing surgical site infection rates, Lifebox will be replicating this program in other sites within Africa and in Asia and Central America in the coming year.

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.