Clean Cut for Cesarean Section trial in Ethiopia improves surgical compliance and reduces mortality following cesarean sections

A groundbreaking study published in JAMA Network Open has revealed the significant impact of Clean Cut, a Lifebox program to strengthen perioperative care practices.  The Checklist Expansion for Antisepsis and Infection Control in Cesarean Section (CLEAN-CS), conducted across nine hospitals in Ethiopia, significantly reduced complications and improved adherence to surgical standards during cesarean deliveries.

The Clean Cut initiative, developed by Lifebox, is a quality improvement intervention designed to strengthen and improve compliance with perioperative care standards and reduce postoperative complications; the trial evaluated its impact on maternal and neonatal outcomes following cesarean delivery in low-resource settings. The trial focused on improving six critical perioperative infection prevention standards:

• Appropriate skin preparation
• Maintenance of the sterile field
• Confirmation of instrument sterility
• Appropriate antibiotic administration
• Complete swab counts
• Appropriate use of  WHO Surgical Safety Checklist

This trial’s success underscores the importance of scaling the Clean Cut program to more hospitals in other low-resource settings. It was a collaborative effort between Lifebox, Addis Ababa University, Stanford University, Boston Medical Center, the Ethiopian Society of Obstetricians and Gynecologists, and several Ethiopian healthcare institutions, with funding from the UBS Optimus Foundation through a Bill and Melinda Gates Foundation Grand Challenge Grant, and additional support from the Fogarty International Center of the National Institutes of Health.