JHQ 306: Surgical Site Infection Prevention Using ‘Strike Teams’: The Experience of an Academic Colorectal Surgical Department-JHQ 306 Article

JHQ 306 Article

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This article describes a quality-improvement initiative to reduce colorectal surgical site infections (SSIs) at a 515-bed academic medical center by using a multidisciplinary “Strike Team” to improve adherence to a complex SSI prevention bundle. Colorectal SSIs remain common and costly, and although prevention bundles can reduce infections, real-world implementation often suffers from inconsistent compliance across multiple pre-, intra-, and postoperative steps.<br /><br />The institution implemented an SSI prevention bundle in 2016 (e.g., smoking cessation support, diabetes/glucose control, mechanical bowel prep plus oral antibiotics, chlorhexidine bathing, warming, standardized chlorhexidine-alcohol skin prep, appropriate antibiotic prophylaxis, normothermia/normoglycemia maintenance, wound-protector and closure practices, and standardized dressing changes). Despite this, colon SSI standardized infection ratio (SIR) remained higher than expected, prompting formation of the Strike Team in late 2018.<br /><br />Beginning January 2019, the Strike Team—comprising colorectal surgery leaders, nursing, anesthesia, pharmacy, infection prevention, and infectious diseases, with strong executive leadership support—met monthly to review each SSI case, identify missed bundle elements, audit adherence trends, address barriers, and deliver actionable feedback directly to frontline clinicians. Performance dashboards and quarterly reporting reinforced accountability, while education and hands-on training addressed knowledge gaps. Key system changes included standardized EMR antibiotic order sets with redosing reminders and workflow changes to ensure consistent, nurse-trained application of chlorhexidine-alcohol skin preparation.<br /><br />During active Strike Team operations, adherence significantly improved for antibiotic prophylaxis, normoglycemia, and standardized intraoperative skin preparation, and closure-related practices increased to high levels. There was a trend toward reduced SSI rates (p=0.07). However, improvements were not sustained after Strike Team activities were paused in March 2020 due to COVID-19 resource redeployment.<br /><br />The authors conclude that preventing colorectal SSIs requires resource-intensive, sustained, multidisciplinary implementation support; Strike Teams may strengthen bundle adherence and improve outcomes, but durability depends on ongoing leadership backing and a strong safety culture.

Keywords

colorectal surgical site infections

SSI prevention bundle

quality improvement initiative

multidisciplinary Strike Team

bundle adherence compliance

academic medical center

antibiotic prophylaxis and redosing

chlorhexidine-alcohol skin preparation

electronic medical record order sets

standardized infection ratio (SIR)