Stanford University School of Medicine, Palo Alto, CA, USA.
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
BMC Health Serv Res. 2019 Aug 17;19(1):579. doi: 10.1186/s12913-019-4383-8.
Clean Cut is a six month, multi-modal, adaptive intervention aimed at reducing surgical infections through improving six critical perioperative processes: 1) handwashing/skin preparation, 2) surgical gown/drape integrity, 3) antibiotic administration, 4) instrument sterility, 5) gauze counts, and 6) WHO Surgical Safety Checklist use. The aim of this study was to elucidate themes across Clean Cut implementation sites in Ethiopia to improve implementation at future hospitals.
We conducted semi-structured interviews of 20 clinicians involved in Clean Cut at four hospitals. Participation was limited to Clean Cut team members and included surgeons, anesthetists, operating room (OR) nurses, ward nurses, OR managers, quality improvement personnel, and hospital administrators. Audio recordings were transcribed and coded using qualitative software. A codebook was inductively and iteratively derived between two researchers, tested for inter-rater reliability, and applied to all transcripts. We conducted thematic analysis to derive our final qualitative results.
The interviews revealed barriers and facilitators to the implementation of Clean Cut, as well as strategies for future implementation sites. Key barriers included material resource limitations, feelings of job burden, existing gaps in infection prevention education, and communication errors during data collection. Common facilitators included strong hospital leadership support, commitment to improved patient outcomes, and organized Clean Cut training sessions. Future strategies include resource assessments, creating a sense of responsibility among staff, targeted training sessions, and incorporating new standards into daily routine.
The findings of this study highlight the importance of engaging hospital leadership, providers and staff in quality improvement programs, and understanding their work contexts. The identified barriers and facilitators will inform future initiatives in the field of perioperative infection prevention.
Clean Cut 是一项为期六个月的多模式、自适应干预措施，旨在通过改善六个关键手术期流程来减少手术感染：1）洗手/皮肤准备，2）手术服/手术巾完整性，3）抗生素使用，4）器械无菌性，5）纱布计数，以及 6）使用世卫组织手术安全检查表。本研究旨在阐明 Clean Cut 在埃塞俄比亚实施点的主题，以提高未来医院的实施效果。
我们对四家医院的 20 名参与 Clean Cut 的临床医生进行了半结构式访谈。参与者仅限于 Clean Cut 团队成员，包括外科医生、麻醉师、手术室护士、病房护士、手术室经理、质量改进人员和医院管理人员。音频记录被转录并使用定性软件进行编码。两位研究人员之间使用归纳和迭代法得出代码本，并进行了组内信度测试，然后应用于所有转录本。我们进行了主题分析，以得出最终的定性结果。
访谈揭示了 Clean Cut 实施的障碍和促进因素，以及未来实施点的策略。主要障碍包括物质资源限制、工作负担感、感染预防教育方面的现有差距以及数据收集过程中的沟通错误。常见的促进因素包括医院领导的大力支持、对改善患者结果的承诺以及有组织的 Clean Cut 培训课程。未来的策略包括资源评估、在员工中建立责任感、有针对性的培训课程以及将新标准纳入日常工作。
本研究结果强调了让医院领导、医务人员和工作人员参与质量改进计划以及了解其工作环境的重要性。确定的障碍和促进因素将为手术期感染预防领域的未来举措提供信息。
