Reducing SSIs: 3 Key Interventions Every Nurse Should Know

A shift in evidence is driving new approaches to protect patients from surgical site infection (SSI) throughout their entire surgical experience. Much of this evidence stems from research on Enhanced Recovery After Surgery (ERAS) protocols, which play a critical role in reducing SSIs, says Cheryl Ernst, MSN, FNP-BC, RNFA. 

Collaborating with Lily Glucksman, FNP-C, Ernst responded to rising postoperative infection rates for certain surgeries at St. Peter’s Hospital in Albany, N.Y., by introducing new practices that challenged traditional methods.

“We needed to explore and adopt innovative evidence-based practices that allowed us to better care for our diverse patient population,” Ernst said. “One effective way to do this starts by acknowledging that the perioperative timeframe includes the time from initial diagnosis through to recovery.”

They initiated this conversation to drive teamwide practice changes in three key areas:

• Pre-habilitate to optimize the patient for surgery
• Follow team-driven intraoperative monitoring to better maintain patient metabolic status
• Establish postop surgery-specific nursing support calls to reduce infection and readmission

Nurse Collaboration Can Improve SSI Prevention

While introducing practice changes that broadened the span of perioperative care did lead to some “growing pains,” the team recognized – and helped others see – the power nurses have in every aspect of surgical care to reduce SSIs.

One critical factor in their success was combining Glucksman’s expertise in ERAS protocols with Ernst’s understanding of OR processes. This collaboration laid the groundwork for brainstorming and action, leading to the establishment of three essential interventions for SSI reduction and improved surgical outcomes across several service lines, including hepatobiliary, pancreatic, colorectal, thoracic, and general surgery.

Intervention #1: Tailor patient education to optimize preoperative health.

Based on the basic principles of ERAS to optimize patient health for any surgery, they developed a preoperative education program to help patients fully understand how to improve their health in the weeks leading up to surgery. The program includes nurse counseling on key aspects of preoperative health goals that research shows can improve surgical outcomes, including:

• Following a healthier diet that reduces sugar intake
• Curbing unhealthy habits such as smoking
• Developing doable fitness goals for before and after surgery

Every patient in the program meets with an advanced practice nurse in their specific surgery office to walk them through this preop counseling and review their surgery and their role in recovery.

Result: This preoperative support has helped patients reduce complications after surgery while building a rapport with the office staff who will guide their recovery.

Intervention #2: Make intraoperative patient monitoring a team effort. 

They implemented protocols to maintain patient body temperature, prevent hypoxemia, limit the chances of blood clot formation, and decrease pressure ulcers. Standardized glucose testing for metabolic monitoring during surgery was identified as an area of opportunity.

Through her doctoral project to earn her DNP, Ernst is investigating benefits of incorporating universal glucose monitoring for surgical patients to maintain perioperative glucose levels under the CDC-recommended 200 mg/dL, regardless of diabetes status. Hyperglycemia during surgery is a known risk factor for SSI.

Result: In her pilot study, several patients were diagnosed with new diabetes or prediabetes through preoperative HgbA1C screenings. More than 60% of non-diabetic patients required insulin treatment for perioperative hyperglycemia, leading to a proven reduction in surgical length of stay by over 1.5 days. “These conditions would have been identified too late, possibly after an SSI or complication, without this monitoring.”

Intervention #3: Structure postoperative RN support calls for every patient.

They first implemented this practice in 2022 in Ernst’s hepatobiliary, pancreatic, and general surgery office. It came in response to the volume of phone calls and ER visits that were made by patients with infection concerns that could have been addressed immediately after surgery. In 2023, Glucksman’s office handling colorectal surgery and the hospitals’ thoracic surgery line followed suit as part of their institution's quality metrics. 

Result: A significant reduction in readmissions, alongside improved patient satisfaction, as patients appreciated having the surgeon’s nurse available to support their recovery.

Read More About Enhanced Recovery After Surgery (ERAS)

• The Effect of Implementing a Standardized Enhanced Recovery After Surgery Pain Management Pathway at an Urban Medical Center in Hawaii - Doronio - AORN Journal

• Systematic Review and Meta-Analysis of Enhanced Recovery After Surgery Versus Conventional Care in Patients Undergoing Radical Prostatectomy - AORN Journal