Program Schedule

Facilitators and Barriers to SSI Bundle Implementation in Select Surgical Procedures

Session: Poster Abstract Session: Surgical Site Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • SSI Bundle Poster Print.pdf (185.6 kB)
  • Background: The Study to Optimally Prevent SSIs in Select Cardiac & Orthopedic Procedures (STOP SSIs) tested an evidence-based bundle to reduce the incidence of surgical site infections caused by S. aureusin patients having cardiac operations or hip or knee arthroplasty. Twenty hospitals in a national health system implemented the bundle.

    Methods: Investigators collected qualitative data about implementation from monthly coaching calls & an end-of-study video conference call with study champions from participating hospitals. Data were imported into MAXQDA & coded for thematic content regarding facilitators & barriers to bundle implementation.

    Results: Numerous factors influenced bundle implementation at & across 3 nested levels: the healthcare network, the hospital, & the individual. Vital facilitators at the network level included a corporate physician champion, infrastructure & resources, & the ability to share practical solutions. These facilitators did not always help participants overcome barriers at the hospital level (e.g., culture, slow committee approval, implementation for urgent & emergent procedures, hardwiring practice across days & shifts), individual level (e.g., resistance or autonomy), or across levels (e.g., competing priorities, decentralized offices, complex communication channels between patients & providers & between levels of care & screening locations). Also, new staff could change existing relationships & processes, or staff who successfully managed bundle implementation might be unable to maintain adherence as other network- or hospital-level demands increased. Facilitators at one level also could create barriers at other levels (e.g., audits of bundle adherence facilitated overall implementation but increased work for study champions). Facilitators & barriers differed between hospitals & hospitals differed in their capacity to overcome barriers.

    Conclusion: This qualitative study found that hospitals varied in their ability to implement the bundle & to overcome obstacles. Hospitals also shared some barriers & facilitators to implementation. This data identifies common facilitators & barriers during implementation & supports hardwiring to sustain evidence-based surgical care practices.

    Heather Reisinger, PhD1, Kimberly Dukes, PhD2, Marin Schweizer, PhD3, Barbara Braun, PhD4, Joanne Hafner, RN, MS5, Julia Moody, MS6, Melissa Ward, MS7, Cheryl Richards, BS, RHIA5, Jason Hickcock, MBA, RN8, Edward Septimus, MD, FIDSA, FSHEA6, Loreen a. Herwaldt, MD, FIDSA, FSHEA3 and Jonathan Perlin, MD, PhD, MSHA, FACP, FACMI6, (1)Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA, (2)Carver College of Medicine, University of Iowa, Iowa City, IA, (3)Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (4)Health Services Research, The Joint Commission, Oakbrook Terrace, IL, (5)The Joint Commission, Oakbrook Terrace, IL, (6)Clinical Services Group, HCA Inc, Nashville, TN, (7)Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, (8)Hospital Corporation of America, Nashville, TN


    H. Reisinger, None

    K. Dukes, None

    M. Schweizer, None

    B. Braun, None

    J. Hafner, None

    J. Moody, None

    M. Ward, None

    C. Richards, None

    J. Hickcock, None

    E. Septimus, None

    L. A. Herwaldt, None

    J. Perlin, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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