Clinicians' and Patients' Experiences and Perceptions on the Prevention and Management of Surgical Site Infections: A Mixed-Methods Systematic Review.

Aim: To explore clinicians' and patients' perceptions of implementing evidence-based practice to improve clinical practice for preventing and managing surgical site infections within hospital acute care settings.

Design: A convergent integrated mixed-methods systematic review using the Joanna Briggs Institute approach.

Methods: Included studies reported (i) acute care hospital clinicians' and patients' experiences and preferences for preventing and managing surgical site infections and (ii) barriers and facilitators to implementing surgical site infection prevention and management guidelines. The Mixed Methods Appraisal Tool and the Quality Improvement Minimum Quality Criteria Set were used for critical appraisal. Quantitative data was transformed into qualitised data, then thematically synthesised with qualitative data and coded all findings into themes. Clinicians' and patients' views were also compared.

Data sources: English language peer-reviewed studies published from 2009 to March 2023 were identified from Medline, EMBASE, CINAHL, PsycINFO and Cochrane Central Library.

Results: Thirty-seven studies (16 quantitative, 17 qualitative, 3 mixed-methods and 1 quality improvement) met the inclusion criteria. Five main themes represent key factors believed to influence the implementation of evidence-based surgical site infection prevention and management guidelines: (1) Intentional non-adherence to insufficiently detailed and outdated guidelines, (2) Knowledge deficits on evidence-based SSI care bring about inconsistent clinical practice, (3) Collaborative interdisciplinary and patient-provider relationship to enhance guideline uptake, (4) Infection surveillance to improve patient safety and quality of life and (5) Negative physical and psychological impacts on patients.

Conclusion: The five themes reflect a need for updated hospital guidelines as a medium to improve surgical site infection knowledge and ensure consistent and evidence-based clinical practice. This review also highlights the significance of interdisciplinary and patient-provider collaboration and infection surveillance to facilitate guideline uptake. The effectiveness of intervention bundles designed to improve these aspects of care will need to be evaluated in future research.

Impact: A future intervention bundle that includes (1) ensuring up-to-date hospital guidelines/policies; (2) fostering collaborative interdisciplinary teamwork culture between physicians, nurses, podiatrists, pharmacists and allied health professionals; (3) encouraging patient or carer involvement in shared decision-making and (4) implementing audit and feedback mechanism on infection surveillance is proposed to improve SSI prevention and management in acute care settings.

Reporting method: This paper followed the PRISMA 2020 checklist guideline for reporting systematic reviews.

Patient or public contribution: This mixed-methods systematic review collates evidence of clinicians' and patients' experiences and preferences for preventing and managing surgical site infections. The inclusion of hospital patients' perspectives supports the development of patient-centred interventions.

Trial registration: The review protocol is registered on the International Prospective Register of Systematic Reviews (PROSPERO 2021 CRD42021250885). Available at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021250885.