Current practices and evaluation of barriers and facilitators to surgical site infection prevention measures in Jimma, Ethiopia

Leigh R Berman; Andrew Lang; Beshea Gelana; Samuel Starke; Dawd Siraj; Daniel Yilma; Daniel Shirley

doi:10.1017/ash.2021.227

Current practices and evaluation of barriers and facilitators to surgical site infection prevention measures in Jimma, Ethiopia

Antimicrob Steward Healthc Epidemiol. 2021 Nov 17;1(1):e51. doi: 10.1017/ash.2021.227. eCollection 2021.

Authors

Leigh R Berman¹, Andrew Lang², Beshea Gelana³, Samuel Starke¹, Dawd Siraj⁴, Daniel Yilma^{5

6}, Daniel Shirley⁴

Affiliations

¹ University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
² University of Wisconsin Health, Madison, Wisconsin.
³ Department of Health Policy and Management, Jimma University, Jimma, Ethiopia.
⁴ Division of Infectious Disease, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
⁵ Department of Internal Medicine, Jimma University, Jimma, Ethiopia.
⁶ Jimma University Clinical Trial Unit, Jimma University, Jimma, Ethiopia.

Abstract

Objective: Surgical site infections (SSIs) greatly burden healthcare systems around the world, particularly in low- and middle-income countries. We sought to employ the Systems Engineering Initiative for Patient Safety (SEIPS) model to better characterize SSI prevention practices and factors affecting adherence to prevention guidelines at Jimma University Medical Center (JUMC).

Design: Our cross-sectional study consisted of semistructured interviews designed to elicit perceptions of and barriers and facilitators to SSI prevention among surgical staff and observations of current preoperative, perioperative, and postoperative SSI prevention practices in surgical cases. Interviews were recorded, manually transcribed, and thematically coded within the SEIPS framework. Trained observers recorded compliance with the World Health Organization's SSI prevention recommendations.

Setting: A tertiary-care hospital in Jimma, Ethiopia.

Participants: Surgical nurses, surgeons, and anesthetists at JUMC.

Results: Within 16 individual and group interviews, participants cited multiple barriers to SSI prevention including shortages of water and antiseptic materials, lack of clear SSI guidelines and training, minimal Infection Prevention Control (IPC) interaction with surgical staff, and poor SSI tracking. Observations from nineteen surgical cases revealed high compliance with antibiotic prophylaxis (94.7%), hand scrubbing (100%), sterile gloves and instrument use (100%), incision site sterilization (100%), and use of surgical safety checklist (94.7%) but lower compliance with preoperative bathing (26.3%), MRSA screening (0%), and pre- and postoperative glucose (0%, 10.5%) and temperature (57.9%, 47.3%) monitoring.

Conclusions: Utilizing the SEIPS model helped identify institution-specific barriers and facilitators that can inform targeted interventions to increase compliance with currently underperformed SSI prevention practices at JUMC.