D226 Assessment Task 1: Enhancing Sterilization Protocols to Reduce SSIs

D226 Assessment Task 1: Enhancing Sterilization Protocols to Reduce SSIs

Student Name

Western Governors University 

D226 BSNU Capstone

Prof. Name

Date

What Are Surgical Site Infections (SSIs) and Why Are They Significant in Healthcare?

Surgical site infections (SSIs) are complications that arise after a surgical procedure at or near the operative incision. These infections may be superficial, affecting only the skin, or more severe, extending into underlying tissues, organs, or implanted devices. SSIs represent a substantial concern within healthcare systems because they are associated with increased patient morbidity, extended lengths of hospital stay, elevated treatment costs, and preventable mortality. The Centers for Disease Control and Prevention (CDC) estimate that SSIs constitute approximately 20% of all healthcare-associated infections among hospitalized patients, underscoring their clinical and financial impact (Centers for Disease Control and Prevention [CDC], 2023).

The significance of SSIs extends beyond individual patient outcomes. Their prevention is closely tied to quality improvement initiatives, patient safety benchmarks, and value-based reimbursement models. Reducing SSIs contributes to improved recovery times, lower readmission rates, and enhanced organizational performance, making infection prevention a core priority in modern healthcare delivery.

BSNU Capstone Course Task One: Healthcare Change Proposal

This paper fulfills the requirements for Task One of the BSNU Capstone Course and presents a structured healthcare change proposal. The primary objective is to identify and engage an organizational sponsor who can evaluate, endorse, and authorize the proposed initiative. In addition, the proposal integrates sponsor feedback, empirical evidence, and a rationale demonstrating how the recommended change supports value-based care outcomes.

The paper further delineates key stakeholders, outlines a phased implementation strategy, and concludes with a reflective analysis of the author’s role as a nurse leader and change agent. Collectively, these elements establish a comprehensive framework for driving sustainable clinical improvement within an emergency care environment.

Organizational Context

The proposed change initiative is situated at Mike O’Callaghan Military Medical Center (MOMMC), a military treatment facility (MTF) operated under the Defense Health Agency (DHA) and the Department of Defense (DoD). Located on Nellis Air Force Base in Las Vegas, Nevada, MOMMC delivers emergency, trauma, and specialty care services to active-duty service members, their dependents, and other eligible DoD beneficiaries.

The author is employed at MOMMC as a civilian contractor and registered nurse in the Emergency Department (ED). The ED comprises 20 treatment beds and two trauma bays and is staffed by a multidisciplinary workforce that includes military personnel, civilian employees, and contracted staff. As a Level III trauma center, MOMMC manages both military and civilian trauma cases. Although staffing levels are generally stable, periodic challenges occur during military deployment cycles. Approximately 40% of ED staff are civilians or contractors, which helps maintain continuity of care during personnel rotations.

Change Proposal Description

Current Process

Under the existing workflow, patients arriving at the emergency department are first directed to a front registration desk staffed by two registration technicians. These staff members complete comprehensive patient registration prior to clinical triage or evaluation. While administratively efficient, this process can inadvertently delay care for patients presenting with time-sensitive conditions, such as chest pain or symptoms suggestive of acute coronary syndromes.

Proposed Change

The proposed intervention restructures front-end ED operations by relocating registration technicians to a back-office area where they will focus on clerical and administrative tasks. The front desk will instead be staffed by one medical technician and one registered nurse. This clinically trained team will perform rapid symptom assessment and initiate abbreviated registration at the point of entry.

This model prioritizes immediate clinical assessment, enabling early identification of patients with ST-segment elevation myocardial infarction (STEMI) or other emergent cardiac conditions. By integrating triage into the initial patient encounter, the ED can expedite diagnostic testing and life-saving interventions.

Purpose of the Change

The central aim of this proposal is to reduce door-to-electrocardiogram (EKG) times for patients presenting with cardiac symptoms. National guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC) recommend that a 12-lead EKG be obtained within 10 minutes of ED arrival for patients with suspected myocardial infarction (Dechamps et al., 2016). Current data at MOMMC indicate compliance with this standard in only 40%–60% of eligible cases.

Positioning clinically trained staff at the front desk is expected to improve early recognition of cardiac emergencies, accelerate diagnostic processes, and align departmental performance with evidence-based cardiac care standards.

Impact of the Proposed Change

Aspect	Current State	Proposed State	Expected Outcome
Front Desk Staffing	Two registration technicians	One medical technician and one RN	Faster symptom recognition and EKG initiation
Door-to-EKG Compliance	40%–60% within 10 minutes	100% compliance	Improved outcomes and guideline adherence
Patient Flow	Delays during full registration	Streamlined triage-first approach	Reduced wait times and higher satisfaction
Role Optimization	Registration-focused	Administrative support in back office	Improved utilization of staff competencies

This redesign aligns clinical expertise with frontline patient needs, enhancing both operational efficiency and patient safety in emergency cardiac care.

Feedback From Organizational Sponsor

Brian Hubbard, RN, BSN, MPA, was selected as the organizational sponsor based on his extensive experience in intensive care, cardiac catheterization, and nursing leadership roles at MOMMC. He provided constructive feedback emphasizing the importance of outcome measurement, staff engagement, and adaptive leadership strategies.

