Awareness of Practice and Comparison with Best Evidence in Surgical Site Infection Prevention in Colorectal Surgery

Abstract

Background: The use of mechanical bowel preparation and prophylaxis with oral antimicrobial agents can prevent surgical site infection (SSI) in colorectal surgical procedures, but routine adoption of these and other practices by surgeons has been limited. The aim of this study was to determine the actual practice and surgeon beliefs about preventative measures in elective colorectal operations and to compare them with established recommendations. Methods: Web-based survey was sent to colorectal surgeons assessing knowledge, beliefs, and practices regarding the use of preventative measures for SSI. Results: Of 355 surgeons, 33% had no feedback of SSI rate; 60% believed in evidence for normothermia, wound edge protection, and use of alcohol solution, and reported use of these strategies. There was a discrepancy in the assumed evidence and use of hyperoxia, glove replacement after anastomosis, surgical tools replacement, and saline surgical site lavage. Most of respondents believe that oral antibiotic prophylaxis diminishes infection, but is indicated only by one third of them. Few surgeons believe in MBP, but many actually use it. Most surgeons believe that there is a discrepancy between published guidelines and actual clinical practice. As proper means to implement guidelines, checklists, standardized orders, surveillance, feedback of SSI rates, and educational programs are rated most highly by surgeons, but few of these are in place at their institutions. Conclusions: Gaps in the translation of evidence into practice remain in the prevention of SSI in colorectal surgical procedures. Several areas for improvement have been identified. Specific implementation strategies should be addressed in colorectal units.

Keywords: colorectal surgery; mechanical bowel preparation; oral antibiotic prophylaxis; prevention; surgical site infection.

FIG. 1.

Infection prevention measures that demonstrated good concordance (less than 20% of difference) between surgeons' beliefs regarding evidence (positive or negative) and clinical practice patterns. Color image is available online.

FIG. 2.

Infection prevention measures that demonstrated discordance (more than 20% of difference) between surgeons' beliefs regarding evidence and clinical practice patterns. Color image is available online.

FIG. 3.

Surgeons' beliefs about oral antibiotic prophylaxis and mechanical bowel preparation (MBP) efficacy. Color image is available online.

FIG. 4.

Actual use of oral antibiotic prophylaxis of responding surgeons. MBP = mechanical bowel preparation). Color image is available online.

FIG. 5.

Actual use of mechanical bowel preparation (MBP) of responding surgeons. Color image is available online.

FIG. 6.

Intra-operative replacement of gloves. Color image is available online.

FIG. 7.

Surgical instrument replacement. Color image is available online.

FIG. 8.

Proportion of surgeons who believe the prevention strategies should be used and comparison with their actual implementation at their hospitals. WHO = World Health Organization; SSI = surgical site infection. Color image is available online.