PERCEPTION OF SURGICAL SITE INFECTION RISK FACTORS FOR SPINE SURGERY VARIES BY OPERATIVE TEAM ROLE

Purpose:

Surgical site infections (SSI) after orthopedic surgery have large personal and societal costs.  The success of interventions to decrease SSI risk, such as perioperative protocols, may be undermined by discordant perceptions of SSI risk among different surgical team members.  We sought to quantify these perceptions on the spine surgery service of a major orthopedic hospital.

Method:

We developed, piloted, and administered a survey of potential SSI risk factors composed of selected binary comparisons of 23 potential pre-, post-, and intraoperative sources of infection risk.  Respondents held one of 5 team roles: surgeon; operating room (OR) nurses or technician; infection control (IC) nurse; physician assistant (PA); or infectious disease (ID) physician.  We calculated the first eigenvector of pairwise comparisons to quantify group-specific risk rankings and also assessed the strength of belief in these rankings across groups on a 0-1 scale (1=strongest belief).

Result:

The survey was conducted at one of the largest orthopedic hospitals in the United States; calculations are based on responses from 147 spine surgery service workers (122 OR staff, 10 surgeons, 9 PAs, and 6 IC staff). OR and IC staff consider proper pre-surgical sterile preparation of patients to be the most important risk factor for SSI.  In contrast, the most important risk factors chosen by surgeons and PAs were patient comorbidities and post-operative soiling of the surgical site, respectively.  Surgeons held the strongest views regarding individual SSI risk factors, followed by IC staff, PAs, and OR staff (relative strength of belief 0.62, 0.60, 0.58, and 0.33, respectively) 

Conclusion:

Risk perceptions for post-spinal surgery SSI vary widely in content and strength of belief among surgical team members at our high-volume orthopedic hospital.  Addressing these role-specific health beliefs may aide in implementing infection control interventions.