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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
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