Wound Ostomy Continence Nurse's Role in Reducing Surgical Site Infections

Importance: Colorectal surgery infection rates range from 15%-30%(Keenan, 2014). Preventive bundles are being implemented to reduce surgical site infection(SSI) rates. Colorectal SSI bundles can reduce infection rates by up to 33.3% with an associated cost savings to the healthcare system of up to $170 million per year(Wick, 2012).

Objective: To evaluate the impact of WOCN (Wound Ostomy Continence Nurse/WOC Nurse) developed patient education program as a component of colorectal surgery SSI prevention care bundle(SSI-PCB).  

Setting and Participants:  Between January 1, 2014 and June 30, 2015, 307 patients underwent colorectal surgery at an academic tertiary referral center and were included in both the SSI-PCB database and the National Surgical Quality Improvement Program(NSQIP).  

Design: WOCN education included: 1)patient focused instruction booklet developed for SSI-PCB by the WOCN; 2)face-to-face visit with the WOCN to discuss SSI-PCB components: mechanical bowel prep, chlorhexidine gluconate 4% solution bathing, and antibiotic prophylaxis.  This is a retrospective study of prospectively collected SSI-PCB compliance data and NSQIP outcome data. The performance of the WOCN education was analyzed to determine its relationship to the rate of postoperative SSI as captured by NSQIP. 

Results: The WOCN education occurred in 239 of the 307 patients(77.9%).  Compliance was statistically higher in patients for key preoperative bundle components: 89.7%(208/232) vs 62.7%(42/67) for mechanical bowel prep(p<0.001); 93.2%(218/234) vs 67.7%(44/65) for the CHG bathing(p<0.001); and 86.4%(203/235) vs 50.8%(34/67) for the antibiotic prophylaxis(p<0.001).  Those who did not receive education had an SSI rate of 10.3%(7/68) compared to 5.0%(12/239) who did receive education(p<0.001).

Conclusion: The impact of a WOC Nurse developed patient education role in SSI prevention is overlooked.  Our study validates the WOC Nurse role in developing and distributing patient education materials. Patient education prior to surgery leads to increased adherence to the SSI-PCB patient components and has a positive impact on SSI outcomes.