title: Identifying opportunities for quality improvement in surgical site infection prevention.
abstract: BACKGROUND
  This study evaluated surgical site infection (SSI) prevention strategies at a network of university hospitals to identify interventions that may be required to improve compliance with guidelines.
  
  
  METHODS
  Qualitative methods were used for thematic analysis of institutional tools and protocols, and transcripts of interviews with 7 surgical division heads and 11 professional managers of quality improvement or infection prevention and control at 7 hospitals. They were asked about awareness of, and accountability for, SSI prevention, and current and recommended strategies to promote compliance.
  
  
  RESULTS
  Despite awareness of SSI prevention guidelines and the presence of organizational factors thought necessary for quality improvement (coordinators, champions), most sites had not reviewed their own practice and implemented corrective strategies. Barriers included use of passive educational strategies, lack of clinician accountability, limited implementation of point-of-care tools, and an absence of performance data.
  
  
  CONCLUSIONS
  The sites involved in this evaluation and others interested in increasing compliance with SSI prevention guidelines might implement education and performance data in tandem with accountabilities that trigger action, more actively engage champions to promote SSI prevention, create or update and incentivize use of tools such as standard orders, and encourage greater teamwork through organizational support of quality improvement.
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Electronic address: anna.gagliardi@sunnybrook.ca.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Gagliardi
authors.affiliation: University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cagla
authors.initials: C
authors.lastname: Eskicioglu
authors.affiliation: Mt. Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: McKenzie
authors.affiliation: Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Darlene
authors.initials: D
authors.lastname: Fenech
authors.affiliation: St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Avery
authors.initials: A
authors.lastname: Nathens
authors.affiliation: Mt. Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Robin
authors.initials: R
authors.lastname: McLeod
mesh_terms: D001291:Attitude of Health Personnel; D003428:Cross Infection / Q000517:prevention & control*; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D007407:Interviews as Topic; D011364:Professional Practice; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000379:methods*; D013530:Surgical Wound Infection / Q000517:prevention & control*