Abstract
BackgroundDespite the extensive research that has been conducted to date, practice often differs from established guidelines and will vary between individuals and organisations. It has been noted that the global uptake of local and international surgical antimicrobial prophylaxis (SAP) guidelines is poor with limited research investigating factors that affect guideline adherence. The purpose of this systematic review was to determine the reported barriers and enablers to the adherence of SAP guidelines.MethodsA search of the literature was performed using four electronic databases (CINAHL, EMBASE, PubMed and SCOPUS) for articles published in the English language from January 1998 to December 2018. Articles were included if they were solely related to SAP and discussed the barriers or enablers to SAP guideline adherence. Articles that assessed the adherence to a range of infection control measures or discussed adherence to antibiotic treatment guidelines rather than SAP guidelines were excluded from this review. Barriers and enablers were mapped to the Theoretical Domains Framework (TDF). The Mixed Methods Appraisal Tool was used to assess the quality of included studies.ResultsA total of 1489 papers were originally retrieved, with 48 papers meeting the eligibility criteria. Barriers and enablers were mapped to 11 out of 14 TDF domains: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, reinforcement, memory, attention and decision processes, environmental context and resources, social influences, emotion and behavioural regulation. Barriers were further categorised into personal or organisational barriers, while enablers were arranged under commonly trialled interventions.ConclusionsThere are numerous factors that can determine the uptake of SAP guidelines. An identification and understanding of these factors at a local level is required to develop tailored interventions to enhance guideline adherence. Interventions, when used in combination, can be considered as a means of improving guideline use.
Highlights
Despite the extensive research that has been conducted to date, practice often differs from established guidelines and will vary between individuals and organisations
Studies have focused on establishing the criteria that determine the appropriateness of surgical antimicrobial prophylaxis (SAP), with recommendations being updated by key bodies such as the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) [8, 9, 12]
Reference lists of full-text papers that met the eligibility criteria were hand searched in order to identify relevant studies that may not have appeared through the database search
Summary
Despite the extensive research that has been conducted to date, practice often differs from established guidelines and will vary between individuals and organisations. Surgical antimicrobial prophylaxis (SAP), the administration of antibiotics immediately prior to surgery, is a key strategy used to help prevent the development of post-operative infections, namely SSIs [7]. In Australia, further guidance is provided by the Australian Commission on Safety and Quality in Health Care via the Antimicrobial Stewardship Clinical Care Standards. This standard provides statements on the delivery of care to a patient with bacterial infections as well as how antibiotics should be prescribed for SAP [13]
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