Moi Lin Ling1
1Singapore General Hospital, Outram Road, Singapore 169608.
Surgical site infections (SSIs), as in other healthcare associated infections, require thoughtful but deliberate action to prevent. Although many prevention guidelines are readily available, the successful implementation of best practices is a daunting logistical task that is fraught with challenges related to the complex systems in the healthcare setting. Implementation strategies will need to be based on current knowledge of potentially effective interventions as well as an assessment of potential barriers to guideline adoption. The identification of barriers may subsequently lead to the development of tailored implementation strategies.
A carefully crafted national campaign can accelerate the spread of evidence-based practices, as seen in the Joining Organizations IN Tackling SSIs (JOINTS) program in USA. This model is based on three principles: (1) the development of a quality improvement plan, (2) small-scale tests of change (“Plan-Do-Study-Act cycles”) to refine implementation approaches through iterative learning, and (3) reliance on multi-disciplinary implementation teams. Managing change can be a huge undertaking for low-resource countries. The Asia Pacific Society of Infection Control (APSIC) launched a collaborative in 2018 to help hospitals in the region implement the APSIC Guidelines for the prevention of SSIs. The projects in participating hospitals aim to achieve large scale spread of successful pilot improvement initiatives over 18 months. Early analysis has shown significant reduction in SSIs following the successful implementation hospital-wide of evidence-based SSI prevention practices in some of the participating hospitals. The system-wide buy-in fostered by including relevant stakeholders in the multidisciplinary team with the strong support of leadership, led to the successful implementation of best-practice guidelines.