Factors Affecting Adherence to a Preoperative Surgical Site Infection Prevention Protocol

Reasons for the lack of treatment regimen adherence (ie, the extent to which patients follow healthcare provider-prescribed instructions1) are likely multifactorial, including health status, belief systems, social supports, economic factors, and regimen complexity.1 In chronic diseases such as pedia...

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Published in:Infection control and hospital epidemiology 2016-06, Vol.37 (6), p.728-730
Main Authors: Schaffzin, Joshua K., Mangeot, Colleen, Sucharew, Heidi, Beck, Andrew F., Sturm, Peter F.
Format: Article
Language:English
Subjects:
Adolescent
Anti-Infective Agents, Local - therapeutic use
Back surgery
Censuses
Child
Chronic illnesses
Congenital diseases
Disease management
Economic factors
Female
Guideline Adherence - statistics & numerical data
Humans
Logistic Models
Male
Multivariate Analysis
Nursing
Patients
Pediatrics
Poverty
Preoperative Care - methods
Prevention
Regression analysis
Research Briefs
Retrospective Studies
Scoliosis
Social Class
Socioeconomic factors
Socioeconomics
Spine
Surgical site infections
Surgical Wound Infection - epidemiology
Surgical Wound Infection - prevention & control
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Summary:Reasons for the lack of treatment regimen adherence (ie, the extent to which patients follow healthcare provider-prescribed instructions1) are likely multifactorial, including health status, belief systems, social supports, economic factors, and regimen complexity.1 In chronic diseases such as pediatric asthma, socioeconomic status (SES) has been associated with readmission and has been thought to represent a marker of adherence to chronic disease management.2 The role of SES in adherence to acute processes is not well understood. All-or-nothing adherence was measured based on self-report.6 The patient variables we considered included age at surgery, sex, race, and insurance, obtained from the electronic medical record (EMR), and number of complex chronic condition (CCC) categories obtained from the Pediatric Health Information System.7 We excluded technology dependence and other congenital or genetic defects from the CCC categorization because ~90% of included patients were positive for 1 or both, presumably due to a fusion procedure and/or scoliosis diagnosis (data not shown). Factors significant for an increased risk of protocol nonadherence in the final multivariate model included any previous spinal surgery, fewer months since protocol initiation, and high census-tract percentage of individuals in poverty (Table 1).TABLE 1 Univariate Analysis of Demographic and Clinical Factors by Protocol Adherence Groups and Multivariate Analysis of Factors Associated with Protocol Nonadherence Univariate Analysisa Multivariate Analysis Variable Adherent (N=302), No. (%) Non-Adherent (N=48), No. (%) P Value Adjusted OR 95% CI P Value Patient characteristics Age at surgery, y±SD 13.4±3.8 11.7±4.9
ISSN:0899-823X
1559-6834
DOI:10.1017/ice.2016.42