Surgical site infection prevention: a qualitative analysis of an individualized audit and feedback model

Surgical site infection (SSI) adversely affects patient outcomes and health care costs, so prevention of SSI has garnered much attention worldwide. Surgical site infection is recognized as an important quality indicator of patient care and safety. The purpose of this study was to use qualitative research methods to evaluate staff perceptions of the utility and impact of individualized audit and feedback (AF) data on SSI-related process metrics for their individual practice, as well as on overall communication and teamwork as they relate to SSI prevention.

This study was performed in a tertiary care center, based on patients treated in the colorectal and hepatic-pancreatic-biliary surgical oncology services. Eighteen clinicians were interviewed. Analysis of interviews via comparative analysis techniques and coding strategies were used to identify themes.

The most important finding of this study was that although nearly all participants believed that the individualized AF model was useful in effecting individual practice change as well as improving awareness and accountability around individual roles in preventing SSIs, it was not seen as a means to enable the multidisciplinary teamwork required for sustainable practice changes. Moreover, such teamwork requires a team leader.

Provision of individualized AF data had a significant impact on promoting individual practice change. Despite this, we concluded that practice change is a shared responsibility, requiring a team leader. So, AF had little bearing on establishing a necessary multidisciplinary team approach to SSI prevention, to create more effective and sustainable practice change among an entire team.