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Implementation strategies to reduce surgical site infections: A systematic review

Published online by Cambridge University Press:  21 February 2019

Promise Ariyo Open the ORCID record for Promise Ariyo [Opens in a new window] ,
Bassem Zayed ,
Victoria Riese ,
Blair Anton ,
Asad Latif ,
Claire Kilpatrick ,
Benedetta Allegranzi  and
Sean Berenholtz
Promise Ariyo*
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Bassem Zayed
Affiliation:
Antimicrobial Resistance and Infection Control Team, WHO Regional Office for Eastern Mediterranean, Cairo, Egypt
Victoria Riese
Affiliation:
Welch Medical Library, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
Blair Anton
Affiliation:
Welch Medical Library, Johns Hopkins University, School of Medicine, Baltimore, Maryland, United States
Asad Latif
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
Claire Kilpatrick
Affiliation:
Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
Benedetta Allegranzi
Affiliation:
Infection Prevention and Control Global Unit, Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
Sean Berenholtz
Affiliation:
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
*
Author for correspondence: Promise Ariyo, Email: [email protected]
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Abstract

Background:

Surgical site infections (SSIs) portend high patient morbidity and mortality. Although evidence-based clinical interventions can reduce SSIs, they are not reliably delivered in practice, and data are limited on the best approach to improve adherence.

Objective:

To summarize implementation strategies aimed at improving adherence to evidence-based interventions that reduce SSIs.

Design:

Systematic review

Methods:

We searched PubMed, Embase, CINAHL, the Cochrane Library, the WHO Regional databases, AFROLIB, and Africa-Wide for studies published between January 1990 and December 2015. The Effective Practice and Organization Care (EPOC) criteria were used to identify an acceptable-quality study design. We used structured forms to extract data on implementation strategies and grouped them into an implementation model called the “Four Es” framework (ie, engage, educate, execute, and evaluate).

Results:

In total, 125 studies met our inclusion criteria, but only 8 studies met the EPOC criteria, which limited our ability to identify best practices. Most studies used multifaceted strategies to improve adherence with evidence-based interventions. Engagement strategies included multidisciplinary work and strong leadership involvement. Education strategies included various approaches to introduce evidence-based practices to clinicians and patients. Execution strategies standardized the interventions into simple tasks to facilitate uptake. Evaluation strategies assessed adherence with evidence-based interventions and patient outcomes, providing feedback of performance to providers.

Conclusions:

Multifaceted implementation strategies represent the most common approach to facilitating the adoption of evidence-based practices. We believe that this summary of implementation strategies complements existing clinical guidelines and may accelerate efforts to reduce SSIs.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 3 , March 2019 , pp. 287 - 300
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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