The persistent breach between evidence and practice in the prevention of surgical site infection. Qualitative study (2020)

Author: Badia et al.

Surgical site infections (SSI) account for up to 25% of all healthcare associated infections (HCAI) with evidence-based guidelines available both nationally and internationally. Despite these guidelines being available there appears to be a gap in the theoretical measures and what is actually practiced. In this study, the authors surveyed members of 11 associations of operative nurses and surgeons to gather data on the respondent’s awareness of evidence, personal beliefs and actual use of the main SSI preventative measures.  These valuable key points can provide areas for quality improvement interventions.


  • SSI continue to be the most common complication among patients undergoing any type of surgery
  • The World Health Organisation (WHO), Centres for Disease Control and Prevention (CDC), National Institute of Health and Clinical Excellence (NICE) and NHS Scotland provide guideline on the prevention of SSI.
  • Up to 50% of surgeons have no regular feed-back of their SSI rate given by their institution
  • Despite the removal of hair by shaving the surgical area is not recommended, 27% of respondents still do it even though more than 40% of them are aware of the evidence against these preventative measures
  • 85% of respondents were both aware of and believed in the evidence for perioperative oxygen but only 28% used this in practice
  • There was a low rate of preoperative nutritional assessment prior to major surgery
  • The different methods for skin antisepsis included 66% using aqueous solutions, 87% using a brushstroke application and 76% using multiple-use antiseptic bottles.
  • Manual drying after antiseptic application was found to be practiced by 30.8% of respondents despite the habit of drying the antiseptic with absorbent paper can lead to a break of antisepsis. In addition, allowing time for the preparation solutions to air dry is imperative to maximize its efficacy and prevent a fire hazard
  • Just over half the respondents viewed the local hospital protocol to be more important than International and National guidelines.
  • The WHO safety checklist was currently used by 81.6% or respondents
  • 9% of respondents felt that educational materials within the hospital and operating theatres should be available
  • The most closely followed current practice guidelines by operative nurses and surgeons are the practice of preoperative shower, surgical hand scrub of the surgical staff, use of impermeable surgical drapes and perioperative normothermia
  • The survey results show that many senior surgeons do not follow the best surgical practices despite being aware of the evidence underlying them


The persistent breach between evidence and practice in the prevention of Surgical Site Infections.

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