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2026 articles

Upstream Prevention in Ambulatory Surgery Centers: How Preoperative Collaboration Reduces Surgical Site Infection Risk

By David Taylor, MSN, RN, CNOR

Abstract

Ambulatory surgery centers (ASC) deliver high-quality surgical care in efficient resource-conscious environments. While surgical site infection (SSI) rates in ASC’s are generally lower than in acute care settings, even a single infection can significantly impact patient outcomes, surgeon confidence, regulatory scrutiny, and organizational reputation. In the ASC setting many determinants of SSI risk occur outside the facility itself, particularly within surgeon offices and preoperative preparation processes. This article examines how intentional collaboration among surgeon offices, preoperative screening processes, and ASC perioperative teams strengthens infection prevention and reduces SSI risk. By shifting focus upstream ASCs can enhance reliability consistency and patient safety.

Introduction

Ambulatory surgery centers are designed for efficiency, throughput, and predictable care delivery. Patients typically arrive on the day of surgery with minimal on-site preoperative evaluation, limited opportunity for intervention, and high expectations for readiness. As a result, many of the conditions that influence surgical site infections, such as patient optimization, skin preparation, and education are established well before the patient enters the ASC.

Unlike hospitals, most ASC’s do not operate formal pre-admission testing (PAT) departments. Instead, they rely heavily on surgeon offices and external providers to assess, prepare, and educate patients. This dependency makes preoperative collaboration not just beneficial, but essential. Without alignment, variability increases, and infection risk follows.

Surgeon Offices as the Foundation of SSI Prevention in ASCs

In the ASC environment, the surgeon’s office functions as the primary gateway for SSI prevention. Preoperative instructions, medical clearance, and risk factor identification often originate in the office setting. However, differences in office workflows, staffing models, and documentation can lead to inconsistent preparation across surgeons and specialties.

High-performing ASCs partner closely with surgeon offices to establish clear, standardized expectations for infection prevention. These may include uniform instructions for preoperative bathing, antimicrobial skin preparation when indicated, smoking cessation guidance, and management of modifiable risks such as poorly controlled diabetes or active skin conditions.

When surgeon offices are aligned with ASC policies and evidence-based practices patients receive consistent messaging and arrive better prepared. Early identification of infection risk allows time for intervention or rescheduling, rather than last minute decision making on the day of surgery.

Preoperative Screening Without Traditional PAT Infrastructure

Most ASCs operate without the extensive PAT resources found in hospitals. Nevertheless, preoperative screening remains a critical control point for SSI prevention. Many ASC’s utilize nurse-led preoperative phone calls, electronic health questionnaires, or surgeon provided documentation to assess readiness.

Collaboration between ASC perioperative leaders, anesthesia providers, and surgeon offices is essential to ensure screening processes are meaningful and standardized. Clear criteria for escalation, such as abnormal glucose levels, recent infections, open wounds, or incomplete preparation, help teams make informed decisions before the patient arrives.

Effective preoperative screening reduces same day cancellations, delays, and work arounds that can compromise infection prevention practices. It also reinforces a culture of safety and preparedness that is vital to high-throughput ASC environments.

Standardizing Patient Preparation Across Continuum

Patient preparation and is one of the most influential and variable elements of SSI prevention in ASCs. Patients may receive instructions verbally, electronically, or in printed form, often from multiple sources. Without coordination, messages can conflict or lack clarity.

Ambulatory surgery centers that prioritize collaboration work to standardize patient education across surgeon offices and ASC staff. This includes consistent language regarding bathing, hair removal, wound care expectations, and postoperative infection signs. Providing clear concise and repeated instructions improves patient compliance and reduces preventable risk.

Because ASCs often serve healthy, mobile patients who return home quickly, patient understanding becomes even more critical. Effective preparation empowers patients to be active participates in infection prevention.

Communication and Documentation in a Fast-Paced Environment

Efficient communication is essential in ASCs, where schedules are tight and margins for error are small. Fragmented documentation between surgeon offices and ASC’s increases the likelihood of missed information related to infection risk.

