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Background: Surgical site infection are preventable yet remain a major contributor of hospital acquired infections. The highest incidences of 7.2% are seen in Africa. One cornerstone for prevention is preoperative skin antiseptic application. However, while some jurisdiction use the World Health Organisation recommendation of a single alcohol based solution such as chlorhexidine gluconate-alcohol, public facilities in Zambia still use combination such as aqueous based antiseptics and methylated spirit.

Objectives:To compare the incidence of surgical site infections at among patient undergoing open abdominal surgery after two field aseptic cleaning versus three field aseptic cleaning.

Methods:The two-field method comprising of aqueous chlorhexidine gluconate and methylated spirit will form the first cohort, while the three-field method which includes the two-field plus aqueous povidone iodine will make the second cohort. Either the two-field or three-field antiseptic technique will be applied sequentially. A total of 1,054 patients undergoing elective open abdominal surgery will be selected from various healthcare facilities across seven provinces. Patients will be prospectively followed up for 30 days after surgery using the World Health Organisation surgical site infection checklist. Data will be collected electronically using Kobo for a period of one year and analysed using SPSS version 29. The Z test for two proportions will be used for hypothesis testing