Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
BMJ Open. 2023 Apr 21;13(4):e073137. doi: 10.1136/bmjopen-2023-073137.
To assess the effects of a quality improvement (QI) team training intervention, by measuring the intervention fidelity and the compliance with a surgical site infection (SSI) bundle in the operating theatre (OT).
Multicentre before-after study.
This study was performed in four Dutch hospitals.
The QI team training intervention consisted of four sessions per hospital and stimulated participants to set culture norms and targets, identify barriers, and formulate management activities to improve compliance with four standard operating procedures (SOPs) of a SSI bundle in the OT. Participants were executive board members, top-level managers, leading clinicians and support staff. The four SOPs were: (1) reducing door movements; (2) preoperative antibiotic prophylaxis prescribing; (3) preoperative shaving; and (4) postoperative normothermia. and logistic regression analyses were performed to analyse the effect of the intervention on compliance with the individual SOPs (primary outcome measure) and on the influence of medical specialty, time of day the procedure took place and time in the OT (secondary outcome measures).
Not all management layers were successfully involved during all sessions in the hospitals. Top-level managers were best represented in all hospitals, leading clinicians the least. The number of implemented improvement activities was low, ranging between 2 and 14. The team training intervention we developed was not associated with improvements in the compliance with the four SOP of the SSI bundle. Medical specialty, time of day, and time in OT were associated with median number of door movements, and preoperative antibiotic prophylaxis administration.
This study showed that after the QI team training intervention the overall compliance with the four SOPs did not improve. Minimal involvement of leading clinicians and a low number of self-initiated activities after the team training were important barriers for compliance.
通过测量干预的实施保真度和手术室（OT）中外科部位感染（SSI）包的依从性，评估质量改进（QI）团队培训干预的效果。
多中心前后研究。
本研究在荷兰的四家医院进行。
QI 团队培训干预包括每家医院的四个会议，鼓励参与者设定文化规范和目标，识别障碍，并制定管理活动，以提高 OT 中 SSI 包的四项标准操作规程（SOP）的依从性。参与者为执行委员会成员、高层管理人员、首席临床医生和支持人员。四项 SOP 为：（1）减少门的移动；（2）术前抗生素预防用药；（3）术前刮毛；（4）术后体温正常。进行逻辑回归分析，以分析干预对遵守个别 SOP（主要结果测量）的影响，以及对医疗专业、手术时间和 OT 时间的影响（次要结果测量）。
并非所有管理层面都能在每家医院的所有会议中成功参与。高层管理人员在所有医院中都有最好的代表性，首席临床医生的代表性最差。实施的改进活动数量很少，范围在 2 到 14 之间。我们开发的团队培训干预与 SSI 包的四项 SOP 的依从性提高无关。医疗专业、手术时间和 OT 时间与门的移动次数中位数以及术前抗生素预防用药有关。
本研究表明，QI 团队培训干预后，四项 SOP 的总体依从性并未提高。首席临床医生的参与度低，以及团队培训后自主开展活动的数量少，是遵守规定的重要障碍。
