Bad Bugs No More: Pennsylvania Hospital Team Slashes Neurosurgery SSI Rates Through Interdisciplinary Innovation

Kaitlin Ronning, DNP, RN, CPAN, and Margaret Vance, MSN, RN, CNOR, NPD- BC, at AORN Global Conference & Expo

Surgical site infections (SSIs) remain one of the most persistent and costly challenges in health care, particularly in complex procedures like spinal fusions. At Pennsylvania Hospital—Penn Medicine, 2 nurse leaders, Kaitlin Ronning, DNP, RN, CPAN, and Margaret Vance, MSN, RN, CNOR, NPD-BC, spearheaded a multidisciplinary initiative to reduce neurosurgery-associated SSIs. Their work, titled “Bad Bugs: Reducing Neurosurgery Surgical Site Infections,” was presented at the AORN Global Surgical Conference & Expo held April 5 through 9, 2025, in Boston, Massachusetts.

From fiscal years (FY) 2018 through 2020, the hospital recorded standardized infection ratios (SIRs) for complex spinal fusions that were statistically higher than national predictions. This prompted the formation of an interprofessional SSI workgroup in May 2022 (FY 21), involving experts from surgery, advanced practice, nursing, infection prevention, quality improvement, and outpatient services. Their shared goal was to identify and implement evidence-based strategies to reverse the troubling trend.

The team initiated a series of tactical interventions grounded in both data and best practice. Among the first changes was replacing traditional liquid chlorhexidine gluconate (CHG) with CHG-impregnated cloths for pre-procedure bathing. To improve compliance, CHG bathing responsibilities were shifted to the preoperative area rather than relying on inpatient units. This change was tracked by a new field added to the electronic medical record system.

The workgroup also introduced a new nasal decolonization product, audited OR surgical site preparation techniques, and standardized wound closure using antimicrobial sutures for both fascial and skin layers. Before wound closure, surgical sites were irrigated with sterile povidone-iodine to reduce microbial load.

Crucially, implementing a spine SSI root cause analysis tool helped the team evaluate incidents with a structured lens, allowing for better-informed adjustments to protocols. Collaborative education for nursing and medical staff was also prioritized, reinforcing consistency in surgical prep practices across the care team.

The results speak volumes. From FY 2023 to April 2024, Pennsylvania Hospital achieved a 31.74% reduction in SSIs for complex spinal fusions, decreasing from a rate of 2.33 to 1.67. This measurable improvement not only enhances patient outcomes but also lowers the potential for costly complications and readmissions.

“Reduction of SSIs requires a team-based approach. An increase in infections is rarely related to one cause, and interventions should be multimodal,” the authors wrote in the notes. “Engagement from all stakeholders and maintaining a blame-free mentality created a successful space to improve practice.”

The project underscores the power of sustained surveillance and education. The team believes that continued engagement and compliance monitoring will help ensure that infection prevention efforts remain effective.

Looking ahead, the neurosurgical SSI workgroup plans to explore additional interventions, including patient-facing education initiatives and technology-based monitoring systems. Their success serves as a model for other institutions grappling with similar challenges in high-risk surgical specialties.