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

https://doi.org/10.1016/j.amjsurg.2009.07.050Get rights and content

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.

Section snippets

Methods

A retrospective chart review was conducted of compliance with SCIP guidelines for SSI prevention in a subset of adult patients undergoing elective and emergent laparotomies for colorectal procedures, abdominal hysterectomies, and abdominal vascular procedures at 2 teaching county hospitals with the same administration in Houston, TX. This subset of laparotomy patients was chosen because these procedures have explicit SCIP recommendations for antibiotic prophylaxis (Table 1). We performed a

Results

Overall, 517 patients were included in the analysis: 171 from July through December 2006 and 271 from July through December 2007. These cases were comprised of 316 abdominal hysterectomies (61%), 189 colorectal cases (37%), and 14 abdominal vascular cases (3%). Of these cases, 442 were elective. Overall compliance with all 3 antibiotic prophylaxis guidelines occurred in 62% (274/442) of these cases. There was a significant improvement in overall compliance with antibiotic prophylaxis between

Comments

Noncompliance with SCIP guidelines has significant consequences. Mahid et al performed a prospective study of more than 5,000 patients at 16 Kentucky hospitals demonstrating that a poor choice of antibiotic was associated with a 3-fold increase in mortality and that hypothermia on arrival to the postoperative care unit was associated with a greater than 4-fold increase in mortality.11 Therefore, it is important that factors contributing to noncompliance with these guidelines be identified. In

Acknowledgments

The authors would like to thank Dr Bryan Sexton for assisting with scanning and compiling the data for the SAQ, Dr Robert Lasky for his statistical advice, and the Harris County Hospital District Administration for their support of this project.

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  • Cited by (0)

    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.

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