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Table 1 Summary of reported barriers

From: Factors that influence adherence to surgical antimicrobial prophylaxis (SAP) guidelines: a systematic review

Author (year) and country Study design and population TDF Domain Description of reported barrier
Al-Azzam et al. (2012) [35]
Quantitative, descriptive (cross-sectional survey) Knowledge Personal barrier (intrapersonal):
- Lack of guideline knowledge
Physicians Environmental context and resources Organisational barriers:
- Work flow
- Lack of organisational communication
- Drug unavailability
- Drug cost
- Presence of institutional policy (preventing the use of international guidelines – note that authors were determining compliance to international guidelines in this paper)
Bonfait et al. (2010) [36]
Quantitative, descriptive Social/Professional role and identity Personal barriers (interpersonal):
- Lack of role delegation for prescribing and administering antibiotics
Orthopaedic surgeons Knowledge Personal barriers (intrapersonal):
- Lack of awareness of guideline content
- Antibiotics not administered due to “negligence or oversight”
Memory, attention and decision processes
Environmental context and resources Organisational barriers:
- Lack of communication between specialties (anaesthetists and surgeons) at induction
- Insufficient staff training
- Excessive workload and inappropriate work allocation
- Lack of written guidelines
- Guidelines present in the wrong place – inaccessible in theatre or on the wards
Broom et al. (2018) [37]
Qualitative Memory attention and decision processes Personal barriers (intrapersonal):
- Lack of confidence in ability to protect against adverse consequences/ fear of repercussions (infections) hence extended duration of prophylaxis (“peace of mind”)
- Level of experience (junior vs senior)
Beliefs about consequences
Beliefs about capabilities
Social influences Organisational barriers:
- Culture of improvisation as the norm rather than guideline adherence
- Antibiotic prophylaxis is seen as low priority by staff in theatre especially if competing demands are present
Environmental context and resources
Chen et al. (2018) [38]
Quantitative descriptive Knowledge Personal barriers (intrapersonal):
- Lack of awareness
- Reliance on personal experience to determine practice
Beliefs about capabilities
Paediatric electrophysiologists Environmental context and resources Organisational barriers:
- Presence of institutional guidelines (preventing national guidelines from being used – note that authors were reviewing compliance to national guidelines in this study)
- Lack of data present for paediatric population (hence national guidelines not being adhered to)
Madubueze et al. (2015) [39]
Quantitative descriptive Skills Personal barriers (intrapersonal):
- Habits that have been picked up during training or practice
- Belief that proper aseptic techniques are not being followed on site
Orthopaedic surgeons Beliefs about consequences
Environmental context and resources Organisational barriers:
- Work environment sterility (not considered clean enough hence the extension of antibiotic use)
Tan et al. (2006) [40]
Qualitative Social/professional role and identity Personal barriers (interpersonal):
Role perception:
- Shared responsibility: belief that there is a shared responsibility in administering antibiotics (should be administered by whoever it is most convenient for at the time)
- Individual responsibility: belief that antibiotic should be administered by nurse or anaesthesiologist
- Resignation: anaesthesiologists expressed resentment at having to administer antibiotics – was considered external to scope of practice; violation of medical hierarchy
Peri-operative administrators (nurse/anaesthesia administrators)
Social influences
Environmental context and resources Organisational barriers:
- Inherent unpredictability of workflow systems as well as unanticipated changes to workflow
- Antibiotic prophylaxis considered as low priority given other competing concerns in theatre
- Administration is seen as inconvenient as it disrupts preoperative routine
- Lack of verbal communication regarding antibiotics information