Certification: A New Way to Fight SSI?

Publish Date: February 22, 2017

Surgical site infection (SSI) is the most common health-care acquired infection, putting the health and safety of an estimated 160,000–300,000 patients in the United States at risk annually. Tracing the root causes and risk factors of SSIs has been a dedicated research area for governmental agencies, professional associations, health care facilities and perioperative teams. The result of this work has been evidence-based practice recommendations, infection prevention bundles, and other work to protect patients.

However, there has been one potential factor that has received little attention but could be a game-changer in the battle against SSI—nurse education and certification.

Could a nurse with advanced education and certification do a better job of protecting patients from SSI than nurses without this knowledge base?

This is one question a team of investigators has been working to answer in their nationwide, multi-site study to explore the correlation between nursing demographic factors, hospital characteristics, and SSIs. These investigators include Diane Boyle, PhD, RN, FAAN, Wyoming Excellence chair in nursing and professor at the Fay W. Whitney School of Nursing at the University of Wyoming, Sandra Bergquist-Beringer, PhD, RN, CWCN, professor at the University of Kansas School of Nursing, Emily Cramer, PhD, research assistant professor at the University of Kansas School of Nursing, and James Stobinski, PhD, RN, CNOR, CSSM, director of credentialing and education at The Competency and Credentialing Institute (CCI).

“There is one key difference between a certified nurse, such as a CNOR and a non-certified nurse,” Stobinski explains. “A CNOR has passed a rigorous knowledge-based test based in part on core resources such as AORN’s Guidelines for Perioperative Practice and a CNOR enters into an organized method of ongoing professional development and lifelong learning that far exceeds what is required by the employer or by the state board of nursing.” He says being certified alters a nurse’s practice and behavior to include a greater degree of confidence.

“These positive changes in behavior may be difficult to quantify and correlate to patient outcomes like SSI but it is worthy subject of ongoing research,” he says.

Correlating Education and SSI Risk Reduction

To explore this research topic, Stobinski has brought his extensive knowledge of perioperative nursing care and his work with CCI to collaborate with Boyle, Bergquist-Beringer, and Cramer who are experts in nursing data and the National Database of Nursing Quality Indicators (NDNQI) data bank. The project is one of the first to combine data from the NDNQI with data from the Centers for Disease Control and Prevention’s (CDC’s) National Health Safety Network (NHSN) database, which collects data on SSI.

“There are so many complex variables that can influence what leads to SSI and we are curious how these variables might be working within a health system or facility,” Boyle notes. She explains that a range of variables examined in this study address both facility-level factors such as if the hospital has earned Magnet status, and unit-level variables such as average staff nurse tenure and if nurses on the unit have a BSN or higher. Boyle and the team are also exploring patient variables, such ASA (as American Society of Anesthesiologists) score, wound contamination classification, and procedure time.

For this study, Boyle says the focus is on SSI rates with colon surgical procedures and abdominal hysterectomies because these surgeries have the longest history for reported SSI rates.

Considering Nursing Scope of Practice

The study team members all feel this study can elicit important findings about the critical role nursing plays in surgical patient outcomes and how hospital culture can be a factor in encouraging or prohibiting a nurse’s role. Stobinski has previously written about the link between hospital culture and nursing scope of practice in a 2015 AORN Journal editorial exploring work by Jack Needleman on the role of invisible architecture and the many factors that can come together to either restrict or advance nurses in attaining certification and the knowledge gained through the certification process.

“All of these factors have not yet been studied effectively and we hope our study can contribute to this better understanding of the complex interplay of variables to include nursing certification status,” Stobinski says. “We are just beginning to realize the complexity of all the factors that come into play to influence SSI rates.”

The research team is finalizing the data analysis for this current study and Stobinski and Boyle plan to share the initial findings at AORN’s Global Surgical Conference & Expo this April in Boston. They agree that this study and this area of research present great opportunities for perioperative nurse researchers, particularly as data collection work at the national, regional and local level continues to advance.


Plan to attend Boyle and Stobinski’s presentation “The Relationship Between Nursing Specialty Certification and SSI Rates in Acute Care Hospitals” on April 1 and listen to recordings of the session on April 1 and 4 in the Education Hub at AORN’s annual conference


Check now to see when the spring 2017 Nurse Executive Leadership SSI workshop will be coming to a city near you.

Read Stobinski’s editorial “Nursing’s Invisible Architecture: Individual Responsibility for Professional Development” in the October 2015 issue of AORN Journal.