Barriers and facilitators for surgical site infection surveillance for adult cardiac surgery in a high-income setting: an in-depth exploration

Tanner, Judith; Brierley Jones, Lyn; Rochon, Melissa; Westwood, Nigel; Wloch, Catherine; Vaja, Ricky; Rogers, Luke; Dearling, Jeremy; Wilson, Keith; Magboo, Rosalie; Aujla, Hardeep; Page, Sue; Whiting, Penny; Murphy, Gavin; Brown, Colin; Lamagni, Theresa; Harrington, Pauline

Abstract

Background
Surgical site infection (SSI) surveillance aims to facilitate a reduction in SSIs through identifying infection rates, benchmarking, triggering clinical review and instituting infection control measures. Participation in surveillance is, however, variable suggesting opportunities to improve wider adoption.

Aim
To gain an in-depth understanding of the barriers and facilitators for SSI surveillance in a high-income European setting.

Methods
Key informant interviews with 16 surveillance staff, infection prevention staff, nurses and surgeons from nine cardiac hospitals in England. Data were analysed thematically.

Findings
SSI surveillance was reported to be resource-intensive. Barriers to surveillance included challenges associated with data collection: data being located in numerous places, multiple SSI data reporting schemes, difficulty in finding denominator data, lack of interface between computerised systems, ‘labour intensive’ or ‘antiquated’ methods to collect data (e.g. using postal systems for patient questionnaires). Additional reported concerns included: relevance of definitions, perceived variability in data reporting, lack of surgeon engagement, unsupportive managers, low priority of SSIs among staff, and a ‘blame culture’ around high SSI rates. Facilitators were increased resources, better use of digital technologies (e.g. remote digital wound monitoring), integrating surveillance within routine clinical work, having champions, mandating surveillance, ensuring a closer relationship between surveillance and improved patient outcomes, increasing the focus on post-discharge surveillance, and integration with primary care data.

Conclusion
Using novel interviews with ‘front-line’ staff, identified opportunities for improving participation in SSI surveillance. Translating these findings into action will increase surveillance activity and bring patient safety benefits to a larger pool of surgical patients.

Citation

Tanner, J., Brierley Jones, L., Rochon, M., Westwood, N., Wloch, C., Vaja, R., Rogers, L., Dearling, J., Wilson, K., Magboo, R., Aujla, H., Page, S., Whiting, P., Murphy, G., Brown, C., Lamagni, T., & Harrington, P. (2023). Barriers and facilitators for surgical site infection surveillance for adult cardiac surgery in a high-income setting: an in-depth exploration. Journal of Hospital Infection, 141, 112-118. https://doi.org/10.1016/j.jhin.2023.08.023

• Journal Article Type: Article
• Acceptance Date: Aug 24, 2023
• Online Publication Date: Sep 19, 2023
• Publication Date: 2023-11
• Deposit Date: Sep 18, 2023
• Publicly Available Date: Sep 20, 2024
• Journal: Journal of Hospital Infection
• Print ISSN: 0195-6701
• Electronic ISSN: 1532-2939
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 141
• Pages: 112-118
• DOI: https://doi.org/10.1016/j.jhin.2023.08.023
• Public URL: https://nottingham-repository.worktribe.com/output/25361561
• Publisher URL: https://www.journalofhospitalinfection.com/article/S0195-6701(23)00296-7/fulltext