title: Surgical site infection: poor compliance with guidelines and care bundles.
abstract: Surgical site infections (SSIs) are probably the most preventable of the health care-associated infections. Despite the widespread international introduction of level I evidence-based guidelines for the prevention of SSIs, such as that of the National Institute for Clinical Excellence (NICE) in the UK and the surgical care improvement project (SCIP) of the USA, SSI rates have not measurably fallen. The care bundle approach is an accepted method of packaging best, evidence-based measures into routine care for all patients and, common to many guidelines for the prevention of SSI, includes methods for preoperative removal of hair (where appropriate), rational antibiotic prophylaxis, avoidance of perioperative hypothermia, management of perioperative blood glucose and effective skin preparation. Reasons for poor compliance with care bundles are not clear and have not matched the wide uptake and perceived benefit of the WHO 'Safe Surgery Saves Lives' checklist. Recommendations include the need for further research and continuous updating of guidelines; comprehensive surveillance, using validated definitions that facilitate benchmarking of anonymised surgeon-specific SSI rates; assurance that incorporation of checklists and care bundles has taken place; the development of effective communication strategies for all health care providers and those who commission services and comprehensive information for patients.
authors.affiliation: School of Applied Sciences, University of Huddersfield, Huddersfield, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Leaper
authors.affiliation: Clinical Nursing Research, DeMontfort University, Leicester, UK.
authors.forename: Judith
authors.initials: J
authors.lastname: Tanner
authors.affiliation: Prevention and Control of Infection, Southport and Ormskirk Hospitals NHS Trust, Southport, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Kiernan
authors.affiliation: Department of Hospital Hygiene, Medical University of Vienna, Vienna, Austria.
authors.forename: Ojan
authors.initials: O
authors.lastname: Assadian
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Edmiston
mesh_terms: D019072:Antibiotic Prophylaxis; D019983:Guideline Adherence; D006801:Humans; D064872:Patient Care Bundles / Q000379:methods*; D058996:Quality Improvement; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control*
keywords: Care bundles; Compliance; Guidelines; Surgical site infection