113 - SSI Colon Reduction Through a Multidisciplinary Approach and Culture Change Strategy

Description: Description of Team:

An interdisciplinary committee including surgery quality, leadership, infection prevention, anesthesiologists, surgeons, pre-surgical optimization clinic, environmental services, and pharmacy.

Preparation and planning:

A committee was formed to address needs for evidence-based practices (EBP) to prevent colon SSIs with a standardized infection ratio (SIR) reduction. In 2023, the SIR for colon procedures was 1.884.

Assessment:

The review of cases from 2022 through 2023 identified gaps in best practices in the perioperative area. Our site had implemented a standardized, evidence-based colon bundle to support quality and infection prevention measures. Despite this, compliance with several key elements, such as documentation of present at time of surgery (PATOS), glycemic control, normothermia, antibiotic prophylaxis, intraoperative measures, and preoperative preparation, was found to be inconsistent. These gaps highlight opportunities for targeted interventions to improve adherence and patient outcomes. This process highlighted the critical need for a culture shift to overcome biases and departmental silos.

Implementation:

Subgroups were established to evaluate outcomes, identify opportunities, and cultivate an open and positive communication using healthy workforce initiatives. This structure ensured that all voices were heard and supported the development of a cohesive, aligned interdisciplinary team reporting through the established committee framework. In 2023, the EBP colon bundle was reviewed at a system-level, it was determined that a standard was needed. In 2024, a colon bundle was implemented. It included EBP for a fascial closure initiative, which involved a change of instrumentation, gown/glove and sterile field area after colon anastomosis with all staplers and instruments for colon repair removed; with documentation completed by the surgical nurse. Additionally, protocol included perioperative glycemic control and a visit through our pre-optimization clinic with the goal of enhanced recovery.

Our site instituted a deeper SSI dive to determine if bundle elements were met during all phases of care. Identified opportunities led to targeted actions within the EBP bundle which were educated to involved clinicians. Concurrently, focused education on documentation requirements for PATOS was provided to surgeons. In 2025, the initiative expanded to include partnerships with nursing units and the care management team to address perioperative phases, as well as post-discharge opportunities at home or subacute rehabilitation settings.

Outcome:

After implementation, the colon SIR in 2024 was 1.718, showing an 8.81% improvement. To date, the colon SIR is 1.374, which is a 20.02% improvement from 2024. The improvement of colon SIR from 2023 to 2025 year to date shows a 27.07% improvement.

Implications for perioperative nursing:

The key implication for perioperative nursing is that a global approach is needed to reinforce best practices to enhance optimization measures with an aligned purpose and integration of all areas. There is a need to continue to stay current with best practices through research and identifying opportunities using a proactive approach. Our next goal is to incorporate artificial intelligence and educational videos to patients & clinicians. This initiative can be shared with other perioperative areas to move SSI prevention forward in a proactive, interdisciplinary approach.