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Table 3 Summary of studies that discussed both barriers and enablers

From: Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review

Author (year) and country

Study design and population

TDF Domain

Description of reported barrier

TDF Domain

Description of reported enabler

Broom et al. (2018) [77]

Australia

Qualitative

Social/professional role and identity

Personal barriers (interpersonal):

Relationship between surgeon and anaesthetist:

- Poor communication between surgeons and anaesthetist

- Lack of task delegation in regards to antibiotic use

Hierarchy within and between surgical and anaesthetist teams:

- Hierarchy affects whether a colleague’s decision would be “challenged”

Skills

Effective communication:

- Working in a private hospital sector as communication was seen as better. Improved responsibility sharing between surgeon and anaesthetist

Surgeons

Anaesthetists

Social influences

Environmental context and resources

Environmental context and resources

Beliefs about capabilities

Personal barrier (intrapersonal):

- Surgeon level of experience influences whether or not they choose to prescribe SAP (junior vs senior staff)

Skills

Knowledge

Environmental context and resources

Organisational barriers:

- Workflow – especially emergency settings, communication and consultation may not occur. SAP may not be considered a priority

- Effect of influential staff members on local cultures of prescribing (again the effect of hierarchy influencing correct SAP use)

Social influences

Giusti et al. (2016) [78]

Italy

Mixed methods

Environmental context and resources

Personal barriers (intrapersonal):

- Disagreement between health care professionals and content in guidelines

- Belief that antibiotics listed in guidelines are not efficacious

- Individual understanding of the meaning of prophylaxis; poorer understanding meant that antibiotic use was extended as a precautionary measure

- Poor knowledge of local hospital data on how SAP is used and the incidence of SSIs

- Level of experience: older, more experienced staff more likely to follow personal experience over guidelines

Knowledge

Guideline dissemination:

- Dissemination of guidelines, particularly when shared and communicated appropriately

Anaesthesiologists

Surgeons

Nurse coordinators

Knowledge

Environmental context and resources

Beliefs about capabilities

Social influences

Multidisciplinary collaboration:

- Trust in guideline developers. Multidisciplinary collaboration to develop guidelines

Beliefs about consequences

Other enablers:

- Belief that guideline adherence can act as a protective tool if legal action is taken against practitioner

Environmental context and resources

External barriers:

- Parental expectation that SAP would be used

- Pharmaceutical company pressure in regards to choice of antibiotic

Organisational barriers:

- Availability of hand hygiene facilities – overcrowding of patient rooms during visiting hours can lead to extended prophylaxis

Nobile et al. (2014) [79]

Italy

Quasi-experimental (pre-post),

Quantitative descriptive

Environmental context and resources

Organisational barrier:

- Lack of guideline presence on wards

Social influences

Multidisciplinary collaboration:

- Collaboration to review and update existing guidelines

Orthopaedic surgeons

Knowledge

Educational services:

- Educational sessions to explain SSI prevention,

Nurses

Pharmacists

Environmental context and resources

guidelines as well as the correct administration of SAP

Guideline dissemination:

- Development of pocket sized guidelines for quick reference

Behavioural regulation

Audit and feedback:

- Feedback given to staff when deviation from practice detected (regular monitoring and evaluation of practice)

  1. Abbreviations: SAP surgical antimicrobial prophylaxis, SSI surgical site infection