Pennsylvania Hospital— Penn Medicine has achieved an impressive reduction in surgical site infections (SSIs) — over 31% within the complex spinal fusion operations, thanks to a multi-disciplinary team led by two nursing stalwarts, Kaitlin Ronning, DNP, RN, CPAN, and Margaret Vance, MSN, RN, CNOR, NPD-BC. Their effective initiative, titled ‘Bad Bugs: Reducing Neurosurgery Surgical Site Infections,’ showcased at the AORN Global Surgical Conference & Expo 2025, serves as a shining model for other institutions battling similar challenges in high-stake surgical fields.
In the fiscal year period from 2018 to 2020, Pennslyvania Hospital recognized an alarming trend in standardized infection ratios (SIRs) for complex spinal fusions, which exceeded national predictions. To combat this, an interdisciplinary SSI workgroup was instituted in May 2022. The group, comprising experts from distinct professional backgrounds such as surgery, advanced practice, nursing, infection prevention, quality improvement, and outpatient services, embarked on a mission to identify and execute evidence-based strategies to counteract this worrisome trend.
The workgroup championed several tactical changes, deeply rooted in the robust field data and best practices. One of the first changes brought to the forefront was the replacement of traditional liquid chlorhexidine gluconate (CHG) with CHG-impregnated cloths designed for pre-procedure bathing. This procedure later migrated to the preoperative area to spur compliance and its monitoring executed through a spanking new attribute in the electronic medical record system.
Simultaneously, they also rolled out a new nasal decolonization product, conducted audits of OR surgical site preparation techniques, and installed a standard wound closure system using antimicrobial sutures. Wound irrigation with sterile povidone-iodine was mandated before wound closure, helping to reduce the microbial load.
A notable shift was made in the implementation of a tool for root cause analyses specific to spinal SSI, fuelling an informed recalibration of their protocols. Education was prioritized, creating consistency in surgical prep practices by bridging nurses and medical staff.
The result of this multi-pronged, team-based approach was a measurable improvement of 31.74% reduction in SSIs for complex spinal fusions from FY 2023 to April 2024, not just building patient outcomes but also reducing potential complications and the linked expensive readmissions. The workgroup’s future projected activities include expanding the interventions with patient education initiatives and implementing technology-based monitoring systems.
The story of tremendous success against SSIs at Pennsylvania Hospital is indicative of the power of consistent surveillance, education, and the commitment of a strategic team undeterred by the blame-game, seeking practical, evidence-based solutions, and relentless in their pursuit of infection prevention.