title: Surgical site infection prevention: a survey to identify the gap between evidence and practice in University of Toronto teaching hospitals.
abstract: BACKGROUND
  A gap exists between the best evidence and practice with regards to surgical site infection (SSI) prevention. Awareness of evidence is the first step in knowledge translation.
  
  
  METHODS
  A web-based survey was distributed to 59 general surgeons and 68 residents at University of Toronto teaching hospitals. Five domains pertaining to SSI prevention with questions addressing knowledge of prevention strategies, efficacy of antibiotics, strategies for changing practice and barriers to implementation of SSI prevention strategies were investigated.
  
  
  RESULTS
  Seventy-six individuals (60%) responded. More than 90% of respondents stated there was evidence for antibiotic prophylaxis and perioperative normothermia and reported use of these strategies. There was a discrepancy in the perceived evidence for and the self-reported use of perioperative hyperoxia, omission of hair removal and bowel preparation. Eighty-three percent of respondents felt that consulting published guidelines is important in making decisions regarding antibiotics. There was also a discrepancy between what respondents felt were important strategies to ensure timely administration of antibiotics and what strategies were in place. Checklists, standardized orders, protocols and formal surveillance programs were rated most highly by 75%-90% of respondents, but less than 50% stated that these strategies were in place at their institutions.
  
  
  CONCLUSIONS
  Broad-reaching initiatives that increase surgeon and trainee awareness and implementation of multifaceted hospital strategies that engage residents and attending surgeons are needed to change practice.
authors.affiliation: Departments of Surgery and Health Policy, Management and Evaluation, University of Toronto, Ontario.
authors.forename: Cagla
authors.initials: C
authors.lastname: Eskicioglu
authors.forename: Anna R
authors.initials: AR
authors.lastname: Gagliardi
authors.forename: Darlene S
authors.initials: DS
authors.lastname: Fenech
authors.forename: Shawn S
authors.initials: SS
authors.lastname: Forbes
authors.forename: Marg
authors.initials: M
authors.lastname: McKenzie
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D005260:Female; D013502:General Surgery / Q000592:standards* / Q000639:trends; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration*; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D020380:Needs Assessment; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires