Table 3.
Barriers and Facilitators to SSI Prevention Characterized Within the SEIPS model and Ranked by the Number of Times Each Theme was Cumulatively Mentioned Within All Interviews
| Tools and Technology | Organization | Environment | Person | Tasks |
|---|---|---|---|---|
| Barriers | ||||
| Insufficient antiseptic (26), water (25), or soap (10) | Lack of protocols and guidelines (30) a | High OR traffic (14) | Insufficient training on SSI prevention (38) a | Lack of patient follow-up (28) |
| Inadequate supply of gloves (20) | IP staff uninvolved (12) a | Poor OR ventilation (7) | Staff not following protocols (10) | Time pressure in emergency cases (17) |
| Lack of antibiotic choice (9) | Poor communication between OR and ward (6) | Too hot in the OR (5) | Poor staff attitude or motivation (2) | High workload (9) |
| Shortage of cleaning tools (4) | Minimal tracking of patient outcomes (4) | Poor OR zone signage (5) a | Complicated surgeries (8) | |
| Cultures not available (4) | Teaching hospital setting (2) | Few bathrooms in hospital (3) | Communication about antibiotics (8) | |
| Facilitators | ||||
| Sterile instrument indicators (23) | Culture of speaking up about breaks in sterility (16) | Environmental services disinfects room and table (6) | Staff knowledgeable about SSI prevention (14) | Surgeries are generally short (1) |
| Available water and antiseptics (11) | Infection Prevention staff known (9) | OR is separate space (5) | Motivation to prevent SSI (6) | Good wound care (1) |
| Antibiotics on hand (5) | Informal notification about surgical complications (7) | Hospital is new (4) | Good training in IP (6) | Rational use of antibiotics (1) |
| Sufficient gloves (4) | SSC (5) | Hospital is clean (3) | Good training (2) | |
| Waste and sharps containers (3) | National/International guidelines known (3) | Handwashing posters are present (3) | ||
| Central supply (2) |
Note. SSC, surgical safety checklist; SSI, surgical site infection; IP, infection prevention; SEIPS, Systems Engineering Initiative for Patient Safety.
a
Characterized as easy-to-modify, relative to other barriers.