title: Exploring obstacles to proper timing of prophylactic antibiotics for surgical site infections.
abstract: BACKGROUND
  Surgical site infections remain one of the leading types of nosocomial infections. The administration of prophylactic antibiotics within a specific interval has been shown to reduce the burden of surgical site infections, but adherence to proper timing guidelines remains problematic. This study examined perceived obstacles to the use of evidence-based guidelines for the timely administration of prophylactic antibiotics to prevent surgical site infections.
  
  
  METHODS
  27 semi-structured interviews were conducted with anesthesiologists (n = 12), surgeons (n = 11), and perioperative administrators (n = 4) in two large academic hospitals to elicit their perceptions of the factors that prevent the timely administration of prophylactic antibiotics. Using a grounded theory approach, transcripts were analyzed for recurrent themes.
  
  
  RESULTS
  Despite having knowledge of guidelines, participants perceived consistent failure in the proper timing of antibiotic administration. Thematic analysis revealed a number of obstacles to the observance of guidelines including: (1) low priority, (2) inconvenience, (3) workflow, (4) organizational communication, and (5) role perception. Workflow and role perception were the dominant obstacles.
  
  
  CONCLUSIONS
  This study suggests that proper antibiotic timing is thwarted by significant obstacles. The gap between evidence-based guidelines and practice is populated by individual values, professional conflicts, and organizational conflicts which must be addressed in order to achieve optimal practice in this domain. Using group interviews to reveal these factors to team members and managers may be a first step to resolving the gap and reducing surgical site infections.
authors.affiliation: University of Toronto, Toronto, Ontario, Canada. jens.tan@utoronto.ca
authors.forename: J A
authors.initials: JA
authors.lastname: Tan
authors.forename: V N
authors.initials: VN
authors.lastname: Naik
authors.forename: L
authors.initials: L
authors.lastname: Lingard
mesh_terms: D000776:Anesthesiology; D019072:Antibiotic Prophylaxis / Q000592:standards*; D003625:Data Collection; D003627:Data Interpretation, Statistical; D019317:Evidence-Based Medicine; D005260:Female; D013502:General Surgery; D019983:Guideline Adherence; D006784:Hospitals, Teaching; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009726:Nurses; D010348:Patient Care Team; D010819:Physician's Role; D013530:Surgical Wound Infection / Q000517:prevention & control*; D013997:Time Factors