In the past 18 months, we have significantly repositioned our organization by focusing on the customer, investing in the business and delivering on productivity and operational improvements.
First, we achieved an increase of more than 250% in adjusted net income per share compared to the third quarter in 2019.
Two, we expanded adjusted operating margin by 240 basis points versus prior year.
Three, we generated operating cash flow $118 million as a result of increased earnings and working capital improvements.
Fifth, we reduced total debt by $70 million in the quarter.
And six, we launched a $200 million follow-on equity offering, which has since closed.
Specifically related to the global solutions segment, we grew revenue $317 million sequentially from Q2 to Q3.
And finally, we reached a milestone in the COVID fight, with nearly 11 billion units of PPE delivered, of which approximately 4 billion units were produced with materials manufactured in our American factories or Owens & Minor owned facilities, all of that being done since the beginning of this year.
We paid down debt by $231 million year-to-date and by $402 million in the last six quarters.
In addition to that, we have another $130 million in cash on hand that is specifically earmarked to pay down additional debts.
And finally, today we are pleased to raise our 2020 full year adjusted earnings per share guidance to a range of $1.90 to $2.
And we are reconfirming double digit adjusted earnings per share growth in 2021.
Earlier today, we announced our revised full year adjusted net income guidance, which has been increased to $1.90 to $2 per share with a continued expectation of double digit growth in 2021.
Beginning with the top line, net revenue in the third quarter was $2.2 billion, compared to $2.3 billion for the prior year.
Gross Margin in the third quarter was 15.7%, an improvement of 350 basis points over prior year, as a greater portion of sales came from the higher margin global products segment and is evidence of the increasing level of operating efficiencies, productivity and fixed cost leverage we've achieved.
Distribution, selling and administrative expense of $263 million in the quarter increased $14 million compared to the third quarter of 2019, primarily as a result of continued investments in the business, partially offset by ongoing productivity gains.
Interest expense of $21 million in the third quarter was $3 million lower than the prior year as a result of lower debt levels due to improved operating cash flows and working capital.
The combined impact from the strong operational performance and execution resulted in income from continuing operations for the quarter of $46 million, an improvement of $43 million compared to prior year.
GAAP income from continuing operations per share for the quarter was $0.76, an increase of $0.70 versus the same period last year.
The resulting adjusted earnings per share for the quarter was $0.81, which represents a year-over-year increase of over 250% and a fourfold improvement sequentially versus Q2.
The foreign currency impact in the quarter was $0.06 favorable.
Revenue for the global solutions segment was $1.9 billion, compared to $2 billion for the same period in the prior year.
Relative to the second quarter, global solutions revenue grew by $317 million attributable to the increase in elective procedures.
To help put this in perspective, revenue improved from about 80% of pre-COVID levels in Q2 to the mid 90s in Q3.
Global solutions posted operating income of $11 million for the third quarter compared to income of $25 million last year, driven by lower volume.
Sequentially, global solutions operating income increased by $21 million or 7% of incremental revenue as volumes improved against our largely stable cost base.
Now turning to the global products segment, revenue was $474 million, compared to $360 million in the third quarter of last year, driven by growth in PPE sales net of the impact of lower elective procedures.
Sequentially, global products revenue increased by $103 million.
Global products reported operating income of $90 million, which increased by $73 million over last year.
In the third quarter, we generated operating cash flow of $118 million and $268 million year-to-date on a consolidated basis as a result of improved profitability and stringent working capital management.
Total debt was $1.3 billion at September 30, representing a sequential reduction of $70 million since the second quarter, and $231 million decline since year-end.
Recently, we executed the next step in our financial strategy to further strengthen our balance sheet with a successful equity raise netting $190 million, closing on October 6.
This offering resulted in the issuance of 9.7 million additional shares, which is expected to negatively impact earnings per share by $0.05 for 2020.
We plan to utilize $134 million held as restricted cash at the end of September, plus other available funds to retire these notes.
As I mentioned earlier in my remarks, we revised our full year adjusted net income guidance upwards to a range of $1.90 to $2 per share, inclusive of the dilution from our recent equity raise.
Q3 revenue associated with elective procedures increased to the mid 90% of pre-COVID levels.

Summary:
And we are reconfirming double digit adjusted earnings per share growth in 2021.
As I mentioned earlier in my remarks, we revised our full year adjusted net income guidance upwards to a range of $1.90 to $2 per share, inclusive of the dilution from our recent equity raise.