Making Surgery Safer

Lynn M. Quast, R.N.

Lynn M. Quast, R.N., is a Mayo Clinic surgical nurse manager working to reduce the odds of infection.

One study Mayo Clinic collaborated in prevented about 135 infections

Lynn M. Quast, R.N., has firsthand experience with colorectal surgery, both as a nurse and as a patient. Almost three years ago, she developed diverticulitis, a painful inflammation of the colon that, if left untreated, can cause serious damage.

The night before the surgery, she worried. She had seen the effects of cutting into the bowels. She knew if all went well she'd be working again in five weeks. If not, she could face a life-altering infection that might require additional surgeries.

And she knew the national average of ending up back in the hospital with a serious infection was nearly 1 in 6.

Everything went fine. Today, as surgical nurse manager at Mayo Clinic, Quast is working with her team to reduce the odds of infection. Recently, she co-authored a study that evaluated each step of the colorectal surgery process, from the patient's pre-surgical skin preparation through the complex surgery and postoperative wound dressing.

The study developed a set of protocols that, when applied consistently, reduced infections and improved patient outcomes.

One key new step is called "Time Out," when the surgeon is ready to close the wound. The surgical technologist and nurse count and remove all contaminated sponges and instruments and open a sterile set. If needed, everyone puts on fresh gloves and changes gowns.

Within a year, surgical site infection rates at Mayo Clinic dropped from 9.8 to 4 percent.

The study involved seven U.S. health care systems, with Mayo Clinic surgeon Robert R. Cima, M.D., leading Mayo's participation. The collaboration estimates the project saved more than $3.7 million by preventing 135 colorectal surgical site infections.

"It's not just about cutting costs and being more efficient, though those are important considerations," Quast says. "It's about the patient not having to go through the added risk, pain and cost of an infection. We have to be continuously aware and relentless."