Reducing Surgical Site Infections: A Multifaceted Approach

General Information

Institution Name: Stony Brook University Hospital

Author Name and Title: Lisa A. Wilbert, RN; AD Quality Measurement & Analytics

Name of Case Study: Reducing Surgical Site Infections: A Multifaceted Approach

Identification of Local Problem

Surgical Site Infections (SSI) are a significant cause of morbidity postoperatively, leading to prolonged hospital stays, readmissions, increased cost and even death in some cases. Stony Brook Medicine was noted to have a high SSI Rate in National Surgical Quality Improvement Program (NSQIP) data from 2019-2023.  Review of these cases revealed variation in compliance with evidence-based SSI prevention practices. As a result, a Performance Improvement (PI) team was reinvigorated and a multifaceted approach to reduce infections and improve patient outcomes institution-wide was designed and implemented to improve these results. 

Context of the QI Activity

Stony Brook Medicine is located on Long Island, New York. The organization includes a 628-bed university hospital and medical school and serves as the county’s only tertiary care center and Level I trauma center. Stony Brook Medicine operates a four-hospital network comprising Stony Brook University Hospital, Stony Brook Children's Hospital, Stony Brook Southampton Hospital, and Stony Brook Eastern Long Island Hospital. Stony Brook University Hospital has been participating in the ACS NSQIP Adult Surgery program since 2006. This SSI reduction initiative was undertaken in 2024 based on data from previous NSQIP Semi-Annual Reports. Stony Brook Medicine was committed to data-driven performance improvement with a focus on patient safety. NSQIP outcome reports multidisciplinary case reviews and healthcare epidemiology (HE) surveillance were used to identify opportunities for improvement. This project was built upon existing quality, surgical, nursing and HE infrastructure and engaged stakeholders across all surgical specialties to standardize evidence-based practices and reduce variation in care.

Interventions

A multifaceted Surgical Site Infection (SSI) reduction initiative was implemented, including expansion of the multidisciplinary SSI workgroup to include all surgical specialties, enhanced monitoring of SSI prevention bundle compliance, universal nasal decolonization, chlorhexidine-based skin decolonization, enhanced patient and staff education, standardized postoperative wound care practices, and implementation of Enhanced Recovery After Surgery (ERAS) protocols.

Implementation Strategy

Following identification of elevated SSI rates on our NSQIP Semi-Annual Reports, a reinvigorated performance improvement team expanded participation across surgical service lines and identified physician champions in each specialty. Monthly case reviews, real-time compliance monitoring through dashboards, ongoing feedback to surgical services, enhanced resident and fellow education, patient education initiatives, and standardized infection prevention workflows were implemented. Compliance data and outcomes were shared regularly with clinical teams and organizational leadership to drive accountability and continuous improvement. 

Costs and Funding Sources 

We received no additional funding. The project was primarily supported through existing institutional resources, including Quality Improvement and Quality Measurement & Analytics, Healthcare Epidemiology, Surgical Services, Nursing, and Physician leadership. There was a cost associated with the nasal decolonization kits and the chlorhexidine products. Interventions leveraged existing staff and educational platforms.

Overall Results and Analysis 

Process compliance measures demonstrated successful implementation of the SSI prevention bundle. Chlorhexidine gluconate (CHG) decolonization and standardized skin preparation achieved 100% compliance across all monitored cases in 2024. This was an improvement from 90% compliance in 2023 when monitoring began. Antibiotic prophylaxis compliance improved from 75% to 100% during the same period.

Substantial improvements were noted in SSI outcomes among all surgical patients, with noted improvement within the geriatric population. All cases SSI improved from a baseline of 4.13% to 2.28% in the Post intervention period which included all cases from calendar year 2024. This result was statistically significant with a p-value of 0.0013.

Among geriatric patients across all surgical specialties, the SSI odds ratio (O/R) improved from 1.12 in 2022 to 0.75 in the most recent reporting period, which included surgeries performed from July 2024 through June 2025.

 Among geriatric general surgery patients, the SSI O/R improved from 1.24 to 0.74 during the same period.

 These improvements were also statistically significant as well as being clinically meaningful. These reductions were associated with fewer post-operative complications, reduced readmissions, lower healthcare utilization and improved patient outcomes.

Appropriate antibiotic dosing and redosing as well as close monitoring of skin prep prior to surgery seemed to be key factors in our improved outcomes. Staff education was provided to reinforce the hospital’s commitment to preventing SSI by adhering strictly to these standardized protocols. These results suggest that coordinated multidisciplinary interventions and standardized prevention practices can significantly reduce SSI rates across surgical populations.  

Limitations

This project was conducted at a single academic medical center, which may limit generalizability. Multiple interventions were implemented simultaneously, making it difficult to isolate the impact of individual components. Ongoing surveillance is necessary to determine long-term sustainability of observed improvements. 

Lessons Learned 

Involving all Surgical Specialties facilitated standardizing processes for all surgical patients, this included identifying Physician Champions in each specialty area.

Continued review of data and outcomes is important to maintain the gain.

Notifying physicians of the occurrence of an SSI that met criteria for NSQIP led to educational opportunities. Increased education for both the clinical team and patients added to the success.

The NSQIP Surgeon Champion and the Physician lead for SSI were directly involved with all drill down and education and their commitment and leadership led to the successful implementation of new practices and improved patient care and outcomes.