The Safe Hands Study: Implementing aseptic techniques in the operating room: Facilitating mechanisms for contextual negotiation and collective action

Abstract

Background: Even though hand hygiene and aseptic techniques are essential to provide safe care in the operating room, several studies have found a lack of successful implementation. The aim of this study was to describe facilitative mechanisms supporting the implementation of hand hygiene and aseptic techniques. Methods: This study was set in a large operating room suite in a Swedish university hospital. The theorydriven implementation process was informed by the literature on organizational change and dialogue. Data were collected using interviews and participant observations and analyzed using a thematic approach. The normalization process theory served as a frame of interpretation during the analysis. Results: Three facilitating mechanisms were identified: (1) commitment through a sense of urgency, requiring extensive communication between the managers, operating room professionals, and facilitators in building commitment to change and putting the issues on the agenda; (2) dialogue for co-creation, increasing and sustaining commitment and resource mobilization; and (3) tailored management support, including helping managers to develop their leadership role, progressively involving staff, and retaining focus during the implementation process. Conclusions: The facilitating mechanisms can be used in organizing implementation processes. Putting the emphasis on help and support to managers seems to be a crucial condition in complex implementation processes, from preparation of the change process to stabilization of the new practice.

Fewer Early Surgical Site Infections After Hip Fracture and Lessons Learned From the Safe Hands Project: A Five-Year Longitudinal Study of 3,553 Patients

“…For every year, the odds of an early SSI decreased, despite that there were signi cantly more patients with cognitive impairment and nursing home residents in the last two study years, indicating greater frailty in the cohort (21). In line with the literature, male gender, prolonged procedure time and more than one urinary catheterisation increased the odds of early SSIs (2,17,19). In contrast, age, diabetes and an ASA score did not predict SSI in our cohort.…”

“…The implementation process for components in the programme and the links to theory have previously been published (16,17). The initial project was expanded to involve the entire hip fracture care pathway, targeting catheter-related urinary tract infections, the risk of bladder distention and de cits in hand hygiene and aseptic techniques.…”

Process Evaluation of an Operational-Level Job Stress Intervention Aimed at Decreasing Sickness Absence among Public Sector Employees in Sweden

“…Due to their key position in the organisation, line managers often possess invaluable knowledge about the workplace-knowledge which is necessary for achieving a good "fit" between intervention and context [23]. They also need extensive knowledge about psychosocial work environment management [54,55], interpersonal relationship [8] and change management [56,57]. The low measure-to-challenge correspondence found in this study indicates that both line managers and their HR partners need support when it comes to these issues.…”

Hand Hygiene Teaching Strategies among Nursing Staff: A Systematic Review

“…The support that they provide is essential to achieve good handwashing in health professionals. Furthermore, it is very important that during the implementation process, managers retain focus to prolong adherence [57].…”