Li W, Liu C, Zhang HY. Application of Plan-Do-Check-Act cycle based on software, hardware, environment, liveware model in preventing infection after endoscopic mucosal resection. World J Gastrointest Surg 2026; 18(3): 114647 [DOI: 10.4240/wjgs.v18.i3.114647]
Corresponding Author of This Article
Hai-Yan Zhang, Chief Nurse, Department of Gastroenterology, The Second People’s Hospital of Huai’an, No. 62 Huaihai South Road, Huai’an 223001, Jiangsu Province, China. zhy810525zhy@163.com
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Gastroenterology & Hepatology
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Retrospective Study
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Mar 27, 2026 (publication date) through Mar 30, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Li W, Liu C, Zhang HY. Application of Plan-Do-Check-Act cycle based on software, hardware, environment, liveware model in preventing infection after endoscopic mucosal resection. World J Gastrointest Surg 2026; 18(3): 114647 [DOI: 10.4240/wjgs.v18.i3.114647]
World J Gastrointest Surg. Mar 27, 2026; 18(3): 114647 Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.114647
Application of Plan-Do-Check-Act cycle based on software, hardware, environment, liveware model in preventing infection after endoscopic mucosal resection
Wen Li, Chun Liu, Hai-Yan Zhang
Wen Li, Department of Nursing, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan 030032, Shanxi Province, China
Chun Liu, Department of Public Health, Minzu Street Community Health Service Center, Wuhan 430000, Hubei Province, China
Hai-Yan Zhang, Department of Gastroenterology, The Second People’s Hospital of Huai’an, Huai’an 223001, Jiangsu Province, China
Co-first authors: Wen Li and Chun Liu.
Author contributions: Li W and Liu C contributed to research design, data collection, data analysis, and paper writing; Zhang HY was responsible for research design, funding application, data analysis, reviewing and editing, communication coordination, ethical review, copyright and licensing, and follow-up; and all authors have read and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Shanxi Bethune Hospital, approval No. YXLL-2025-069.
Informed consent statement: All research participants or their legal guardians provided written informed consent prior to study registration.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No other data available.
Corresponding author: Hai-Yan Zhang, Chief Nurse, Department of Gastroenterology, The Second People’s Hospital of Huai’an, No. 62 Huaihai South Road, Huai’an 223001, Jiangsu Province, China. zhy810525zhy@163.com
Received: October 31, 2025 Revised: December 5, 2025 Accepted: January 16, 2026 Published online: March 27, 2026 Processing time: 147 Days and 4.1 Hours
Abstract
BACKGROUND
Endoscopic mucosal resection (EMR) is widely used for superficial gastrointestinal tumors but carries a notable risk of surgical site infection (SSI), which impairs recovery and increases morbidity. Existing infection control strategies often lack systematic integration of human, environmental, and procedural factors. The software, hardware, environment, liveware (SHEL) model offers a comprehensive framework to identify such multidimensional risks, while the Plan-Do-Check-Act (PDCA) cycle enables continuous quality improvement. We hypothesized that integrating the SHEL model into a PDCA-based nursing management protocol would significantly reduce post-EMR SSI rates and enhance patient outcomes compared to conventional care.
AIM
To investigate the effect of a SHEL-based PDCA cycle in preventing EMR infection.
METHODS
This study was conducted in Shanxi Bethune Hospital with 140 EMR patients, randomly assigned to control (routine perioperative nursing) or observation (SHEL model-integrated PDCA cycle nursing) groups (n = 70 each). Outcomes included postoperative incisional infection rate, recovery, operating room care quality, and patient satisfaction. Data were analyzed using χ2 tests and t-tests.
RESULTS
The incidence of postoperative SSI in the observation group was significantly lower than that in the control group (5.71% vs 18.57%, P = 0.020). Postoperative recovery indicators, including first flatus time (7.34 ± 1.37 hours vs 9.89 ± 1.37 hours, P < 0.001), first defecation time (12.59 ± 2.42 hours vs 17.21 ± 2.44 hours, P < 0.001), first ambulation time (10.01 ± 1.27 hours vs 12.81 ± 1.51 hours, P < 0.001), and hospital stay (7.10 ± 1.66 days vs 12.98 ± 1.80 days, P < 0.001), were all significantly shorter in the observation group. Operating room care quality scores and overall patient satisfaction (84.29% vs 65.71%, P = 0.011) were also significantly higher in the intervention group.
CONCLUSION
The SHEL-based PDCA cycle significantly reduces infection rates, accelerates recovery, and improves nursing quality and patient satisfaction after EMR.
Core Tip: This study validated the value of a collaborative intervention based on the Software, hardware, environment, liveware model of an integrated Plan-Do-Check-Act cycle in preventing infections after endoscopic mucosal resection. The findings emphasize the interplay of systematic risk identification and dynamic quality improvement in reducing surgical site infections and accelerating postoperative recovery. The comprehensive model effectively reduced infection rates and facilitated patient recovery, providing a practical tool for standardized perioperative management. This study fills a gap in systemic infection control in endoscopic surgery and highlights the need for risk analysis and iterative optimization in care management.
