Understanding determinants of infection control practices in surgery: the role of shared ownership and team hierarchy

Abstract

Background Despite a large literature on surgical site infection (SSI), the determinants of prevention behaviours in surgery remain poorly studied. Understanding key social and contextual components of surgical staff behaviour may help to design and implement infection control (IC) improvement interventions in surgery. Methods Qualitative semi-structured interviews were conducted with surgeons ( n = 8), nurses ( n = 5) theatre personnel ( n = 3), and other healthcare professionals involved in surgery ( n = 4) in a 1500-bed acute care London hospital group. Participants were approached through established mailing lists and snowball sampling. Interviews were recorded and transcribed verbatim. Transcripts were coded and analysed thematically using a constant comparative approach. Results IC behaviour of surgical staff was governed by factors at individual, team, and wider hospital level. IC practices were linked to the perceived risk of harm caused by an SSI more than the development of an SSI alone. Many operating room participants saw SSI prevention as a team responsibility. The sense of ownership over SSI occurence was closely tied to how preventable staff perceived infections to be, with differences observed between clean and contaminated surgery. However, senior surgeons claimed personal accountability for rates despite feeling SSIs are often not preventable. Hierarchy impacted on behaviour in different ways depending on whether it was within or between professional categories. One particular knowledge gap highlighted was the lack of awareness regarding criteria for SSI diagnosis. Conclusions To influence IC behaviours in surgery, interventions need to consider the social team structure and shared ownership of the clinical outcome in order to increase the awareness in specialties where SSIs are not seen as serious complications. Electronic supplementary material The online version of this article (10.1186/s13756-019-0565-8) contains supplementary material, which is available to authorized users.

The Use of a Three-in-One Practice-Management-Innovation Training Model in the Construction of an Infection Control Team

“…In so doing, the hospital has been successful in building a unified infection control management system. 13 At the same time, innovative project-based management in continuing education has been adopted, which has ensured that full-time personnel have the opportunity to participate in provincial and municipal annual meetings every year, and part-time personnel can participate in corresponding provincial and municipal annual meetings and learn from their peers at the hospital. Continuing education is also implemented on the Home of Infection Control platform, so staff can bring themselves up-to-date with the latest knowledge about hospital infection as well as communicating with their peers anytime and anywhere.…”

Infection prevention and control research priorities: what do we need to combat healthcare-associated infections and antimicrobial resistance? Results of a narrative literature review and survey analysis

“…Commonly mentioned barriers include a lack of training/knowledge or awareness [ 18 , 19 ], and a lack of institutional resources, especially in low- and middle-income countries (LMIC) [ 19 , 20 ]. On the contrary, close relationships between healthcare workers [ 21 ], positive leadership and role modelling are often seen as facilitating factors [ 22 , 23 ]. While behavioural determinants have been identified, only few interventions have been proposed and tested to address them.…”

How do surgeons feel about the ‘Getting it Right First Time’ national audit? Results from a qualitative assessment

“…This study was conducted in three hospitals belonging to the Imperial College Healthcare National Health Service Trust (ICHNT) hospital group across West London, United Kingdom. We designed a qualitative study using semi-structured interviews with a range of stakeholders involved in surgery [3]. Four questions on the GIRFT audit were specifically asked to surgeons: how did you first hear about the GIRFT audit; how did you find the implementation; what has been the impact of the audit on practice; how would you improve the audit process.…”