Preventing surgical site infections: Facilitators and barriers to nurses’ adherence to clinical practice guidelines—A qualitative study

Abstract

Aims To 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. Background Current 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. Design A qualitative study incorporating ethnographic data collection techniques. Methods Data 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. Findings Data 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. Conclusions There 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 practice Adhering 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.

Wound care practices across two acute care settings: A comparative study

“…Results of the current study suggest differences exist between sites relative to the content nurses documented. Our findings are consistent with a recent study that reported nurses often used their own judgement on where and what to report in relation to patients’ wounds (Lin et al, ). Differences across hospitals in this study may also be due to environmental factors.…”

“…Clearly, inconsistencies in practices may be due to environmental factors outside of the control of healthcare providers, viz, time constraints, skill mix, workload and patient acuity. A recent qualitative study reported distractions from other staff and patients can reduce hand hygiene adherence after wound care (Lin et al, ). Hand hygiene is critical in the application of standard precautions (Berrios‐Torres et al, ) and reduces the patient's risk of developing a SSI (Lin et al, ).…”

“…Differences across hospitals in this study may also be due to environmental factors. Findings from a recent qualitative study describing the barriers and enablers to wound documentation suggest that time constraints and clinical workloads contribute to the lack of completeness in EHR (Lin et al, ).…”

“…Over the past 20 years, recommendations in clinical practice guidelines (CPGs) for SSI prevention have been developed and updated to reflect advances in the evidence base (Gillespie et al, ). Despite this, there remains inconsistency in the use of CPGs, contributing to great variability (Brölmann et al, ; Gillespie, Chaboyer, St John, Morley, & Nieuwenhoven, ; Lin et al, ) in wound care practices globally. Additionally, variance in the quality of evidence that underpins recommendations coupled with the fact that very few recommendations pertain to wound care strategies (Brölmann et al, ; Gillespie et al, ) contributes to uncertainty and a lack of standardisation in clinical practice.…”

Nurses’ Adherence to Patient Safety Principles: A Systematic Review

“…The nurses' role is to preserve patient safety and prevent harm during the provision of care in both short-term and long-term care settings [11,12]. Nurses are expected to adhere to organizational strategies for identifying harms and risks through assessing the patient, planning for care, monitoring and surveillance activities, double-checking, offering assistance, and communicating with other healthcare providers [13,14].…”