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Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections

University of Toronto, Toronto, Ontario, Canada

Correspondence to:
Dr J A Tan
Research Fellow, University Health Network, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4; jens.tan{at}utoronto.ca Background: Surgical site infections remain one of the leading types of nosocomial infections. The administration of prophylactic antibiotics within a specific interval has been shown to reduce the burden of surgical site infections, but adherence to proper timing guidelines remains problematic. This study examined perceived obstacles to the use of evidence-based guidelines for the timely administration of prophylactic antibiotics to prevent surgical site infections.

Methods: 27 semi-structured interviews were conducted with anesthesiologists (n = 12), surgeons (n = 11), and perioperative administrators (n = 4) in two large academic hospitals to elicit their perceptions of the factors that prevent the timely administration of prophylactic antibiotics. Using a grounded theory approach, transcripts were analyzed for recurrent themes.

Results: Despite having knowledge of guidelines, participants perceived consistent failure in the proper timing of antibiotic administration. Thematic analysis revealed a number of obstacles to the observance of guidelines including: (1) low priority, (2) inconvenience, (3) workflow, (4) organizational communication, and (5) role perception. Workflow and role perception were the dominant obstacles.

Conclusion: This study suggests that proper antibiotic timing is thwarted by significant obstacles. The gap between evidence-based guidelines and practice is populated by individual values, professional conflicts, and organizational conflicts which must be addressed in order to achieve optimal practice in this domain. Using group interviews to reveal these factors to team members and managers may be a first step to resolving the gap and reducing surgical site infections.

Abbreviations: OR, operating room; SSI, surgical site infection

Keywords: surgical site infections; prophylactic antibiotic timing; evidence-based practice

This article has been cited by other articles:

				S Espin, L Lingard, G R Baker, and G Regehr Persistence of unsafe practice in everyday work: an exploration of organizational and psychological factors constraining safety in the operating room. Qual. Saf. Health Care, June 1, 2006; 15(3): 165 - 170. [Abstract] [Full Text] [PDF]