Indicators for monitoring the quality of surgical site infection prevention: A scoping review.

BACKGROUND: Surveillance of surgical site infection (SSI) prevention is important to detect unwarranted variations in practice that require address to avoid patient harm. Performance indicators quantify the quality of care, but the availability of such measures for clinical use across the surgical journey is unclear. This scoping review aimed to identify and summarise indicators (structure, process, outcome) developed and/or used to monitor the quality of SSI prevention care. METHODS: Databases and guideline repositories were searched for research, guidelines and technical documents which specified indicators for SSI prevention in any setting and inclusive of the whole surgical journey. Screening and data extraction were performed by two independent reviewers. Narrative synthesis was based on the PAGER framework, with indicators mapped to categories and subcategories. RESULTS: Across 77 documents, 276 indicators were identified. Most were process indicators (n=152; 55.1%), followed by structure (n=65; 23.6%) and outcome indicators (n=59; 21.4%). Structural measures were mapped to eight subcategories, including presence of protocols for specific care components (n=25; 38.5%) and surveillance (n=19; 29.2%). Process indicators were mapped to 18 subcategories, with most related to antibiotic administration (n=100; 65.8%), and fewer to topics such as skin/area preparation (n=8; 5.3%), hand hygiene (n=6; 3.9%) and normothermia (n=6; 3.9%). Most outcome measures reported SSI incidence (n=54; 91.5%). CONCLUSION: There is a need for standardised and validated indicators aligned across structure, process and outcome domains, which can be nuanced to specialty, procedure and local context. This would support organisations and clinicians globally to implement local monitoring and quality improvement mechanisms.