Surgical site infections (SSIs) are a frequent occurrence after abdominal surgery. They are an important cause of morbidity and mortality in postoperative patients as well as increased healthcare expenditure due to prolonged hospitalization and treatment costs. There are guidelines for prevention of SSIs, but compliance to them is often lacking or is suboptimal; moreover, these are not self-implementing. Hence, implementation interventions have been designed to encourage adherence to the guidelines. A systematic review was conducted to define various implementation interventions used to prevent SSIs post-abdominal surgery. Relevant literature was searched in Medline/PubMed database and Web of Science Core Collection and 40 studies were included in the review. Implementation subcategories of the EPOC category system developed by the Cochrane Review Group Effective Practice and Organisation of Care (EPOC) were used to classify implementation interventions. An effectiveness analysis was also conducted to examine the association between the number of implementation interventions, specific compositions thereof and the reduction in risk of SSIs, both absolute and relative.

Audit and feedback (80%, 32/40), organizational culture (70%,28/40), monitoring the performance of healthcare delivery (65%,26/40), reminders (53%,21/40) and educational meetings (45%,18/40) were identified as the five most commonly used implementation interventions adopted to prevent SSIs. Twenty-nine studies employed a multimodal strategy, with 3 or more interventions. Thirteen studies, which had used 3 to 5 interventions, showed the largest absolute risk reduction of 10.8% (p < .001); studies that used the top five interventions showed the largest relative risk reduction of 52.4% versus 43.1% for studies, which did not include these interventions. However, the analysis did not reveal significant differences in risk reduction either by the number of implementation interventions used or by use of the five most frequent ones (versus not).

The review concluded that multimodal strategies with standard implementation interventions (audit and feedback, organizational culture, performance monitoring, reminders, and educational meetings) are mainly used in cases of abdominal surgery to prevent SSIs. Effective analysis of differences in risk reduction of SSIs was inconclusive in terms of number and type of interventions. The researchers recommend more studies to establish the types and number of implementation interventions that would further enhance compliance with measures to prevent SSIs in abdominal surgery.

Tomsic I, et al. BMC Health Serv Res. 2020 Mar 20;20(1):236.