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
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References
- The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs.Infect Control Hosp Epidemiol. 1999; 20: 725-730
- Nosocomial infection update.Emerg Infect Dis. 1998; 4: 416-420
- Guideline for prevention of surgical site infection, 1999.Am J Infect Control. 1999; 27: 97-132
- Antimicrobial prophylaxis for surgical wounds.Arch Surg. 1993; 128: 79-88
- Antibiotic prophylaxis for cardiovascular surgery.Ann Intern Med. 1984; 101: 770-774
- Use of systemic antibiotics for prophylaxis in surgery: a critical review.Arch Surg. 1977; 112: 326-334
- CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections.Infect Control Hosp Epidemiol. 1992; 13: 606-608
- Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization.N Engl J Med. 1996; 334: 1209-1215
- Hospitals collaborate to decrease surgical site infections.Am J Surg. 2005; 190: 9-15
- Efficacy of protocol implementation on incidence of wound infection in colorectal operations.J Am Coll Surg. 2007; 205: 432-438
- Opportunities for improved performance in surgical specialty practice.Ann Surg. 2008; 247: 380-388
- Antimicrobial prophylaxis for surgery: an advisory statement from the national surgical infection prevention project.Clin Infect Dis. 2004; 38: 1706-1715
- Use of antimicrobial prophylaxis for major surgery: baseline results from the national surgical infection prevention project.Arch Surg. 2005; 140: 174-182
- Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures.Am J Surg. 1996; 171: 548-552
- The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery.Clin Infect Dis. 2006; 43: 322-330
- Single-institutional experience with the surgical infection prevention project in intra-abdominal surgery.Surg Infect Larchmt. 2007; 8: 425-435
- Adherence to local hospital guidelines for surgical antimicrobial prophylaxis: a multicentre audit in Dutch hospitals.J Antimicrob Chemother. 2003; 51: 1389-1396
- Teamwork and error in the operating room: analysis of skills and roles.Ann Surg. 2008; 247: 699-706
- Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions.J Am Coll Surg. 2007; 205: 778-784
- Postoperative infection with meticillin-resistant Staphylococcus aureus and socioeconomic background.Lancet. 2004; 363: 706-708
- Antibiotic prevention of infections complicating radical abdominal hysterectomy.Obstet Gynecol. 1984; 64: 539-545
- Risk factors for tissue and wound complications in gastrointestinal surgery.Ann Surg. 2005; 241: 654-658
- Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel.Anesthesiology. 2006; 105: 877-884
- Compliance with guidelines on antibiotic prophylaxis in total hip replacement surgery: results of a retrospective study of 416 patients in a teaching hospital.Infect Control Hosp Epidemiol. 2004; 25: 302-307
- Comparison of change in quality of care between safety-net and non-safety-net hospitals.JAMA. 2008; 299: 2180-2187
- The Surgical Infection Society guidelines on antimicrobial therapy for intra-abdominal infections: an executive summary.Surg Infect Larchmt. 2002; 3: 161-173
- Risk factors associated with surgical site infection in upper and lower gastrointestinal surgery.Surg Today. 2008; 38: 404-412
- Appropriateness of antibiotic therapy on weekends versus weekdays.J Antimicrob Chemother. 2007; 60: 625-628
- Mortality among patients admitted to hospitals on weekends as compared with weekdays.N Engl J Med. 2001; 345: 663-668
- Thermal care in the perioperative period.Best Pract Res. 2008; 22: 39-62
- Temperature monitoring and perioperative thermoregulation.Anesthesiology. 2008; 109: 318-338
- Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial.Lancet. 2001; 358: 876-880
- Navigating towards improved surgical safety using aviation-based strategies.J Surg Res. 2008; 145: 327-335
- A surgical safety checklist to reduce morbidity and mortality in a global population.N Engl J Med. 2009; 360: 491-499
- The effect of a quality improvement collaborative to improve antimicrobial prophylaxis in surgical patients: a randomized trial.Ann Intern Med. 2008; 149: 472-480
- Pay for performance, quality of care, and outcomes in acute myocardial infarction.JAMA. 2007; 297: 2373-2380
- The association between quality improvement activities performed by managed care organizations and quality of care.Am J Med. 2004; 117: 297-304
- Does pay-for-performance improve the quality of health care?.Ann Intern Med. 2006; 145: 265-272
Article info
Publication history
Published online: June 23, 2010
Received in revised form:
May 28,
2009
Received:
January 5,
2009
Footnotes
This research was supported in part by a grant under the Robert Wood Johnson Foundation Physician Faculty Scholars Program.
Clinical Trials Information: Prevention of Surgical Site Infections, Clinical Trials Identifier: NCT00353613, http://clinicaltrials.gov/ct2/show/NCT00353613?term=kao&rank=2.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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