Nursing Advocacy and Evidence-Based Practice Cut SSI Rates in Colon and Hysterectomy Surgeries

At AORN 2025, nurses shared how strengthened advocacy and updated evidence-based protocols significantly reduced surgical site infections in colon and hysterectomy cases. By reinforcing antimicrobial stewardship, interdisciplinary communication, and colorectal prevention bundles, systemic inflammatory response syndrome (SIRS) declined significantly, underscoring the measurable impact of perioperative nursing leadership on patient safety.

When surgical site infections began rising due to anastomotic leaks and incidental colon lacerations, perioperative nurses took action. Claudia Chanes, MSN-Ed, RN, CNOR, who spoke with ICT; and Zebina Sonia Roger, BSN, BS, RN, MT(ASCP), CIC, FAPIC, GB, shared that strengthened nursing advocacy and updated evidence-based practices led to significant reductions in infection rates among patients undergoing colon and abdominal hysterectomy. At the Association of periOperative Registered Nurses (AORN) Global Surgical Conference & Expo 2025, held in Boston, Massachusetts, April 5 to 8, they presented a poster titled “Advocacy Reduces Infection Related to Anastomotic Leaks and Incidental Lacerations.”

This poster presents a quality improvement project focused on reducing surgical site infections (SSIs) in patients undergoing colon and abdominal hysterectomy surgeries by strengthening nursing advocacy and implementing the latest evidence-based practices (EBP). The project was driven by an observed increase in SSIs related to anastomotic leaks and incidental colon lacerations. The goal was to evaluate how adopting updated EBP guidelines and improving interdisciplinary communication could positively impact patient outcomes.

“As nurses, one of our roles is to advocate,” Chanes told ICT. “So, this is what we did with that project. The most important thing is recommendations that adjust antimicrobials and antibiotics, and, if the patient has [a surgical site infection (SSI)], any complication that requires continuous antimicrobial therapy, per the infection control document. The other thing that we encourage is a big project. It's a multidisciplinary team to prevent SSI malfunction.”

The initiative involved collaboration among infection prevention leaders, surgical educators, gynecologists, and colorectal and general surgeons. Education sessions were provided to the surgical services team, and current evidence-based practice (EBP) literature addressing SSI prevention in colorectal and abdominal procedures was shared.

Key recommendations included strict adherence to colorectal prevention bundles, reinforcement of anastomotic integrity, use of fluorescence angiography to assess tissue perfusion, application of surgical sealants, and consistent use of enhanced recovery after surgery (ERAS) protocols. For hysterectomy cases, recommendations emphasized antimicrobial stewardship with infectious disease consultation, multidisciplinary perioperative planning, awareness of prior surgical complications, and vigilant intraoperative communication.

Approximately 400 colorectal and 250 hysterectomy cases were included in the evaluation. Outcome data were collected using National Healthcare Safety Network (NHSN) criteria. The standardized infection ratio (SIR) showed improvement following implementation of these strategies. In FY22, colon surgeries had an SIR of 0.850, and abdominal hysterectomies had an SIR of 1.800. By FY23, the SIR decreased to 0.335 for colon surgeries and 1.110 for hysterectomies, representing substantial reductions.

The project highlights the critical role of nursing advocacy in ensuring adherence to evidence-based protocols, strengthening communication among perioperative staff, and promoting ongoing surveillance of SSI data. Preventing postoperative infections requires sustained commitment to guideline compliance, continuous education, and structured monitoring. While the study did not measure the exact number of surgeries that followed each EBP intervention, the observed improvement in infection rates suggests that coordinated practice change can meaningfully enhance patient safety and surgical outcomes.