Preventing surgical site infections: Facilitators and barriers to nurses' adherence to clinical practice guidelinesA qualitative study

AimsTo identify the facilitators of and barriers to nurses' adherence to evidence-based wound care clinical practice guidelines (CPGs) in preventing surgical site infections (SSIs) in an Australian tertiary hospital. BackgroundCurrent research suggests that up to 50% of nurses are unaware of the evidence-based recommendations to prevent SSIs and that adherence to evidence-based CPGs is suboptimal. However, little is known regarding the facilitators and barriers to adherence to evidence-based CPGs. DesignA qualitative study incorporating ethnographic data collection techniques. MethodsData collection included semi-structured individual interviews and focus groups (N=20), and examination of existing hospital policy and procedure documents. Thematic analysis using inductive and deductive approaches was conducted. This manuscript adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. FindingsData analysis revealed four themes: adhering to aseptic technique, knowledge and information seeking, documenting wound care and educating and involving patients in wound care. Facilitators and barriers within each theme were identified. Facilitators included participants' active information-seeking behaviour, a clear understanding of the importance of aseptic technique, and patient participation in wound care. Barriers included participants' knowledge and skills deficits regarding application of aseptic technique principles in practice, the availability of the hospital's wound care procedure document, suboptimal wound care documentation and the timing of patient education. ConclusionsThere is a need to develop interventions to improve nurses' adherence to recommended CPGs including following aseptic technique principles, hand hygiene, documentation and patient education. Hospital procedure documents that outline wound care need to reflect current recommended CPGs. Relevance to clinical practiceAdhering to evidence-based CPGs has been found to be effective in reducing and preventing SSIs. Our study provides an in-depth understanding of the barriers and facilitators to nurses' adherence to recommended CPGs. The findings may inform future practice improvements in wound care.