Surgical Team Perspectives on Infection Prevention Best Practices in the Operating Room

Background:

Surgical team practices are influenced by institutional culture, yet national focus on quality has resulted in dissemination of best practices across operating rooms (ORs). We designed a survey to assess attitudes regarding several horizontal infection prevention (IP) practices targeting perioperative care.

Methods:

An IRB approved survey was created to address 6 key practices for our IP program in the OR: 1) hand hygiene/ gloving, 2) timeouts, 3) chlorhexidine use, 4) temperature control, 5) OR attire and 6) staphylococcal screening/decolonization. OR personnel from neurosurgery (NS) and cardiothoracic surgery (CTS) completed surveys from 10/2015 to 12/2015.  

Results:

Surveys were completed by 42 providers: 26 from NS and 16 from CTS. There were 12 (30%) attending physicians, 13 (32%) residents, 7 (18%) nurses, and 8 (20%) other providers including nurse practitioners, physician assistants, and perfusionists.

A summary of responses is shown in Figure 1. Staff had a high level of agreement with the importance of surgical timeouts, staphylococcal screening/decolonization, and preferential use of chlorhexidine. Hand hygiene compliance was imperfect, with only 64% and 67% reporting consistent performance before and after gloving.

Knowledge of IP practices differed by staff characteristic. Residents and “other” provider types were less likely than attendings/nurses to know that chlorhexidine was superior to betadine for skin preps (62% vs 18%, p=0.0201). NS members reported frequent Bair Hugger use (76% always/mostly using), yet were unsure if this was a patient safety strategy (50% vs 19% of CTS group, p=0.0244). Nurses were more likely to always wear a personal fabric OR cap (100% vs <6% for all other provider types), which were laundered every few days to every few months; only one person washed after every use.  All provider types lacked awareness of the effectiveness of universal decolonization for preventing infections (17/39, 44%) and of its cost effectiveness (13/39, 33%).

Conclusion:

Staff understanding of the rationale for best practices may be lacking even when these practices are followed. Further education targeted to provider type may improve consistency with best practices for IP in the OR.