Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3?

Meeks, Derek W.; Lally, Kevin P.; Carrick, Matthew M.; Lew, Debbie F.; Thomas, Eric J.; Doyle, Peter D.; Kao, Lillian S.

doi:10.1016/j.amjsurg.2009.07.050

« Previous Next »The American Journal of Surgery
Volume 201, Issue 1 , Pages 76-83, January 2011

Compliance with guidelines to prevent surgical site infections: As simple as 1-2-3?

Derek W. Meeks, M.D.
- Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
Kevin P. Lally, M.D., M.S.
- Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
- Department of Pediatric Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
Matthew M. Carrick, M.D.
- Department of Surgery, Baylor College of Medicine, Houston, TX, USA
Debbie F. Lew, M.P.H.
- Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
Eric J. Thomas, M.D., M.P.H.
- Department of Medicine, University of Texas Health Sciences Center at Houston, Houston, TX, USA
Peter D. Doyle, M.D.
- Department of Anesthesia, University of Texas Health Sciences Center at Houston, Houston, TX, USA
Lillian S. Kao, M.D., M.S.
- Department of Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
- Corresponding author. Tel.: +1-713-566-5095; fax: +1-713-566-4583

Received 5 January 2009; received in revised form 28 May 2009 published online 23 June 2010.

Abstract

Background

The purpose of this study was to assess predictive factors and compliance with surgical site infection (SSI) prevention guidelines at 2 county hospitals.

Design

Chart review and analysis of laparotomy patients undergoing colorectal, hysterectomy, or abdominal vascular procedures over two 6-month periods 1 year apart and evaluation of safety climate using the Safety Attitudes Questionnaire (SAQ).

Results

Overall compliance with all antibiotic prophylaxis guidelines was 62% (n = 442). Gynecologic surgery was an independent predictor of compliance with antibiotic prophylaxis guidelines in elective cases, and nonemergency status was an independent predictor when all cases were considered. Postoperative normothermia was predicted by hospital, procedure length, initial intraoperative temperature, and service. The SAQ had a 91% response rate. Contrary to expected, safety domain scores and agreement with statements on collaboration and teamwork were not predictive of compliance.

Conclusion

Interventions to improve poor compliance with infection prevention guidelines must be multifaceted, hospital- and service-specific, and resilient during emergencies. Good safety and teamwork climate are not sufficient.

Keywords: Surgical site infections, Guidelines, Evidence-based practice, Safety management, Teamwork