Background. Despite a large literature on surgical site infection (SSI), the determinants of
prevention behaviours in surgery remain poorly studied. Understanding key social and
contextual components of surgical staff behaviour may help to design and implement
infection control (IC) improvement interventions in surgery.
Methods. Qualitative semi-structured interviews were conducted with surgeons (n = 8),
nurses (n = 5) theatre personnel (n = 3), and other healthcare professionals involved in surgery
(n=4) in a 1500-bed acute care London hospital group. Participants were approached through
established mailing lists and snowball sampling. Interviews were recorded and transcribed
verbatim. Transcripts were coded and analysed thematically using a constant comparative
approach.
Results. IC behaviour of surgical staff was governed by factors at individual, team, and wider
hospital level. IC practices were linked to the perceived risk of harm caused by an SSI more
than the development of an SSI alone. Many operating room participants saw SSI prevention
as a team responsibility. The sense of ownership over SSI occurence was closely tied to how
preventable staff perceived infections to be, with differences observed between clean and
contaminated surgery. However, senior surgeons claimed personal accountability for rates
despite feeling SSIs are often not preventable. Hierarchy impacted on behaviour in different
ways depending on whether it was within or between professional categories. One particular
knowledge gap highlighted was the lack of awareness regarding criteria for SSI diagnosis.
Conclusions. To influence IC behaviours in surgery, interventions need to consider the social
team structure and shared ownership of the clinical outcome in order to increase the
awareness in specialties where SSIs are not seen as serious complications.