Beyond Compliance: A Call to Collaboration in the Fight Against Surgical Site Infections

Why evidence-based practice — not minimum mandates — must guide our path to zero preventable HAIs

A conversation I had recently with an infection preventionist stopped me in my tracks. I had introduced an evidence-based intervention backed by compelling peer-reviewed data — one with real potential to reduce Surgical Site Infections (SSIs) and protect both patients and care teams. The response I received was not a clinical objection, nor a question about the science. Instead, I was told: “If it’s not mandated by a clinical guideline, we’re not going to try it.” That moment crystallized something important: we have a critical gap in how some clinicians understand the role of clinical guidelines, and it may be costing patients their safety — and in some cases, their lives.

What Clinical Guidelines Actually Do — and Don’t Do

Organizations like AORN (the Association of periOperative Registered Nurses) publish rigorous, evidence-based guidelines to support best practice in the perioperative environment. The AORN Guidelines for Perioperative Practice are among the most respected and comprehensive clinical frameworks in surgical care. They synthesize vast bodies of research, helping practitioners navigate complex decisions about patient safety in the OR.

But here is what must be clearly understood: clinical guidelines are not product approval lists. They do not name, endorse, or mandate the use of specific technologies or devices. That is not their purpose. Guidelines establish principles — such as maintaining air quality, minimizing contamination risk, and applying evidence-based environmental controls. It is then the clinician’s professional responsibility to evaluate the available peer-reviewed literature and determine which interventions best fulfill those principles in their specific practice setting.

Waiting for a guideline to name a technology before adopting it is not cautious practice. It is a misunderstanding of how evidence-based medicine works — and it leaves patients exposed to preventable harm in the interim.

The Burden of Surgical Site Infections Is Too Great to Accept Complacency

Surgical Site Infections remain one of the most common and costly Healthcare-Associated Infections (HAIs) in the United States. They are associated with prolonged hospital stays, increased readmissions, significant patient morbidity, and, in the most severe cases, death. The financial burden runs into the billions annually — but no dollar figure captures the human cost borne by patients and their families.

Equally important is the toll SSIs take on the caregiver team. Clinicians who dedicate their careers to healing patients do not enter this field to watch them suffer from preventable complications. When an SSI occurs, it reverberates through the entire care team. The emotional and moral weight is real. Reducing HAIs is not just a patient safety imperative — it is an act of stewardship for our caregivers as well. This shared burden is precisely why the goal cannot be compliance with a minimum standard. The goal must be zero preventable HAIs. Every tool at our disposal, supported by credible evidence, deserves serious consideration.

The AORN Guidelines as a Framework, not a Ceiling

AORN’s guidelines on infection prevention, surgical environment management, and air quality serve as an essential starting point for any perioperative team serious about SSI reduction. They provide a strong foundation built on peer-reviewed evidence, expert consensus, and years of clinical refinement. Perioperative nurses, surgeons, infection preventionists, and hospital administrators would be well served to engage deeply with these resources.

But the guidelines represent a floor, not a ceiling. Accreditation standards and regulatory bodies set minimum thresholds to maintain baseline safety across all care settings. They are not designed to represent the best that is clinically possible. That aspiration belongs to the frontline teams, the infection preventionists, the perioperative nurses, and the surgeons who can choose to go further.

When a clinician reads an AORN guideline recommending evidence-based air quality management in the OR, the professional response is to ask: What peer-reviewed evidence exists for interventions that support this goal? What technologies, practices, or protocols have demonstrated efficacy in reducing bioburden or airborne contamination? That is how evidence-based practice is supposed to work.

Collaboration Is the Missing Ingredient

Reducing SSIs requires a multidisciplinary commitment. Infection preventionists, perioperative nurses, surgeons, environmental services, and hospital leadership must be aligned around a common goal and a shared willingness to evaluate new evidence. Siloed thinking — whether driven by departmental turf, resource constraints, or a misplaced deference to minimum requirements — creates gaps that bacteria and pathogens readily exploit.

The conversation I referenced earlier highlighted a dangerous dynamic: when infection preventionists and perioperative teams are not aligned on the purpose of clinical guidelines, potential advances in patient safety are blocked—not by evidence, but by process. The solution is not to eliminate standards or bypass governance. It is to build a culture in which multidisciplinary teams regularly convene to review the literature together, ask hard questions, and make informed decisions. 

Resources like the AORN Evidence Rating Model give teams a shared language for evaluating evidence. They create a structured pathway for teams to vet new interventions responsibly, without waiting for a regulatory mandate that may be years away. Taking advantage of these frameworks is not optional for teams committed to excellence — it is an obligation.

Now More Than Ever: Apply Every Evidence-Based Tool

We are in a defining period for infection prevention. The lessons of recent years — pandemic preparedness, antimicrobial resistance, the fragility of supply chains — have made it undeniably clear that doing the minimum is not sufficient. Every evidence-supported practice that can reduce patient harm should be actively evaluated and, where appropriate, implemented.

This means reading the peer-reviewed literature with intention. It means engaging industry partners who bring emerging technologies and asking the right questions: What is the mechanism? What does the clinical evidence show? How does it complement our existing protocols? It means being willing to pilot, measure, and iterate.

We owe this to our patients. We owe this to our colleagues who stand beside us in the OR every day. And we owe it to the integrity of a profession built on the promise to do no harm. The standard is not the standard of care. Excellence is. Zero preventable HAIs is not a marketing slogan. It is a clinical imperative. And reaching it demands that every stakeholder in the surgical care continuum engage with the evidence, collaborate across disciplines, and apply every tool the science supports.