Showering twice with a special antiseptic wash before surgery is a standard part of the preparation process. This routine is designed to protect the patient’s health during the operation and recovery. The goal of this bathing protocol is to significantly reduce the risk of infection by minimizing the number of microorganisms present on the skin’s surface. Following this pre-operative routine precisely contributes directly to the success of the surgery and the patient’s overall well-being.
The Threat of Surgical Site Infections
The primary concern addressed by the pre-surgical shower is the risk of a Surgical Site Infection (SSI). An SSI is an infection that develops where surgery took place, and SSIs remain one of the most frequent complications following an operation. These infections can range from minor issues at the incision site to severe complications involving deep tissue or organs, often leading to extended hospital stays and higher health care costs.
The bacteria causing most SSIs originate from the patient’s own skin flora, not the hospital environment. Even skin that appears clean hosts billions of microbes, and some of these can be introduced into the surgical wound during the procedure. The risk of an SSI is estimated to affect 2% to 4% of all patients undergoing inpatient surgical procedures. Patient factors, such as diabetes, smoking status, and the presence of other skin conditions, can increase this risk.
The Science of the Antiseptic Wash
The special cleanser used in pre-operative bathing is typically a solution containing Chlorhexidine Gluconate (CHG). This antiseptic agent is a broad-spectrum antimicrobial, effective against a wide range of bacteria, fungi, and some viruses. CHG works by disrupting the cell membranes of microorganisms, causing the cell to die.
A primary advantage of CHG over regular soap is its prolonged residual activity. After the solution is rinsed off, CHG molecules bind to the proteins on the skin’s surface, creating a protective layer. This residual film continues to exert an antimicrobial effect for several hours after the shower, suppressing the regrowth of microbes. This sustained action is why CHG is preferred for surgical preparation, providing ongoing protection until the moment of the operation.
Why Two Showers Are Necessary
The instruction to shower twice, typically once the night before surgery and again the morning of, maximizes the antiseptic’s effectiveness. The first shower serves a preparatory function, washing away superficial debris, oil, and transient microorganisms. This initial cleaning removes barriers that might prevent the antiseptic from properly binding to the skin.
The second shower, performed just before leaving for the hospital, ensures maximum antimicrobial concentration. Applying CHG a second time reinforces the residual layer established by the first wash, leading to a higher and more sustained level of antiseptic on the skin. This cumulative effect is necessary to target the deeper, more embedded resident skin flora, which are the most common source of SSIs. Multiple applications of CHG produce higher levels of the antiseptic bound to skin proteins compared to a single wash.
Following Pre-Operative Preparation Instructions
Compliance with the detailed instructions is as important as the antiseptic itself for infection prevention. During both showers, patients must wash their hair with regular shampoo first. They then apply the CHG solution to the body from the neck down, carefully avoiding sensitive areas like the eyes, ears, and mouth. The CHG lather should remain in contact with the skin for a recommended duration, often up to five minutes, to allow the agent to work before being thoroughly rinsed off.
After the final antiseptic wash, patients must pat the skin dry with a clean, freshly laundered towel and dress in clean clothing. Patients should sleep on clean bed linens after the night-before shower to prevent recontamination. Patients must avoid applying any lotions, powders, deodorants, or perfumes after the final shower, as these products can interfere with or neutralize the residual antimicrobial effect of the CHG. Patients must also avoid shaving the surgical area for a few days before surgery, as nicks or cuts can damage the skin’s integrity and increase the risk of infection.