Application of Plan-Do-Check-Act cycle based on software, hardware, environment, liveware model in preventing infection after endoscopic mucosal resection

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 χ 2 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.