Effectiveness versus Uptake: The Challenges of Implementing Evidence-Based Strategies to Reduce Surgical Site Infection in Patients with Colon Surgeries

Abstract

Background: National and international recommendations for the prevention of surgical site infection (SSI) were published six years ago, but little is known about implementation in colon surgeries. Methods: We conducted an observational study to evaluate the implementation of seven SSI-prevention elements in colon surgeries. Study coordinators recorded the implementation using an electronic case report. Surgeons completed a survey that identified key drivers of implementation. Three peer-to-peer calls and a study coordinator survey provided insights on the obstacles and drivers to implementation. Results: The elements ranged in compliance from 100% to below 1%. Absence of documentation in the electronic medical record (EMR), conflicting local policies, and a lack of standardization of processes and products were significant obstacles in implementation. Discussion: Standardizing peri-operative procedures may be accomplished by implementing guidelines. Using implementation science to reduce variability and stocking leads to product standardization with items that support evidence-based practices. Administration, material management, and surgical leadership all have a duty to the patient to reduce obstacles to implement evidence-based practices. Conclusions: Our study reveals variability in in the integration of published guidelines into clinical practice. Every surgical patient deserves the best possible care by using evidence-based guidelines and practices centered on reducing SSIs.

Optimal timing for antimicrobial prophylaxis to reduce surgical site infections: a retrospective analysis of 531 patients

“…The focus is on preoperative bowel cleansing, own hair removal, glycaemic control and normothermia. These measures have been shown to significantly reduce SSI and should now be incorporated into the surgical approach 22 – 25 . However, this has not yet been implemented.…”

Modified Delphi RAND/UCLA Consensus on Recommendations for Preventing Surgical Site Infections in Colorectal Surgery

“…Implementation strategies, including engagement, education, execution, and evaluation, along with promoting a culture of safety and openness to change, can help improve adherence 24 . A recent study emphasized the need for attention to effectively implement comparable guidelines; the elements varied in adherence, with some having compliance rates of 100%, whereas others were below 1% 30 . The main challenges were the absence of documentation in the electronic medical record, conflicting local policies, and lack of standardization in processes and products 30 …”

“…24 A recent study emphasized the need for attention to effectively implement comparable guidelines; the elements varied in adherence, with some having compliance rates of 100%, whereas others were below 1%. 30 The main challenges were the absence of documentation in the electronic medical record, conflicting local policies, and lack of standardization in processes and products. 30 Our study had important limitations that should be acknowledged.…”

“…30 The main challenges were the absence of documentation in the electronic medical record, conflicting local policies, and lack of standardization in processes and products. 30 Our study had important limitations that should be acknowledged. First, there was a demographic imbalance, as most participants were from Argentina, which could lead to a lack of external validity or generalizability of the study findings in the region, as planned.…”