The persistent breach between evidence and practice in the prevention of surgical site infection. Qualitative study

Int J Surg . 2020 Oct;82:231-239. doi: 10.1016/j.ijsu.2020.08.027. Epub 2020 Aug 30

Fecha de la publicación: 30/08/2020

Autor: Josep M Badia (1), Inés Rubio-Pérez (2), José López-Menéndez (3), Cecilia Diez (4), Bader Al-Raies Bolaños (5), Julia Ocaña-Guaita (6), Xose M Meijome (7), Manuel Chamorro-Pons (8), Ramón Calderón-Nájera (9), Gloria Ortega-Pérez (10), Rosa Paredes-Esteban (11), Cristina Sánchez-Viguera (12), Ramon Vilallonga (13), Antonio L Picardo (14), Elena Bravo-Brañas (15), Eloy Espin (16), José M Balibrea (17), Spanish Observatory of Surgical Infection

Palabras clave: Preventative measures, Prevention and control, Surgical site infection, Surgical wound infection, Surveys and questionnaires

PMID

PMID: 32877754
DOI: 10.1016/j.ijsu.2020.08.027

Affiliations

¹Department of Surgery, Hospital General de Granollers, Avinguda Francesc Ribas 1, 08402, Spain; Universitat Internacional de Catalunya, Barcelona, Spain. Electronic address: jmbadia@fphag.org.

²Department of Surgery, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain. Electronic address: dr.inesrubio@gmail.com.

³Department of Cardiac Surgery, Hospital Universitario Ramón y Cajal, Ctra. de Colmenar Viejo Km. 9, 100, 28034, Madrid, Spain. Electronic address: jose_lm78@icloud.com.

⁴Surgical Area, Hospital Universitari Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain. Electronic address: CDiez@santpau.cat.

⁵Department of Vascular Surgery, Hospital de Manises, Av. de La Generalitat Valenciana, 50, 46940, Manises, Valencia, Spain. Electronic address: baderalraies@icloud.com.

⁶Department of Vascular Surgery, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo Km. 9, 100, 28034, Madrid, Spain. Electronic address: juliaocagua@yahoo.es.

⁷Gerencia de Asistencia Sanitaria Del Bierzo, León, Gerencia de Asistencia Sanitaria Del Bierzo, Nursing and Healthcare Research Unit, C/ El Medio, 1, 24400, Ponferrada, León, Spain. Electronic address: meijome@gmail.com.

⁸Department of Oral and Maxillofacial Surgery, Hospital Ruber Juan Bravo, Calle de Juan Bravo, 49, 28006, Madrid, Spain. Electronic address: mchamorropons@hotmail.com.

⁹Department of Aesthetic, Plastic and Reconstructive Surgery, Hospital Ruber Internacional, Calle de La Masó, 38 28034, Madrid, Spain. Electronic address: ramoncaldena@gmail.com.

¹⁰Department of Surgical Oncology, MD Anderson Cancer Center, Calle de Arturo Soria, 270, 28033, Madrid, Spain. Electronic address: gortega@mdanderson.es.

¹¹Unidad de Cirugía Pediátrica, Hospital Universitario Reina Sofía, Av. Menendez Pidal, S/n, 14004, Córdoba, Spain. Electronic address: rosam.paredes.sspa@juntadeandalucia.es.

¹²Servicio de Neurocirugía, Hospital Regional Universitario de Málaga, Av. de Carlos Haya, 84, 29010, Málaga, Spain. Electronic address: svcristinavs@hotmail.com.

¹³Endocrine-Metabolic and Bariatric Surgery Unit, Hospital Universitari Vall D’Hebrón, Passeig de La Vall D’Hebron, 119, 08035, Barcelona, Spain. Electronic address: vilallongapuy@hotmail.com.

¹⁴Endocrine-Metabolic and Bariatric Surgery Unit, HM Montepríncipe, Avenida de Montepríncipe Nº 25, 28660, Boadilla Del Monte, Madrid, Spain. Electronic address: aluispicardo@salud.madrid.org.

¹⁵Department of Aesthetic, Plastic and Reconstructive Surgery, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain. Electronic address: elbrabra@hotmail.com.

¹⁶Department of Surgery, Hospital Universitari Vall D’Hebrón, Passeig de La Vall D’Hebron, 119, 08035, Barcelona, Spain. Electronic address: eespin@vhebron.net.

¹⁷Department of Surgery, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain. Electronic address: balibrea@gmail.com.

Abstract

Background: Despite the dissemination of guidelines for surgical site infection (SSI) prevention, a gap between the theoretical measures and their compliance persists. Accurate estimates of the implementation of preventative measures is crucial before planning dissemination strategies.

Methods: A web-based survey was distributed to members of 11 Associations of operative nurses and surgeons. Questions aimed to determine their awareness of evidence, personal beliefs and actual use of the main preventative measures.

Results: Of 1105 responders, 50.5% receive no feed-back of their SSI rate. Responders show a moderate rate of awareness of the recommendations about not removing hair, hair clipping, skin antisepsis with alcoholic solutions, and normothermia. Antibiotic prophylaxis is given for more than 24 h by 18.8% of respondents. Screening for S. aureus is performed by 27.6%. Hair removal by shaving is used by 16.6% of responders. The most common antiseptic solutions are alcoholic chlorhexidine (57.2%) and aqueous povidone (23.3%). 62.8% of surgeons allow the solution to air dry before applying surgical drapes. Adhesive drapes in the surgical field are used routinely in 33.4% of cases. Perioperative normothermia, glucose control and hyperoxia are used in 84.3%, 65.9% and 23.3% of cases. Antimicrobial sutures and negative pressure therapy are used by 20.2% and 43.5% of teams, respectively. Prior to closing the incision, 83.9% replace surgical instruments always or selectively. Wound irrigation before closing is used in 78.1% of cases, mostly with saline. Check-lists, standardized orders, surveillance, feed-back and educational programs were rated most highly by respondents as a means to improve compliance with preventative guidelines, but few of these strategies were in place at their institutions.

Conclusion: Gaps in the translation of evidence into practice remain in the prevention of SSI among different surgical specialities. Several areas for improvement have been identified, as some core prevention measures are not in common use.