Background: Surgical site infections (SSIs) following groin exposure in vascular surgery are associated with significant morbidity, prolonged hospital length of stay, and increased healthcare costs. The groin is particularly susceptible to infection due to local skin flora and moisture, with studies demonstrating higher infection rates compared to other vascular operative sites (1). Despite standard perioperative infection prevention measures in the operating room, SSI rates following groin exposure remain unacceptably high. This quality improvement (QI) project aimed to reduce groin SSI rates through the implementation of a standardized preoperative chlorhexidine-based scrub protocol.
Methods: A single-center QI initiative was evaluated using a before-and-after study design. The control group consisted of patients who underwent standard preoperative hair clipping and OR prep per facility protocol. 161 adult patients undergoing vascular procedures requiring groin exposure between July 2023 and April 2025 were included in the control group. The intervention consisted of chlorhexidine scrub self-administered by patients to the groin prior to elective outpatient vascular procedures involving groin exposure. Education was provided to patients and clinic staff to ensure protocol adherence. The primary outcome was subsequent OR procedures for groin SSI debridement noted on chart review. Secondary outcomes included groin wound vac placement and microbiology data.
Results: The study included a total of 161 pre-intervention patients with rates of return to OR for groin SSI debridement at 16.1%, higher than previously published studies (2). Post-intervention data collection is ongoing.
Conclusions: Analysis of the pre-intervention cohort demonstrated higher than expected rates of groin SSI requiring operative debridement. There is need for strategies to reduce groin SSI in vascular surgery patients, justifying the implementation of our ongoing pre-operative chlorhexidine scrub initiative. Ongoing monitoring of SSI rates and protocol adherence will better characterize the efficacy of enhanced skin antisepsis protocols for high-risk surgical sites in vascular surgery.