A randomised control trial using soap in the prevention of surgical site infection in Tanzania


      • Surgical Site Infection (SSI) is a global public health problem with the largest burden in the LMICs.
      • This is the first study looking into the effectiveness of using soap to prevent SSI in children undergoing surgery.
      • The intervention may be feasible and sustainable as it is inexpensive, readily available and involves the parent.
      • There is a need to develop strategies to prevent SSI beyond the hospital settings.



      Surgical site infections (SSIs) are common and serious complications of surgery. Guidelines on preventing SSIs have been developed, but the role of preoperative bathing with plain soap among paediatric population is unclear. We aimed to assess the effectiveness of pre-operative bathing using plain soap in preventing SSIs among paediatric surgical patients.

      Materials and Methods

      An open-label, randomised trial was conducted at Muhimbili National Hospital in Tanzania. Preoperatively, patients in the intervention group washed their body using plain soap, while those in the control group did not. The primary outcome was SSI postoperatively. Statistical tests included χ2, Wilcoxon rank sum, and univariate and multivariable logistic regression.


      Of the 252 patients recruited,114 were randomised to the intervention arm. In the control arm, 40.6% (56/138) of participants developed SSIs compared to 11.4% (13/114) in the intervention arm (p < 0.01). After adjusting for confounding factors in multivariable analysis, the intervention reduced the odds of an SSI by 80% (OR: 0.20 [95% CI: 0.10, 0.41]; p < 0.01). Preoperative antibiotics were deemed to be an effect modifier of the association between the intervention and SSI (p = 0.05). The intervention significantly reduced the odds of an SSI by 88% among participants not given preoperative antibiotics (OR: 0.12 [95% CI: 0.05, 0.30]; p < 0.01).


      This study has shown that preoperative bathing with soap significantly reduces SSIs in paediatric surgical patients. It is a simple, cost effective and sustainable intervention.

      Level of Evidence

      Level II


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        • Webster J.
        • Osborne S.
        Preoperative bathing or showering with skin antiseptics to prevent surgical site infection.
        Cochr Database Syst Rev. 2015;
        • Harrop J.S.
        • Styliaras J.C.
        • Ooi Y.C.
        • et al.
        Contributing Factors to Surgical Site Infections.
        J Am Acad Orthop Surg. 2012; 20: 94-101
        • George S.
        • Leasure A.R.
        • Horstmanshof D.
        Effectiveness of decolonization with chlorhexidine and mupirocin in reducing surgical site infections: a systematic review.
        Dimens Crit Care Nurs. 2016; 35: 204-222
        • Owens C.D.
        • Stoessel K.
        Surgical site infections : epidemiology, microbiology and prevention.
        J Hosp Infect. 2008; 70: 3-10
        • Biccard B.M.
        • Madiba T.E.
        • Kluyts H.-.L.
        • et al.
        Perioperative patient outcomes in the African surgical outcomes study: a 7-day prospective observational cohort study.
        Lancet. 2018; 391: 1589-1598
        • Allegranzi B.
        • Bischoff P.
        • de Jonge S.
        • et al.
        New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective.
        Lancet Infect Dis. 2016; 16: e276-e287
        • Gonzalez D.O.
        • Ambeba E.
        • Minneci P.C.
        • et al.
        Surgical site infection after stoma closure in children: outcomes and predictors.
        J Surg Res. 2017; 209: 234-241
        • Khoshbin A.
        • So J.P.
        • Aleem I.S.
        • et al.
        Antibiotic prophylaxis to prevent surgical site infections in children: a prospective cohort study.
        Ann Surg. 2015; 262: 397-402
        • Philipo G.S.
        • Bokhary Z.M.
        • Bayyo N.L.
        • et al.
        A journey undertaken by families to access general surgical care for their children at muhimbili national hospital, Tanzania; prospective observational cohort study.
        World J Surg. 2022;
        • Leaper D.J.
        • Edmiston C.E.
        World Health Organization: global guidelines for the prevention of surgical site infection.
        J Hosp Infect. 2017; 95: 135-136
      1. Global guidelines for the prevention of surgical site infection, 2nd ed. n.d. (accessed 8 August 2022).

