Examining barriers to implementing a surgical-site infection bundle.

Area of Science:

• Healthcare quality improvement
• Infection prevention
• Surgical safety

Background:

• Surgical-site infections (SSIs) pose significant risks to patient outcomes.
• Evidence-based bundles can reduce SSIs, but implementation challenges are common.
• Sustaining these practices requires overcoming multifaceted barriers.

Purpose of the Study:

• To explore the implementation processes of SSI prevention bundles in diverse US hospital settings.
• To identify facilitators and barriers to the successful adoption and sustainability of SSI bundles.

Main Methods:

• Qualitative study utilizing in-depth, semistructured interviews.
• Thematic analysis of interview transcripts from 30 hospital personnel across 6 US hospitals.
• Inclusion of participants from academic tertiary-care, academic-affiliated community, and unaffiliated community hospitals.

Main Results:

• Bundle complexity and variability in barriers across services were key challenges.
• No single implementation strategy proved universally effective; tailored approaches were necessary.
• Sustained interprofessional collaboration emerged as a critical facilitator for successful implementation.

Conclusions:

• Implementing SSI prevention bundles is complex and requires context-specific strategies.
• Adaptations to implementation approaches are essential for different settings and populations.
• Improving bundle adoption, fidelity, acceptability, and sustainability hinges on addressing setting-specific barriers.