Nursing Leadership Drives Focused Work to Reduce Surgical Site Infections

As GBMC continues to strengthen its redesigned Lean Management System, nursing leaders are playing a key role in advancing one of the organization’s highest-impact priority areas: reducing surgical site infections.

Through the updated Lean Management System structure, GBMC has narrowed its organizational focus from more than 20 active projects to four strategy boards centered on work with the greatest potential to improve financial stability, quality outcomes, and the patient experience. One of those boards is focused on surgical site infection reduction, with an initial emphasis on colorectal procedures.

For Rachel Hellmann, DNP, RN, CNOR, Nurse Manager – General Operating Room, and Silvana “Silvie” Willoughby, MSN, RN-BC, CEN, Periop and Procedural Clinical Program Manager, the work builds on years of multidisciplinary collaboration through GBMC’s surgical site infection committee. That committee reviews surgical site infections with Infection Prevention and other key stakeholders, identifies opportunities for improvement, and forms workgroups to address gaps in practice.  

The current effort takes that work a step further by organizing improvement opportunities across the patient’s entire surgical journey: before the patient arrives at the hospital, in pre-op, in the operating room, and after discharge.

“We’ve been looking at different ‘buckets,’” Silvie said. “There are elements that have to happen before the patient ever gets to us, elements that happen once they’re in our pre-op area, elements that happen while they’re in the operating room and then post.”  

Data showed that the in-hospital elements controlled by nursing were consistently at or above target, while several pre-hospital elements were below target. That finding led the team to look closely at patient education, office workflows, and barriers that may prevent patients from completing important preparation steps such as chlorhexidine gluconate bathing, carbohydrate drinks, bowel preparation, smoking cessation, and medication instructions.  

One major opportunity was simplifying patient instructions. The colorectal surgery packet was reduced from 19 pages to 14 pages, with a two-page draft now in review. The team is also developing patient education videos, QR code access, and future Epic Care Companion tools to provide reminders and support at the right time.  

As Silvie explained, many patients are absorbing a great deal of information after receiving a serious diagnosis. “These patients were probably just told that they had cancer. They have to have this very complicated surgery,” she said. “That’s a lot for patients to absorb in a short period of time.”