Mr. Hubbard endorsed the proposed staffing redesign and recommended implementing a 60- to 90-day pilot phase prior to full-scale adoption. He acknowledged that nurses and medics may be required to work one to two additional shifts per month during the trial period, which could generate modest resistance. To mitigate this risk, he emphasized transparent communication, shared decision-making, and consistent reinforcement of the initiative’s impact on patient safety and survival.

Potential Barriers and Mitigation Strategies

Barrier	Description	Mitigation Strategy
Staff Resistance	Increased workload during pilot phase	Engage staff early, solicit feedback, emphasize patient safety benefits
Administrative Hesitancy	Concerns about staffing model changes	Present evidence-based outcomes and national guideline alignment
Skill Gaps	Limited experience with rapid registration	Provide targeted education, simulation, and mentorship

Addressing these barriers requires proactive leadership, staff empowerment, and a clear articulation of long-term benefits for both patients and clinicians.

Value-Based Care Enhancement

The proposed initiative directly supports value-based care principles by improving efficiency, safety, and patient-centered outcomes without increasing operational costs. Anticipated benefits include reduced door-to-EKG times, earlier detection of life-threatening conditions, stronger interdisciplinary collaboration, improved patient throughput, and higher satisfaction scores. By optimizing workflow and staff deployment, MOMMC can deliver higher-quality care while maintaining fiscal responsibility.

Key Stakeholders and Collaboration

Stakeholder	Role in Implementation
Staff Nurses and Medics	Conduct rapid triage and EKG acquisition
Registration Technicians	Manage administrative tasks in back office
ED Nurse Manager	Oversee staffing and workflow
ED Medical Director	Provide clinical oversight
Registration Director	Ensure registration process alignment
Chief Nurse	Support policy and resource allocation
Hospital Commander	Authorize organizational support
Staffing Chief	Approve staffing adjustments

Monthly meetings will be conducted to review data from the Genesis electronic health record (EHR), focusing on door-to-EKG times, patient length of stay, and satisfaction metrics.

Resources and Cost Considerations

This change initiative relies primarily on existing internal resources and does not require additional financial investment. Because military personnel compensation is not hourly-based, temporary workload redistribution does not affect payroll expenditures. Resource utilization will focus on staff training, performance monitoring, and engagement activities, all of which can be accommodated within current operational structures.

Implementation Plan

Phase	Description
Planning	Engage stakeholders, define pilot scope, finalize logistics
Milestones	Monitor weekly and monthly performance metrics
Implementation	Train staff and launch rapid registration pilot
Evaluation	Conduct 90-day review and determine sustainability

Ongoing evaluation will be supported through data-driven analysis to ensure sustained improvement and inform long-term policy decisions.

Expected Outcomes

Outcome	Description
100% Guideline Compliance	EKG obtained within 10 minutes for all eligible patients
Improved Clinical Outcomes	Faster intervention reduces cardiac complications
Higher Patient Satisfaction	Decreased wait times enhance patient experience
Financial Efficiency	Improved throughput supports service utilization
Regulatory Compliance	Continued alignment with AHA and DoD standards

These outcomes reinforce ethical nursing principles, including nonmaleficence and fidelity, by ensuring timely, safe, and effective care.

Use of Technology

The Genesis EHR system will serve as the primary platform for monitoring performance outcomes. This system enables real-time tracking of patient flow, triage efficiency, and EKG completion times. Leadership dashboards can be leveraged to promote transparency, accountability, and continuous quality improvement.

Measuring Success

Success will be evaluated using both quantitative and qualitative indicators, including sustained improvement in performance metrics, positive patient satisfaction survey results, enhanced staff morale, and consistent adoption of revised workflows. Continuous communication and recognition of achievements will support long-term sustainability.

Reflection on the Change Agent Role

Drawing on more than two decades of emergency nursing experience, the author has witnessed systemic inefficiencies that delay critical patient care. Through evidence-based practice, leadership engagement, and interdisciplinary collaboration, the author embraces the role of a change agent committed to improving emergency care outcomes. Advocacy, education, and data-informed decision-making serve as foundational strategies for fostering a culture of continuous quality improvement.

Potential for Broader Application

If successful, this rapid triage and registration model can be scaled across other military treatment facilities nationwide. Broader implementation within the DoD healthcare system has the potential to improve emergency response times, reduce cardiac-related morbidity and mortality, and enhance operational readiness for both military and civilian populations.

References

Butt, T. S., Bashtawi, E., Bououn, B., Wagley, B., Albarrak, B., Sergani, H. E., Mujtaba, S. I., & Buraiki, J. (2020). Door-to-balloon time in the treatment of ST segment elevation myocardial infarction in a tertiary care center in Saudi Arabia. Annals of Saudi Medicine, 40(4), 281–289. https://doi.org/10.5144/0256-4947.2020.281

Centers for Disease Control and Prevention. (2023). Healthcare-associated infections: Surgical site infections (SSI). https://www.cdc.gov/hai/ssi/

D226 Assessment Task 1: Enhancing Sterilization Protocols to Reduce SSIs

Dechamps, M., Castanares-Zapatero, D., Berghe, P. V., Meert, P., & Manara, A. (2016). Comparison of clinical-based and ECG-based triage of acute chest pain in the emergency department. Internal and Emergency Medicine, 12(8), 1245–1251. https://doi.org/10.1007/s11739-016-1558-8

Hunsaker, B. (2024, November 10). Personal communication.