etween April 2022 and March 2023, U of U Health found itself in the 95th percentile for surgical site infection (SSI) rates following hysterectomy, according to Vizient rankings. This high standard infection ratio (SIR) meant our patients faced longer recovery times and increased healthcare utilization—outcomes we were determined to change. 

Driven by our commitment to patient care, we set an ambitious goal: to reduce our SIR from 2.3 in March 2023 to 0.9 by July 2024. To achieve this, we formed an interdisciplinary team, bringing together all stakeholders and care team members. Through a thorough root cause analysis, we identified the necessary interventions to lower our SSI rate and improve patient outcomes. 

Goal: Reduce our SIR from 2.3 in March 2023 to 0.9 by July 2024.

Improving Guideline Adherence with Standardized Interventions 

First, we focused on reducing bioburden before surgery. We implemented the following: 

• Patients completing a bath with chlorhexidine gluconate (CHG) or antibacterial soap the night before surgery. 
• Perioperative nurses using a CHG wipe on the day of surgery in the surgical area and for vaginal prep. 
• A standardized perioperative antibiotic selection, ensuring correct antibiotics were administered within 60mins prior to incision and re-dosed as indicated. 

Next, we addressed patient-specific factors that can lead to SSIs. These instructions included smoking cessation and avoiding shaving before surgery. We created patient instructions and encouraged our providers to counsel patients on these instructions eight weeks prior to surgery. 

We also screened at-risk populations for diabetes and ensured patients with diabetes had reasonable glucose control both before and after surgery. If a patient had an A1C above 8%, we delayed surgery (if possible) until the A1C fell below 8%. 

Finally, we worked to maintain normothermia before and during procedures. Our preoperative nurses  applied a BAIR hugger to patients to maintain normothermia in the pre-op area and ensured consistent use of the same BAIR hugger intraoperatively and post-operatively. 

Organizing and Assigning Interventions 

Once we identified all the interventions needed, we organized them into phases of care and identified key stakeholders. Our phases included: 

1. The outpatient team began counseling patients on surgical prep instructions and screening for diabetes. 
2. The perioperative and post-operative nursing team began using the CHG wipes, and BAIR huggers. 
3. Our anesthesia team helped ensure appropriate antibiotic administration and normothermia intra-operatively. 
4. Our surgical team standardized the surgical prep, including infection control measures. 

Our implementation of these phases began in October 2023. In the five months following, we recorded zero SSIs. Our SIR rate for April 2024 was 0.947, just shy of our 0.9 goal for July. Our team’s dedication to implementing these new procedures has been crucial to our success. As our adherence to these interventions has steadily increased, our infection rate has decreased. 

Next Steps 

Based on the successful improvement findings, our next steps are to: 

• Roll out these interventions to the Huntsman Cancer Institute. 
• Utilize Epic to improve adherence, including automating documentation and order sets. 
• Continuous  evaluation and root cause analysis as necessary to determine if reintervention is necessary. 
• Developed the Gynecology Quality Improvement Patient Safety Committee to monitor any concerning SSI trends in our department