Identifying opportunities for quality improvement in surgical site infection prevention

Background: This study evaluated surgical site infection (SSI) prevention strategies at a network of university hospitals to identify interventions that may be required to improve compliance with guidelines. Methods: Qualitative methods were used for thematic analysis of institutional tools and protocols, and transcripts of interviews with 7 surgical division heads and 11 professional managers of quality improvement or infection prevention and control at 7 hospitals. They were asked about awareness of, and accountability for, SSI prevention, and current and recommended strategies to promote compliance. Results: Despite awareness of SSI prevention guidelines and the presence of organizational factors thought necessary for quality improvement (coordinators, champions), most sites had not reviewed their own practice and implemented corrective strategies. Barriers included use of passive educational strategies, lack of clinician accountability, limited implementation of point-of-care tools, and an absence of performance data. Conclusion: The sites involved in this evaluation and others interested in increasing compliance with SSI prevention guidelines might implement education and performance data in tandem with accountabilities that trigger action, more actively engage champions to promote SSI prevention, create or update and incentivize use of tools such as standard orders, and encourage greater teamwork through organizational support of quality improvement. Copyright (C) 2009 by the Association for Professionals in Infection Control and Epidemiology, Inc. (Am J Infect Control 2009:37:398-402.)