Implementation Science Help Prevent Infections in Colon Surgeries

Implementation science can improve health care quality by incorporating research findings and evidence-based guidelines into routine practice. However, limited studies exist on the barriers and facilitators to implementing updated surgical site infection prevention strategies. An observational study evaluated the implementation of surgical site infection (SSI)-reduction recommendations in real-world settings, highlighting challenges due to inconsistent measurement techniques, definitions, and policies. The authors state that health care organizations should address these issues when implementing evidence-based guidelines.

The “Implementation Challenges to Prevent Infections in Colon Surgeries” study was presented at the Association for Professionals in Infection Control and Epidemiology (APIC) 2023 Annual Conference and Exhibition, held in Orlando, Florida, June 26 to 28, 2023.

The authors and presenters were Peter B. Graves, BSN, RN, CNOR, independent perioperative, consultant, speaker, and writer, Clinical Solution, LLC, Corinth, Texas; Maureen P. Spencer, M.Ed, BSN, RN, CIC, FAPIC, infection preventionist consultant, Infection Preventionist Consultants, Halifax, Massachusetts; Lena Camperlengo, DrPH, MPH, RN, Senior Director, Premier, Inc, Ocala, Florida. They spoke with Infection Control Today^® (ICT^®) in an in-depth discussion about their presentation.

Graves told ICT, “The part that I thought was so important, and that caught the attention of the editors [of] the surgical infection journal, was that nobody's looked at the implementation of the colorectal guidelines. And it's such an important aspect of prevention that we continue to see many infections in that specialty. And we must do better. And one of the things that made this paper so appealing to the surgical infection society was [that] they write the guidelines, have the experts, and still can't seem to get consensus amongst all their providers.”

Camperlengo added, “So we had our study coordinators document or look for documentation. They even went and had interviews with surgeons and anesthesiologists, [and] looked in nursing notes, etc, for documentation. That was that the 7 components, the guideline components, [that] were followed in a high-risk pooling surgery. The first finding was [that] the documentation, often, wasn't there for a handful of these 7 components. They seemed to be always there, and they were near 100% compliance. So we, as co-authors of the study, and designers of the study, had to ask ourselves, how do we bring the rest of these guidelines up to the same [adherence] level as ours [concerning] prophylactic IV antibiotics as well as skin prep?”

Spencer explained the 7 variables, “In November of 2016, the World Health Organization published their first global SSI guidelines. This was fantastic for other countries that have done a lot of work in Asia [because] some of the things in CDC weren't applicable. So this was developed for outside the US, followed by the American College of Surgeons updating their guidelines in early 2017, followed by the Wisconsin guidelines, which I feel are the most comprehensive. But the Department of Public Health commissioned this project to develop their own SSI guidelines for Wisconsin, followed very closely by the CDC update from their guideline back in 1999. So we had to wait till 2017 to get updated guidelines. So that's what we did, we took the 4 of those guidelines, and then pulled out 7 variables.”

(Quotes have been edited for clarity.)