Successful ASC established streamlined communication pathways, such as standardized preoperative forms, shared checklists, or electronic documentation requirements. Regular review of near-miss events and post operative infections, even rare ones, provides valuable insights into system vulnerabilities and opportunities for improvement.

Leadership’s Role in Driving Preoperative Alignment

Leadership engagement is a defining factor in successful ASC collaboration. Perioperative and executive leaders must set clear expectations that SSI prevention begins well before the day of surgery. This includes holding surgeon offices accountable for meeting preparation standards while providing the tools and support needed for success.

Leadership support for education, standardized materials, and interdisciplinary collaboration reinforces the importance of upstream prevention. In ASC’s where physician engagement is particularly influential, strong relationships and shared goals are essential.

Conclusion

In ASCs, SSI prevention is shaped long before the patient arrives at the facility. Surgeon offices, preoperative screening processes, and patient preparation practices form the foundation of safe surgical care.

By strengthening collaboration across this continuum, ACS can reduce variability, improve reliability, and protect patients from preventable harm. Upstream prevention is not an added burden in the ASC setting, it is a strategic necessity that supports quality outcomes, operational efficiency, and sustained success.

David Taylor, MSN, RN, CNOR, is executive healthcare consultant and principal of Resolute Advisory Group, LLC He is a dynamic, highly respected healthcare executive with extensive enterprise-level leadership experience and a proven record of driving innovation, operational excellence, and measurable improvements in patient care, safety, and system-wide efficiency. Skilled in aligning clinical and operational strategy, leveraging technology and data-driven insights, and building high-performing teams to advance quality, revenue, productivity, and cost containment. Recognized thought leader and national speaker committed to advancing best practices and delivering innovative, patient-centered care through collaboration, education, and strategic vision.

Beyond the Operation Room: How Preoperative Collaboration Reduces Surgical Site Infection Risk

By David Taylor, MSN, RN, CNOR

This article originally appeared in the May-June 2026 issue of Healthcare Hygiene magazine.

Abstract

Surgical site infections (SSI) are often examined through the lens of intraoperative technique and postoperative care; However, a significant portion of infection risk is established well before the patient enters the operating room. Variability in surgeon office practices, pre-admission testing processes, and preoperative patient preparation contributes to inconsistent adherence to evidence-based prevention risk. By aligning processes, improving communication, and standardizing expectations, healthcare organizations can shift SSI prevention upstream and achieve more reliable outcomes.

Introduction

Surgical site infection prevention has traditionally focused on the intraoperative environment, which sterile technique, antibiotic prophylaxis, and environmental controls are most visible. While these factors remain critical, growing evidence suggests that many SSI’s are influenced by conditions and behaviors established days or weeks prior to surgery. Glycemic control, skin integrity, nutritional status, smoking cessation, and patient understanding of preoperative instructions all originate outside the operating room (OR).

Fragmentation across the preoperative continuum particularly between surgeon offices, preadmission testing a (PAT), and perioperative services, creates gaps that increase infection risk. Effective SSI reduction requires a coordinated approach that extends beyond the hospital walls and engages all stakeholders involved in preparing the patient for surgery.

The Surgeon Office as the First Point of SSI Prevention

For many patients, the surgeon’s office is the first and most influential point of contact in the surgical journey. Preoperative education, risk assessment, and expectation-setting frequently begin in this setting. However, variability in office workflows, staffing models, and resources can lead to inconsistent implementation of infection prevention (IP) practices.

When surgeon offices are fully integrated into organizational SSI prevention strategies, become powerful allies. Standardized protocols for preoperative skin preparation, antimicrobial bathing instructions, nasal decolonization when indicated, and management of modifiable risk factors such as smoking and uncontrolled diabetes can significantly reduce infection risk. Alignment between perioperative leaders and surgeon practices ensures that evidence-based expectations are communicated early and reinforced consistently.

Clear communication pathways also allow surgeon offices to escalate concerns, such as unresolved infections, skin breakdown, or non-adherence to preoperative instructions, before the patient arrives for surgery.

Pre-Admission Testing as a Critical Risk Identification Point

Preadmission testing serves as a pivotal checkpoint for identifying and mitigating SSI risk. Preadmission teams are uniquely positioned to assess comorbidities, review medications, evaluate laboratory results, and verify readiness for surgery. Effectively structured PAT processes enable early intervention for patients at elevated risk.

