A small study conducted at the Medical College of Wisconsin in Milwaukee shows that text message reminders can increase patients' compliance with pre-surgical showering, thus reducing their risk of acquiring an infection during surgery.

Pre-surgical antiseptic showers, using a chemical like chlorhexidine gluconate (CHG), reduce the number of microbes on the skin, which guards the patient against surgical site infections, or SSIs. The researchers write that 400,000 surgical site infections occur each year in the US and a quarter of those are fatal. Surgeons can reduce the risk of SSIs if they recommend that their patient take two or three antiseptic showers 24 to 48 hours prior to admission, according to a press release from the American College of Surgeons.

In the study, published in the Journal of the American College of Surgeons, researchers split 80 volunteers into three groups. Half of the volunteers were instructed to shower three times and half were instructed to shower twice. Within each of those groups, half received text messages reminding them to shower and half did not. 

“In general, getting patients to comply with this preadmission cleansing strategy is a challenge throughout health care,” lead study author Dr. Charles Edmiston, professor of surgery at Medical College of Wisconsin and a hospital epidemiologist, said in a statement. “While patients want to be compliant, they will often forget to fulfill this preadmission requirement. So, that’s why we looked to new technology for a solution. When you use a prompt like texting or emailing, you make the patient an intimate partner in the health care process.”

Study subjects returned to the lab to have their skin analyzed by researchers for levels of CHG, the chemical with which they were instructed to shower. Researchers found that the volunteers who did not receive text messages had 66 percent lower skin concentrations of CHG on average. The study didn't look to see whether the skin concentration of harmful microbes was similarly reduced, but the evidence does suggest that the text messages increased compliance considerably.

The next step, researchers said, will be to increase the standardization of when and how patients take the showers. The study showed a significant variation in CHG skin concentration even within groups which could be mitigated with standardized protocols.

“I think a study like this provides us with a tremendous opportunity to empower patients because it clearly makes them an intimate partner in the whole health care experience,” Edmiston said. “It’s reminding them that they are not a passive player but rather an active participant in an important risk-reduction strategy that if successfully completed can contribute to an improved clinical outcome.”