A comprehensive qualitative investigation of the factors that affect surgical site infection prevention in cardiac surgery in England using observations and interviews

Judith Tanner; Lyn Brierley Jones; Nigel Westwood; Melissa Rochon; Catherine Wloch; Ricky Vaja; Luke J Rogers; Jeremy Dearling; Keith Wilson; Bilal H Kirmani; Sunil K Bhudia; Cha Rajakaruna; Mario Petrou; Louise Bailes; Angila Jawarchan; Maureen Baker; Gavin J Murphy

doi:10.1016/j.jhin.2024.04.016

A comprehensive qualitative investigation of the factors that affect surgical site infection prevention in cardiac surgery in England using observations and interviews

J Hosp Infect. 2024 May 7:S0195-6701(24)00159-2. doi: 10.1016/j.jhin.2024.04.016. Online ahead of print.

Authors

Judith Tanner¹, Lyn Brierley Jones², Nigel Westwood³, Melissa Rochon⁴, Catherine Wloch⁵, Ricky Vaja⁶, Luke J Rogers⁷, Jeremy Dearling³, Keith Wilson⁸, Bilal H Kirmani⁹, Sunil K Bhudia⁶, Cha Rajakaruna¹⁰, Mario Petrou⁶, Louise Bailes⁷, Angila Jawarchan⁴, Maureen Baker⁹, Gavin J Murphy¹¹

Affiliations

¹ School of Health Sciences, University of Nottingham, Nottingham, UK. Electronic address: judith.tanner@nottingham.ac.uk.
² School of Health Sciences, University of Nottingham, Nottingham, UK.
³ Patient and Public Representative, UK.
⁴ Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁵ HCAI, Fungal, AMR, AMU & Sepsis Division, UK Health Security Agency, London, UK.
⁶ Department of Cardiothoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁷ Department of Cardiothoracic Surgery, University Hospitals of Bristol and Weston NHS Foundation Trust, Bristol, UK.
⁸ Patient and Public Representative, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
⁹ Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital NHS Trust, Liverpool, UK.
¹⁰ Bristol Heart Institute, Bristol, UK.
¹¹ Department of Cardiothoracic Surgery, University of Leicester, Leicester, UK.

PMID: 38723904
DOI: 10.1016/j.jhin.2024.04.016

Abstract

Background: Interview and questionnaire studies have identified barriers and challenges to preventing surgical site infections (SSIs) by focusing on compliance with recommendations and care bundles using interviews, questionnaires and expert panels. This study proposes a more comprehensive investigation by using observations of clinical practice plus interviews which will enable a wider focus.

Aim: To comprehensively identify the factors which affect SSI prevention using cardiac surgery as an exemplar.

Methods: One hundred and thirty hours of observed clinical practice followed by individual semi-structured interviews with 16 surgeons, anaesthetists, theatre staff and nurses at four cardiac centres in England. Data were analysed thematically.

Findings: The factors were complex and existed at the level of the intervention, the individual, the team, the organisation and even the wider society. Factors included: the attributes of the intervention; the relationship between evidence, personal beliefs and perceived risk; power and hierarchy; leadership and culture; resources; infrastructure; supplies; organisation and planning; patient engagement and power; hospital administration; workforce shortages; Covid-19 pandemic; 'Brexit'; and the war in Ukraine.

Conclusion: This is one of the first studies to provide a comprehensive overview of the factors affecting SSI prevention. The factors are complex and need to be fully understood when trying to reduce SSIs. A strong evidence-base was insufficient to ensure implementation of an intervention.

Keywords: Surgical site infection; barriers; cardiac surgery; facilitators; interventions; qualitative.