Robust collaboration between PAT, IP, anesthesia, and surgical services allows for standardized screening and escalation protocols. For example, Abnormal glucose levels, positive colonization screens, or incomplete preoperative preparation can be addressed proactively rather than discovered on the day of surgery (DOS).

Organizations with strong PAT integration often demonstrate improved compliance with antibiotic timing, normothermia planning and medication reconciliation. This coordination reduces last minute delays cancellations and workarounds that can compromise IP practices.

The Impact of Consistent Preoperative Patient Preparation

Patient preparation is a cornerstone of SSI prevention, yet it is frequently undermined by inconsistent messaging and variable follow through. Patients may receive different instructions from surgeon offices, PAT nurses, and perioperative staff, leading to confusing and non-adherence

Collaborative organizations align educational materials, verbal instructions, and documentation across all preoperative touch points. Consistency reinforces patient understanding and accountability. Standardized bathing protocols, clear instructions regarding hair removal, wound care expectations, and medication management reduces variability and improve compliance.

Additionally engaging patients as active participants in infection prevention fosters shared responsibility period when patients understand why specific steps matter, they are more likely to adhere to preoperative requirements.

Breaking Down Silos Through Standardization and Communication

One of the greatest barriers to effective SSI prevention is siloed practice. Surgeon offices, PAT departments, and perioperative services often operate independently using different documentation systems and workflows this fragmentation increases the risk of missed information and inconsistent care.

Perioperative leaders play a critical role in breaking down these silos by establishing standardized protocols, shared documentation expectations, and clear handoff processes. Multidisciplinary work groups that include representatives from surgeon offices and PAT can identify gaps aligning practices and develop practical solutions.

Regular feedback loops such as sharing SSI data, and near-miss events across the continuum reinforce the importance of collaboration and continuous improvement.

Leaderships Role in Enabling Preoperative Collaboration

Effective collaboration does not occur by chance; it requires intentional leadership. Organizational leaders must prioritize preoperative integration and provide the infrastructure needed to support it. This includes standardized order sets, intra-operable documentation, educational resources, and adequate staffing.

Leaders also set expectations for accountability period when SSI prevention is framed as a shared responsibility that begins at surgical scheduling and continues through postoperative care, teams are more likely to engage and sustain improvement efforts.

Conclusion

Surgical site infection prevention extends far beyond the operating room risk is shaped by decisions behaviors and processes that occur in surgeon offices, PAT, and preoperative preparation. Healthcare organizations that invest in robust collaboration across the continuum are better positioned to reduce variability, close gaps, and improve patient outcomes.

By aligning expectations standardizing practices, and strengthening communication, perioperative leaders can shift SSI prevention upstream, transforming fragmented processes into a cohesive, patient-centered approach. The result is not only fewer infections, but a safer, more reliable surgical experience for every patient.

Leading Change That Matters: Practical Strategies for Perioperative Leaders to Reduce Surgical Site Infections

By David Taylor, MSN, RN, CNOR

This debut column originally appeared in the March-April 2026 issue of Healthcare Hygiene magazine.

Despite advances in surgical technique, technology, and infection prevention and control (IPC) sciences, SSI persist as one of the most common healthcare associated infections (HAI). Surgical site infections are associated with increased morbidity, mortality, and cost, and negatively impact patient satisfaction and publicly reported quality metrics. While clinical guidelines provide a clear framework to prevention, success ultimately depends on consistent execution across complex perioperative systems.

The reduction of SSI is not solely a technical or clinical challenge; it is a leadership imperative. Perioperative leaders occupy a pivotal position within surgical services, uniquely positioned to influence interdisciplinary teams and align organizational priorities. Effective leadership is essential to translating evidence into practice and sustaining reliable performance over time.

Establish Shared Accountability Across Disciplines

A foundational step in reducing SSIs is establishing shared accountability among all members of the surgical team. Infection prevention initiatives that are perceived as nursing-driving or compliance-focused often fail to engage surgeons and anesthesia professionals meaningfully. Perioperative leaders must intentionally frame SSI outcomes as a collective responsibility, emphasizing that prevention spans preoperative assessment, intraoperative practice, and postoperative care.

