Article type
Abstract
Background: Surgical site infections (SSIs) can cause significant harm to patients, such as increased length of hospital stay, readmissions, suffering, or even death. It is estimated that 50% of these infections can be prevented. The implementation of evidence-based practice (EBP) is crucial to ensure better prevention and control of SSIs.
Objectives: To implement and promote compliance with the best evidence-based recommendations on prevention and control of SSIs, in a central operating room.
Methods: Carried out between October 2022 and June 2023, the project followed the JBI Evidence Implementation Framework, structured into seven steps across three phases: 1) Pre-Planning; 2) Baseline Audit, Feedback and Change Strategies` Implementation; 3) Impact Assessment and Sustainability Planning. The project team conducted a nine-criteria baseline audit on a 100-patient sample in an operating room. After implementing strategies, a follow-up audit was conducted, with the same samples and criteria, to assess the impact of these strategies on compliance with evidence recommendations.
Results: Areas of non-compliance were highlighted in the baseline audit, revealing inconsistency in the prevention of SSIs. A root cause analysis identified barriers such: lack of knowledge regarding intervention bundle; unfamiliarity with standardised handover; manual and obsolete doors; and insufficient number of cutting machines.
After interventions to implement best practices, the nine criteria compliance rate (Figure 1) improved as follows: Handover with ISBAR technique (criterion 1) from 9% to 42%, yet highlighting areas for further enhancement. Pre-surgical bath protocol (criterion 2) achieved 100% of compliance. Patient file verification and safe surgery protocol checking (criterion 3) had a negligible decrease from 100% to 99%. Prophylactic antibiotic protocol (criterion 4) remained stable at 91%. Significant improvements were in trichotomy performance glycemia control, and maintaining normothermia (criteria 5,6 and 7). Keep operating room doors closed (criterion 8) increased from 17% to 98%. Lastly, the nurse´s confirmation of surgical materials` sterilisation (criterion 9) reached compliance at 100%.
Conclusions:
The results indicate that audit-feedback cycle implementation is an effective method to increase EBP compliance. Given the increases in compliance and the opportunity to improve, the sustainability plan must be continuously monitored to allow timely adjustments and ensure the practice's continuous improvement.
Objectives: To implement and promote compliance with the best evidence-based recommendations on prevention and control of SSIs, in a central operating room.
Methods: Carried out between October 2022 and June 2023, the project followed the JBI Evidence Implementation Framework, structured into seven steps across three phases: 1) Pre-Planning; 2) Baseline Audit, Feedback and Change Strategies` Implementation; 3) Impact Assessment and Sustainability Planning. The project team conducted a nine-criteria baseline audit on a 100-patient sample in an operating room. After implementing strategies, a follow-up audit was conducted, with the same samples and criteria, to assess the impact of these strategies on compliance with evidence recommendations.
Results: Areas of non-compliance were highlighted in the baseline audit, revealing inconsistency in the prevention of SSIs. A root cause analysis identified barriers such: lack of knowledge regarding intervention bundle; unfamiliarity with standardised handover; manual and obsolete doors; and insufficient number of cutting machines.
After interventions to implement best practices, the nine criteria compliance rate (Figure 1) improved as follows: Handover with ISBAR technique (criterion 1) from 9% to 42%, yet highlighting areas for further enhancement. Pre-surgical bath protocol (criterion 2) achieved 100% of compliance. Patient file verification and safe surgery protocol checking (criterion 3) had a negligible decrease from 100% to 99%. Prophylactic antibiotic protocol (criterion 4) remained stable at 91%. Significant improvements were in trichotomy performance glycemia control, and maintaining normothermia (criteria 5,6 and 7). Keep operating room doors closed (criterion 8) increased from 17% to 98%. Lastly, the nurse´s confirmation of surgical materials` sterilisation (criterion 9) reached compliance at 100%.
Conclusions:
The results indicate that audit-feedback cycle implementation is an effective method to increase EBP compliance. Given the increases in compliance and the opportunity to improve, the sustainability plan must be continuously monitored to allow timely adjustments and ensure the practice's continuous improvement.