Surgical Site Infection Prevention: An Analysis of Compliance With Good Practice in Large Hospitals

Abstract

Background: Surgical site infection (SSI) is considered one of the most frequent adverse events globally. One of the strategies to mitigate its occurrence was proposed by the WHO in 2008 as part of the Safe Surgery Saves Lives program to reduce the rate of SSI by 25% by 2020. Objectives: To evaluate adherence to SSI prevention and control actions in large hospitals using a score. Methods: This cross-sectional study was conducted in 30 hospitals in Minas Gerais, Brazil, from February 2018 to April 2019. Data collection was performed through interviews with the coordinator of the hospital infection control service (HICS), situational diagnoses, and observation of a surgical procedures at the time of the visit. Data were analyzed using SPSS software. The variables were described using descriptive statistics. The project was approved by the Research Ethics Committee of the Federal University of Minas Gerais (COEP/UFMG) (CAAE: 30782614.3.00005149). A score was determined to identify the degree of compliance of institutions to SSI prevention practices. Results: In 93.3% of the HICSs, routines or protocols for the use of prophylactic antibiotic in surgery and compliance audits were mentioned, 69% reported hair removal with a clipper. SSI surveillance occurred in all institutions; however, only 63.3% disclosed SSI rates. In the situational observations, 60% of the professionals performed hand antisepsis within 3–5 minutes. Most frequently, hair removal was performed inside the operating room in 76.7% of the observed procedures and an electric clipper was used 56.7% of the time. In the surgery audit, prophylactic antimicrobial administration occurred between 30 and 60 minutes before surgical incision in only 63.3% of the observed procedures. The traffic in the operation room was limited to the necessary minimum in only 53.3% of observed procedures and unnecessary opening of the doors occurred in 76.7% of the observations. Patient temperature was not monitored in 70% of the audited procedures. Conclusions: According to the proposed score, 1 of the institutions (3.3%) complied with SSI prevention and control measures sufficiently; 25 complied partially (83.3%); and 4 (13.3%) demonstrated poor compliance.

Funding: None

Disclosures: None