[Case Study] How A Perioperative Nurse Team Reduced Surgical Site Infections By 40%

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Reduction of Surgical Site Infections Using Lean An Ochsner Health Case Study by AHRMM

Title: Reduction of Surgical Site Infections Using Lean An Ochsner Health Case Study
Channel: AHRMM

[Case Study] How A Perioperative Nurse Team Reduced Surgical Site Infections By 40%

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[Case Study] How A Perioperative Nurse Team Reduced Surgical Site Infections By 40%

Surgical site infections (SSIs) are among the most common and costly healthcare-associated infections (HAIs). They prolong hospital stays, increase patient readmission rates, and place a massive financial burden on healthcare systems.

To combat this challenge, a dedicated perioperative nurse team at a 350-bed community hospital launched an evidence-based quality improvement initiative. By standardizing their clinical workflows and taking ownership of infection control, this team achieved a remarkable 40% reduction in surgical site infections within 12 months.

This case study breaks down the exact strategies, clinical interventions, and data-driven protocols they used to achieve these results.

The Challenge: Identifying the Root Causes of SSIs

Before implementing any changes, the perioperative nursing team needed to understand why infections were occurring. The hospital’s baseline SSI rate for high-risk procedures—specifically colorectal surgeries and total joint arthroplasties—hovered at 3.8%, well above the national benchmark.

Baseline Data and Risk Assessment

The team reviewed 18 months of retrospective patient data. They evaluated patient demographics, comorbidities, pre-surgical prep methods, and intraoperative variables.

Identifying Gaps in the Perioperative Workflow

Through multidisciplinary brainstorming sessions and workflow audits, the team identified several critical gaps in care:

Inconsistent Preoperative Skin Preparation: Patients were not receiving standardized instructions or tools for chlorhexidine gluconate (CHG) bathing at home.
Antibiotic Timing Delays: Prophylactic antibiotics were occasionally administered outside the optimal 60-minute pre-incision window.
High Operating Room (OR) Traffic: Frequent door openings during surgeries compromised the sterile environment.
Variable Wound Closure Techniques: There was no standardized protocol for closing surgical incisions, leading to cross-contamination of clean tissues.

The Intervention: A 3-Phase Evidence-Based Nursing Protocol

To address these gaps, the perioperative nurse team designed and executed a comprehensive, three-phase SSI prevention protocol aligned with guidelines from the Association of periOperative Registered Nurses (AORN) and the Centers for Disease Control and Prevention (CDC).

Phase 1: Preoperative Optimization & Patient Engagement

Infection prevention starts long before the patient enters the operating room. The preoperative nursing team focused on optimizing patient health and skin preparation:

Standardized CHG Bathing: Patients were provided with 4% CHG liquid soap and a highly visual, easy-to-read instruction sheet. They were required to bathe with CHG the night before and the morning of surgery.
Nasal Decolonization: For orthopedic and cardiac cases, patients received pre-operative nasal decolonization using 10% povidone-iodine to reduce Staphylococcus aureus colonization.
Warming in the Pre-op Holding Area: To prevent hypothermia (a known risk factor for SSIs), active warming blankets were applied in the holding area to maintain a core temperature above 36°C (96.8°F).

Phase 2: Intraoperative Standardization & Environmental Controls

The intraoperative nursing team established strict, non-negotiable protocols inside the operating suite:

The "Clean Closure" Technique: Prior to closing the fascial layer, the surgical team performed a complete glove and instrument change. A dedicated, sterile "closure tray" was opened, ensuring no instruments used during the deeper portion of the procedure touched the skin or subcutaneous tissues.
Strict Traffic Control: Signs were posted on OR doors, and wireless counters tracked door openings. Staff were educated on the correlation between air turbulence, bacterial counts, and SSI rates.
Glycemic Control: Blood glucose levels were monitored every 2 hours during long surgeries, with active protocols to keep levels below 180 mg/dL.

Phase 3: Postoperative Care & Wound Surveillance

Post-anesthesia care unit (PACU) and surgical ward nurses standardized wound maintenance:

Intact Dressings: Surgical dressings were kept clean, dry, and intact for the first 48 hours post-surgery unless a leak or complication occurred.
Standardized Discharge Education: Patients and caregivers received hands-on training on hand hygiene, wound care, and identifying early signs of infection (redness, warmth, drainage) before leaving the hospital.

Key Interventions and Compliance Metrics

To ensure the success of the new protocol, the nursing team tracked compliance weekly. The table below illustrates the shift in clinical compliance from the baseline period to the post-implementation phase.

| Perioperative Phase | Specific Intervention | Baseline Compliance | Post-Implementation Compliance | | :--- | :--- | :--- | :--- | | Preoperative | 2-dose CHG skin prep compliance | 52% | 94% | | Preoperative | On-time antibiotic administration (within 60 mins) | 81% | 98% | | Intraoperative | Maintenance of normothermia (>36°C) | 74% | 96% | | Intraoperative | Execution of "Clean Closure" protocol | 35% | 92% | | Intraoperative | Reduction of OR door openings (<15 per hour) | 42% | 88% | | Postoperative | Sterile dressing intact for 48 hours | 68% | 95% |

The Results: A 40% Reduction in SSIs and Beyond

The implementation of this nurse-led, standardized protocol yielded immediate and sustainable improvements over a 12-month period:

[Baseline SSI Rate]  3.8%  ====================>
                                            |  40% Reduction
[Post-Protocol Rate] 2.28% =============>

Decreased Infection Rates: The overall surgical site infection rate dropped from 3.8% to 2.28%, representing a 40% relative risk reduction.
Financial Savings: By preventing an estimated 18 surgical site infections over the year, the hospital saved approximately $450,000 in avoided ICU stays, readmissions, and extended antibiotic therapies.
Improved Patient Outcomes: Average post-operative hospital stays for colorectal patients decreased by 1.8 days due to fewer wound complications.

Actionable Takeaways for Healthcare Leaders

If your perioperative team wants to replicate these results, use these four steps to build momentum:

Empower Frontline Nurses: Nurses spend the most time with patients and are the natural guardians of the sterile field. Give them the authority to pause a procedure if sterile technique is compromised.
Use Visual Reminders: Place checklist posters in pre-op bays and OR suites to keep protocol steps top-of-mind for surgeons, anesthesia providers, and scrub techs.
Share Data Transparently: Publish compliance and infection rates monthly in staff breakrooms. Healthy competition and visible progress keep teams engaged.
Engage Patients as Partners: Do not underestimate the power of patient education. When patients understand why CHG bathing matters, compliance sky-rockets.

Conclusion: Empowering Nurses to Lead Infection Control

This case study proves that reducing surgical site infections does not require expensive new technologies or experimental drugs. Instead, it requires clinical discipline, standardized workflows, and a empowered perioperative nurse team dedicated to evidence-based practice. By focusing on consistent execution of simple, proven interventions, healthcare organizations can dramatically improve patient safety and clinical outcomes.

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