Multidisciplinary governance structures, such as SSI prevention committees with representation from surgery, anesthesia, nursing, sterile processing, and infection prevention, reinforce shared ownership and accountability is distributed equally, teams are more likely to engage in problem solving and adapt consistent practices.

Leveraging Data to Drive Engagement and Improvement

Data transparency is essential for improvement; However, the manner in which data are presented significantly influences stakeholder response. Perioperative leaders should use SSI data as a catalyst for inquiry rather than a mechanism for blame. Presenting trends, risk adjusted outcomes, and case level analysis in a non-punitive context encourages engagement and collective learning.

Structured case reviews and interdisciplinary discussion allowed teams to identify system level gaps, such as breakdowns in antibiotic administration, temperature management, or environmental controls. When leaders emphasize learning and improvement, data becomes a shared tool for advancing patient safety rather than a source of divisiveness.

Developing Surgeon and Anesthesia Champions

Physician engagement is critical to successful SSI prevention. Identifying and supporting surgeon and anesthesia champions can significantly accelerate adoption of evidence-based practices. Champions serve as credible peer advocates who can influence professional norms and reinforce expectations with their specialties.

Structured case reviews and interdisciplinary discussions allow teams to identify system-level gaps, such as breakdowns in antibiotic administration, temperature management, or environmental controls. When leaders emphasize learning and improvement, data becomes a shared tool for advancing patient safety rather than a source of defensiveness.

Aligning SSI Prevention with Organizational Priorities

Administrative support is essential for sustaining SSI prevention efforts. Perioperative leaders must clearly articulate how SSI reduction aligns with organizational priorities, including patient safety, regulatory compliance, financial performance, and reputation management.

Perioperative leaders should collaborate closely with these champions, involving them in protocol development, data review, and education efforts. Champions should be selected based on clinical credibility and peer influence rather than formal leadership roles alone. Peer-to-peer communication remains one of the most effective mechanisms for driving behavioral change in the surgical environment.

Standardizing High-Impact Practices While Respecting Clinical Judgment

Variation in perioperative practice is well-documented contributor to inconsistent outcomes. Leaders should prioritize standardization of high-impact, evidence-based practices such as antimicrobial prophylaxis, shin antisepsis, hair removal, normothermia, glycemic control, and operating room traffic management.

At the same time, perioperative leaders must respect clinically justified variation. Engaging surgeons and anesthesia professionals in the development of standardized protocols ensures that guidelines reflect current evidence while preserving appropriate clinical judgment. This collaborative approach promotes adherence and reduces resistance.

Empowering Frontline Staff and Promoting Psychological Safety

Frontline perioperative staff play a critical role in SSI prevention but may hesitate to speak up in hierarchical environments perioperative leaders must actively foster psychological safety by modeling respectful communication, responding constructively to concerns, and reinforcing that speaking up is an expected professional behavior.

Supporting staff who identify potential risks or call for corrective action reinforce a culture of safety and reliability. Empowered teams are better equipped to prevent errors and maintain consistent execution of IP practices.

Sustaining Improvement Through Continuous Leadership Focus

Sustainable SSI reduction requires ongoing leadership attention rather than short-term campaigns. Perioperative leaders should integrate SSI prevention into routine operations through continuous monitoring, regular feedback, education, and performance review.

Celebrating improvements are recognizing teams’ high reliability reinforces positive behaviors and maintains engagement. Continuous improvement frameworks ensure that gains are sustainable despite staff turnover, procedural changes, or increased surgical complexity.

Conclusion

Reducing SSIs requires more than adherence to protocols; It requires leadership capability of influencing culture, behavior, and interdisciplinary collaboration. Perioperative leaders are uniquely positioned to drive this change by fostering shared accountability, leveraging data effectively, empowering champions, and supporting frontline teams. When SSI prevention is embedded into organizational priorities and daily practice, the result is safer surgery, stronger teams, and improved outcomes for patients. Leading change that matters ultimately means leading in ways that protect patients at their most vulnerable moments.