Methods to assess belly button cleanliness prior to keyhole surgery

Participants in the intervention group will be provided with materials and written instructions to clean their umbilicus. Cleaning will occur when participants present to hospital for laparoscopic surgery. Cleaning may occur at any time in the waiting period between patients' presentation to hospital and their operation, so long as the cleaning occurs on the same day as the operation. Cleaning will occur in the privacy of admission clinic rooms, and researchers, who are medical students or doctors, will be present in the clinic room to observe the cleaning routine. Cleaning the umbilicus is expected to take no longer than five minutes of participants’ time. The cleaning materials will comprise ordinary household hygiene products to which participants have no known allergy, for example, soap, body wash and olive oil. All participants will continue to have their umbilici cleaned by surgeons prior to skin incision intraoperatively. The cleaning of participant umbilici will be undertaken to facilitate validation of the Umbilical Cleanliness Scale (UCS). The UCS is a 5-point scale designed to enable a rapid visual assessment of umbilical cleanliness intraoperatively. The initial items on the UCS were devised by consultant surgeons who participate in abdominal surgery. These surgeons will not participate in the subsequent validation of the scale. Departmental consultant and registrar surgeons will be asked to use the UCS to score photographs of clean and unclean patient umbilici. Researchers will photograph patient umbilici intraoperatively, just prior to anti-septic skin preparation. Photographs of patients will be of the abdomen only and will not be identifiable. Photographs will be printed on a hard-copy handout that will be provided to surgeons to record their scores. Each surgeon will score the same set of photographs on two separate occasions separated by at least two weeks. No patient-identifying information will be included on these handouts. The scoring of hand-outs is expected to take no longer than five minutes of surgeons’ time. The bacterial load of participant umbilici will also be measured using a swab taken by researchers at the time the photographs are taken. Swabs (and their results) will be non-identifiable. The process of photographing and swabbing umbilici intraoperatively is expected to take no longer than two minutes per participant.