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Multifaceted strategies may improve clinician adherence to SSI prevention
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After conducting a systematic review of published studies, researchers said they were unable to identify the best strategy to improve clinician adherence to evidence-based interventions to prevent surgical site infections, or SSIs. However, they said successful approaches tended to employ multifaceted strategies that included engagement, education, execution and evaluation.
Writing in Infection Control & Hospital Epidemiology, Promise Ariyo, MD, MPH, assistant professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine, and colleagues explained the substantial clinical and economic burden of SSIs in high-, low- and middle-income countries.
Although many interventions and guidelines to reduce SSIs have been described, “evidence-based recommendations are often not delivered at the bedside,” they wrote.
For their review, Ariyo and colleagues searched PubMed, Embase, CINAHL, Cochrane Library, and WHO regional databases for articles published between Jan. 1, 1990, through Dec. 31, 2015, that described efforts to improve adherence.
They identified 125 studies, of which 124 were cohort studies and one was a randomized controlled trial. Eighty-four percent of the studies were conduced in high-income countries and 16% in LMICs. However, only eight studies met the criteria as having an acceptable-quality design, Ariyo and colleagues said.
According to their analysis, 56% of the total number of studies identified provided data on adherence with SSI preventive measures. Of those, 95% reported an increase in compliance with prevention measures. But 28% of the studies did not statistically evaluate the impact of interventions on SSI rates. Among those that did, 69% reported significant decreases in SSIs and 24% reported no change or no statistical decrease.
Multifaceted strategies were used to promote adherence in 82% of the studies, Ariyo and colleagues found. The most common measure of adherence was appropriate use of surgical antibiotic prophylaxis, which was reported in 68% of the studies, they said.
“Most of the studies used a multifaceted approach and addressed change at multiple levels within their health care organization,” they wrote. “These strategies aimed 1) to build and encourage multidisciplinary teamwork, 2) to obtain leadership buy-in, 3) to increase staff and patient awareness and knowledge about SSIs and prevention practices, 4) to standardize and simplify clinical processes, 5) to create verification procedures, and 6) to provide timely feedback to stakeholders to support improvement efforts.”
When the researchers evaluated the types of interventions implemented as part of a multifaceted strategy, they found 63% of studies “described efforts to engage frontline staff” and 54% “used some form of education” to introduce new measures to frontline staff, compared with 11% of studies that focused on educating patients. Eighty-six percent described “execution strategies to improve adherence” and 59% “described evaluation activities,” such as feedback or benchmarks.
“We believe this review complements clinical practice guidelines and fills an important gap in the existing SSI literature by organizing a broad range of strategies into a practical framework that can be used to enhance the adoption of evidence-based practices and accelerate efforts to reduce SSI,” Ariyo and colleagues concluded. – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.
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