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Simon G. Ammanuel, Caleb S. Edwards, Andrew K. Chan, Praveen V. Mummaneni, Joseph Kidane, Enrique Vargas, Sarah D’Souza, Amy D. Nichols, Sujatha Sankaran, Adib A. Abla, Manish K. Aghi, Edward F. Chang, Shawn L. Hervey-Jumper, Sandeep Kunwar, Paul S. Larson, Michael T. Lawton, Philip A. Starr, Philip V. Theodosopoulos, Mitchel S. Berger, and Michael W. McDermott

antiseptic protocol utilizing preoperative CHG showers. This uniform policy change permits the assessment of SSI in the preimplementation and postimplementation periods. Methods This study conformed to STROBE guidelines. All data were anonymized. Because this study was considered a quality improvement initiative, institutional review board approval and patient consent were not required. Data were collected from April 2012 to April 2016. A preoperative shower protocol utilizing CHG was implemented at our institution in November 2013 as part of a quality improvement

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Joshua K. Schaffzin, Katherine Simon, Beverly L. Connelly, and Francesco T. Mangano

saline for preventing shunt infection . J Neurosurg Pediatr 6 : 273 – 276 , 2010 20809712 10.3171/2010.5.PEDS1018 24 Institute for Healthcare Improvement : How-to Guide: Prevent Surgical Site Infection for Hip and Knee Arthroplasty. Cambridge, MA , Institute for Healthcare Improvement , 2012 25 Kaiser AB , Kernodle DS , Barg NL , Petracek MR : Influence of preoperative showers on staphylococcal skin colonization: a comparative trial of antiseptic skin cleansers . Ann Thorac Surg 45 : 35 – 38 , 1988 10.1016/S0003-4975(10)62391-0 3337574 26

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Victor Vakayil, Jeremiah Atkinson, Vikram Puram, James J. Glover, James V. Harmon, Catherine L. Statz, David W. Polly Jr., and Robert E. Bulander

etiology for their surgery ( Fig. 1 ). All patients received standard and identical preoperative surgical site preparation, which included antibiotic prophylaxis with 2 g of intravenous cefazolin (3 g for patients ≥ 120 kg) within 1 hour before the surgical incision, with redosing every 2–4 hours as required until surgical closure. Patients allergic to penicillin instead received 900 mg of IV clindamycin and were administered additional doses every 6 hours as required. Patients received skin antisepsis using chlorhexidine gluconate–containing antiseptics for preoperative