        • Mwambete K.
        • Lyombe F.
        Antimicrobial activity of medicated soaps commonly used by Dar es Salaam residents in Tanzania.
        Indian J Pharm Sci. 2011; 73: 92
        • Westen E.H.M.N.
        • Kolk P.R.
        • Velzen C.L.V.A.N.
        • et al.
        Single-dose compared with multiple day antibiotic prophylaxis for cesarean section in low-resource settings, a randomized controlled, noninferiority trial.
        Acta Obstet Gynecol Scand. 2015; 94: 43-49
        • Ademuyiwa A.O.
        • Hardy P.
        • Runigamugabo E.
        • et al.
        Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial.
        Lancet. 2021; 398: 1687-1699
        • Ernest E.C.
        • Hellar A.
        • Varallo J.
        • et al.
        Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention.
        BMJ Glob Health. 2021; 6e006788
        • Bojdo A.
        • Sawicka E.
        • Zak K.
        • et al.
        Risk factors of surgical site infection in newborn infants.
        Med Wieku Rozwoj. 2008; 12: 771-777
        • Catania V.D.
        • Boscarelli A.
        • Lauriti G.
        • et al.
        Risk factors for surgical site infection in neonates: a systematic review of the literature and meta-analysis.
        Front Pediatr. 2019; 7: 101
        • Curcio D.
        • Cane A.
        • Fernández F.
        • et al.
        Surgical site infection in elective clean and clean-contaminated surgeries in developing countries.
        Int J Infect Dis. 2019; 80: 34-45
        • Crader M.F.
        • Varacallo M.
        Preoperative antibiotic prophylaxis.
        StatPearls Publishing, StatPearls, Treasure Island (FL)2022
        • Bratzler D.W.
        • Dellinger E.P.
        • Olsen K.M.
        • et al.
        Clinical practice guidelines for antimicrobial prophylaxis in surgery.
        Surg Infect. 2013; 14: 73-156
        • World Health Organization. Regional Office for Africa
        Antimicrobial resistance in the WHO African region: a systematic literature review.
        World Health Organization. Regional Office for Africa, 2021
        • Tadesse B.T.
        • Ashley E.A.
        • Ongarello S.
        • et al.
        Antimicrobial resistance in Africa: a systematic review.
        BMC Infect Dis. 2017; 17: 616
        • Velin L.
        • Umutesi G.
        • Riviello R.
        • et al.
        Surgical site infections and antimicrobial resistance after cesarean section delivery in rural Rwanda.
        Ann Glob Health. 2021; 87: 77
        • Mwita J.C.
        • Souda S.
        • Magafu M.G.M.D.
        • et al.
        Prophylactic antibiotics to prevent surgical site infections in Botswana: findings and implications.
        Hosp Pract. 2018; 46: 97-102
        • Billoro B.B.
        • Nunemo M.H.
        • Gelan S.E.
        Evaluation of antimicrobial prophylaxis use and rate of surgical site infection in surgical ward of Wachemo University Nigist Eleni Mohammed Memorial Hospital, Southern Ethiopia: prospective cohort study.
        BMC Infect Dis. 2019; 19: 298
        • Setiawan B.
        The role of prophylactic antibiotics in preventing perioperative infection.
        Acta Medica Indones. 2011; 43: 262-266
        • Syed M.K.
        • Al Faqeeh A.A.
        • Othman A.
        • et al.
        Antimicrobial prophylaxis in clean pediatric surgical procedures: a necessity or redundancy?.
        Cureus. 2020; 12e10701
        • System A report from the N
        National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004.
        Am J Infect Control. 2004; 32: 470-485