Understanding determinants of infection control practices in surgery: the role of shared ownership and team hierarchy

Despite a large literature on surgical site infection (SSI), the determinants of prevention behaviours in surgery remain poorly studied. Understanding key social and contextual components of surgical staff behaviour may help to design and implement infection control (IC) improvement interventions in surgery.

Qualitative semi-structured interviews were conducted with surgeons (n = 8), nurses (n = 5) theatre personnel (n = 3), and other healthcare professionals involved in surgery (n = 4) in a 1500-bed acute care London hospital group. Participants were approached through established mailing lists and snowball sampling. Interviews were recorded and transcribed verbatim. Transcripts were coded and analysed thematically using a constant comparative approach.

IC behaviour of surgical staff was governed by factors at individual, team, and wider hospital level. IC practices were linked to the perceived risk of harm caused by an SSI more than the development of an SSI alone. Many operating room participants saw SSI prevention as a team responsibility. The sense of ownership over SSI occurence was closely tied to how preventable staff perceived infections to be, with differences observed between clean and contaminated surgery. However, senior surgeons claimed personal accountability for rates despite feeling SSIs are often not preventable. Hierarchy impacted on behaviour in different ways depending on whether it was within or between professional categories. One particular knowledge gap highlighted was the lack of awareness regarding criteria for SSI diagnosis.

To influence IC behaviours in surgery, interventions need to consider the social team structure and shared ownership of the clinical outcome in order to increase the awareness in specialties where SSIs are not seen as serious complications.