AORN26: Multidisciplinary Culture Change Cuts Colon SSI Rates by Over 27%

Reducing surgical site infections (SSIs), particularly in colorectal procedures, remains one of the most challenging and high-impact priorities in perioperative care. At the 2026 (Association of periOperative Registered Nurses) AORN Global Surgical Conference & Expo (AORN26), a team from Advocate Christ Medical Center presented a compelling example of how a coordinated, multidisciplinary approach combined with culture change can lead to meaningful improvements in patient outcomes.

The poster, “SSI Colon Reduction Through a Multidisciplinary Approach and Culture Change Strategy” led by Parisa McDonough, RN, BSN, CNOR, alongside colleagues Cassandra Ciavarella, MSN, RN; Christine A. Westphal, MSN, RN, CNL, CV-BC; and Tracy Haberkorn, RN, BSN, MSN, CNOR, outlined a structured initiative to reduce colon SSIs through evidence-based practices and system-wide alignment.

Identifying the Gaps

In 2023, the organization reported a standardized infection ratio (SIR) of 1.884 for colon procedures, signaling a need for targeted intervention. Although an evidence-based colon bundle was already in place, a detailed review of cases from 2022 through 2023 revealed inconsistent compliance with key elements.

These gaps included documentation of present at time of surgery (PATOS), glycemic control, normothermia, antibiotic prophylaxis, intraoperative practices, and preoperative preparation.

The findings highlighted a familiar challenge for infection prevention professionals: implementing evidence-based protocols is only the first step. Ensuring consistent adherence across teams and workflows is where the real work begins.

Read Infection Control Today for more AORN26 coverage.

Breaking Down Silos

To address these issues, the organization formed an interdisciplinary committee comprising stakeholders from surgery quality, infection prevention, anesthesia, pharmacy, environmental services, leadership, and presurgical optimization clinics.

This structure was critical in identifying not only clinical gaps but also cultural and communication barriers that contributed to variability in practice. The team recognized that improving outcomes would require more than reinforcing protocols. It would require a shift in mindset. Departmental silos, workflow biases, and inconsistent communication needed to be addressed alongside clinical interventions.

Implementing a Standardized, System-Level Approach

In 2024, the team implemented a revised colon bundle at the system level, incorporating enhanced evidence-based practices and standardization across perioperative phases. One of the most notable interventions was a fascial closure initiative. This included changes in instrumentation and required a full reset of the sterile field following colon anastomosis. Gowns, gloves, and instruments were replaced, and all staplers and tools used during colon repair were removed from the field. Surgical nurses were responsible for documenting compliance.

Additional components of the bundle included strengthened protocols for glycemic control, normothermia, antibiotic prophylaxis, and mandatory visits to a pre-optimization clinic to improve patient readiness and recovery.

To ensure accountability, the team conducted more in-depth SSI reviews to confirm that bundle elements were followed consistently across all phases of care. Identified gaps were addressed through targeted education for clinicians, including focused training on PATOS documentation for surgeons.

Expanding Beyond the Operating Room

Recognizing that infection risk does not end at the operating room door, the initiative expanded in 2025 to include partnerships with inpatient nursing units and care management teams. This expansion allowed the team to address perioperative care more holistically, including post-discharge considerations in home and subacute rehabilitation settings.

For infection preventionists, this approach reinforces the importance of continuity across the care continuum. Effective SSI prevention requires coordination not only within the operating room (OR) but also across transitions of care.

Measurable Improvement

The results of the initiative demonstrate the impact of this comprehensive approach. Following implementation, the colon SIR decreased from 1.884 in 2023 to 1.718 in 2024, representing an 8.81% improvement. More notably, year-to-date data for 2025 show a further reduction to 1.374, reflecting a 20.02% improvement from 2024 and an overall 27.07% reduction compared with the baseline.

These outcomes highlight the effectiveness of combining evidence-based interventions with structured collaboration and culture change.

Implications for Infection Prevention and Perioperative Teams

The key takeaway from this initiative is that SSI reduction requires a global, integrated approach.

For perioperative nurses and infection prevention professionals, the findings underscore the need to move beyond isolated interventions and toward system-wide alignment.

Standardized bundles must be supported by consistent education, real-time feedback, and interdisciplinary communication. Just as importantly, organizations must address the cultural factors that influence adherence to best practices.

Looking Ahead

The team plans to build on this success by incorporating artificial intelligence tools and educational video resources for both clinicians and patients. These innovations aim to further strengthen compliance, improve understanding, and sustain long-term improvements. The initiative also offers a scalable model that can be applied to other surgical specialties and institutions.

As health systems continue to prioritize quality and patient safety, this work presented at AORN26 demonstrates that meaningful SSI reduction is achievable when clinical excellence is paired with collaboration, accountability, and a shared commitment to change.