The Crani Bundle: Chlorhexidine Gluconate Bathing, Patient Hand Hygiene, and Surgical Site Dressing Care in Preventing Surgical Site Infections

J Nurs Care Qual. 2025 Apr 22. doi: 10.1097/NCQ.0000000000000869. Online ahead of print.

Abstract

Background: Surgical site infections (SSIs) are preventable complications. The Joint Commission (TJC) National Patient Safety Goal® (NPSG) 7 focuses on decreasing health care-associated infections (HAIs), such as SSIs.

Local problem: The neurosurgery service line encountered 4 SSIs from craniotomy procedures over a 27-month period with 2 occurring in 1 month requiring immediate attention.

Methods: A pre- (January 2018 to March 2020)/post-implementation (April 2020 to July 2022) design, using rapid Plan-Do-Study-Act cycles, guided this evidenced-based practice quality improvement project.

Interventions: The Crani Bundle, a nurse-led SSI prevention initiative focusing on patient hand hygiene and postoperative chlorhexidine gluconate bathing, was developed and implemented to reduce SSI after craniotomy (SSI-CRAN).

Results: Implementation of the Crani Bundle decreased SSI-CRAN from 3.38% (n = 4/118) to 0.0% (n = 0/87).

Conclusions: The Crani Bundle was effective in reducing SSI-CRAN, meeting TJC NPSG® of preventing HAIs and improving patient safety.

Keywords: anti-infective agents; evidence-based practice quality improvement; hand disinfection; neurosurgical procedures; surgical wounds.