Association of Safety Culture with Surgical Site Infection Outcomes

Fan, Caleb J.; Pawlik, Timothy M.; Daniels, Tania; Vernon, Nora; Banks, Katie; Westby, Peggy; Wick, Elizabeth C.; Sexton, J. Bryan; Makary, Martin A.

doi:10.1016/j.jamcollsurg.2015.11.008

Cited by 129 publications

(132 citation statements)

References 18 publications

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“…We chose to base our analysis of variables possibly associated with SSI to modifiable and nonmodifiable risk factors collected for ACS‐NSQIP. The relationship of many of these variables to SSI and other important perioperative outcomes has been previously confirmed including incorporation into an online risk calculator . It is not surprising that high BMI and smoking are associated with SSI but perhaps somewhat surprising that diabetes was not an independent risk factor in our analysis.…”

Section: Discussionsupporting

confidence: 58%

Compliance with preoperative care measures reduces surgical site infection after colorectal operation

Guzmán-Pruneda¹,

Husain²,

Jones

et al. 2018

Journal of Surgical Oncology

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Background Surgical site infections (SSIs) are a major cause of morbidity complicating colorectal operations. Several evidence‐based preoperative strategies are associated with decreased SSI rates. We hypothesize that compliance with multiple strategies is associated with lower incidence of SSI after the elective colorectal operation. Methods Preoperative care measure compliance before colorectal operations were assessed. Measures included antiseptic wash the night before and day of operation, oral antibiotic, and mechanical bowel preparation, antibiotic prophylaxis, Chloraprep skin preparation, and hair clipping. Rates of SSI after colectomy and other pertinent outcomes were stratified by full and partial compliance with preoperative measures. Exclusion criteria included bowel perforation, ischemia, complete obstruction, intra‐abdominal abscess, and no intraoperative skin closure. Results Eight hundred twenty‐six subjects underwent colectomy between 2010 and 2016; 469 met inclusion criteria. Compliance with all measures occurred in 214 (46%) and was independently associated with lower postoperative infection rates (odds ratio [OR], 0.37; confidence interval [CI], 0.16‐0.85; P = 0.02). SSI occurred in 51 (11%): was superficial in 35 (7%); deep in 5 (1%); and organ space in 11 (2%). SSI rates were reduced from 16% (partial or no compliance group) to 5% (full compliance group). No stand‐alone intervention was independently associated with decreased SSI rate. Multivariate analysis found the following factors associated with a lower risk of SSI: full compliance with all five process measures, lower BMI, nonsmoker, and minimally invasive operation. Discussion and Conclusion Compliance with preoperative care strategies reduces rates of SSI after colectomy with a cumulative effect more pronounced than any single intervention reinforcing the need for protocol‐driven and evidence‐based care for patients undergoing colorectal operations.

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Section: Discussionsupporting

confidence: 58%

Compliance with preoperative care measures reduces surgical site infection after colorectal operation

Guzmán-Pruneda¹,

Husain²,

Jones

et al. 2018

Journal of Surgical Oncology

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“…Improved clinical outcomes were identified in 12.2% ( N = 18) of the studies reviewed. Examples of clinical outcomes linked to organizational learning include reductions in surgical site infections (Fan et al, ), mortality (Lees et al, ), medication errors (Drach‐Zahavy & Pud, ), patient pain scores (Lees et al, ), and hospital length of stay (Filice et al, ).…”

Section: Resultsmentioning

confidence: 99%

Organizational learning in hospitals: A realist review

Lyman

Jacobs

Hammond

et al. 2019

Journal of Advanced Nursing

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Aim To establish a middle‐range theory of organizational learning in hospitals. Design A realist review of the literature, conducted according to established standards for realist and meta‐narrative evidence syntheses. Middle‐range theory development was performed according to Smith and Liehr's recommendations. Data sources Two comprehensive scientific databases and six discipline‐focused databases spanning health care, life sciences, business, sociology, and psychology were searched from inception to 12 May 2016. Review methods Citations meeting the inclusion criteria were appraised using the Mixed Methods Appraisal Tool. Data extraction was guided by a focus on the contextual factors, mechanisms, and outcomes associated with organizational learning. Results The initial search yielded 2,332 citations, 147 of which were ultimately included in the review. The included citations were generally of high quality. Reviewed evidence indicates certain aspects of organizational context can be conducive to mechanisms of organizational learning, leading to a range of positive organizational outcomes. Conclusion This review updates and expands on a previous review of the literature on organizational learning in hospitals, refines the concept of organizational learning in hospitals, and provides a middle‐range theory of organizational learning in hospitals. Impact This updated review provides a strong evidence base for future work on the topic of organizational learning in hospitals. The refined concept of organizational learning makes it possible to develop reliable, valid research instruments that better reflect of the full scope of organizational learning. Finally, the middle‐range theory guides researchers and clinical leaders as they advance the science and practice of organizational learning.

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“…The best scores on dimensions regarding safety culture were related to the lower incidence of surgical site infection in hospital 4 , reduction of injuries, critical adverse events and risk-adjusted mortality 5 . In risk-adjusted morbidity analyses of the patients and characteristics of the hospital, however, the positive responses of safety culture were not related to mortality in patients with acute myocardial infarction 6 , nor was affected after reduction of catheter-associated infections 7 .…”

Section: Introductionmentioning

confidence: 98%

Patient safety culture in a university hospital

Galvão

Lopes

Oliva

et al. 2018

Rev. Latino-Am. Enfermagem

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Objective:to assess patient safety culture in a university hospital. Method:cross-sectional study with data collection through the Hospital Survey on Patient Safety Culture applied in electronic device. A total of 381 employees were interviewed, corresponding to 46% of the sum of eligible professionals. Data were analyzed descriptively. the Cronbach’s alpha was used to calculate the frequency and reliability. Results:most were women (73%) from the nursing area (50%) and with direct contact with patients (82%). The composites related to “teamwork within units” (58%, α=0.68), “organizational learning - continuous improvement” (58%, α=0.63), “supervisor/manager expectations and actions promoting patient safety” (56%, α=0.73) had higher positive responses. Nine composites had low positive responses, with emphasis on “nonpunitive response to error” (18%, α=0.40). Only the item “in this unit, people treat each other with respect” had positive response above 70%. The patient safety assessment in the work unit was positive for 36% of employees, however only 22% reported events in past year. Conclusion:the findings revealed weaknesses in the safety culture at the hospital, with emphasis on culpability.

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Association of Safety Culture with Surgical Site Infection Outcomes

Abstract: These data suggest an important role for positive safety and teamwork culture and engaged hospital management in producing high-quality surgical outcomes.

Cited by 129 publications

References 18 publications

Compliance with preoperative care measures reduces surgical site infection after colorectal operation

Compliance with preoperative care measures reduces surgical site infection after colorectal operation

Organizational learning in hospitals: A realist review

Patient safety culture in a university hospital

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