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Human factors


Psychological factors and preventing SSIs


Dr. Richard Sherry, a Clinical Psychologist, proposes a change of approach in surgical care that considers psychological human factors in efforts to reduce surgical site infection and the risk of complications. He calls for a change in how human behaviour is considered – with emotional milieu being viewed as significant as the interaction of microbes.


New research is highlighting the impact of toxic work cultures and the pervasiveness of these issues throughout surgery. There is also evidence that staff issues and burnout can impact patient care and rate of complications.1 Better care of the health and emotional well-being of staff has a direct link to better outcomes for patients and, therefore, can lead to a reduction in complications including infections. Positive cycles of health for both staff, as well as patients, necessitates understanding and ensuring a positive direction of development. A vital question emerges: how can we work to create these positive and healthy surgical environments? To give some historical background and


context, breakthroughs in the understanding of histology and pathogens, as well as disease surveillance, began with Ignas Semmelweis, the Hungarian obstetrician and physician in Vienna, during the 1800s. He is credited with developing the medical imperative of hand washing and working to stop unnecessary cross contamination.2


Observing the significant reduction in patient deaths and instances of infection highlighted the first dawning awareness of the impact on


patient health, where microbes could be now more clearly conceptualised. Changes within these practical approaches also addressed the profile of surgical risk and patient safety for infection – marking a breakthrough in the reduction of mortality and surgical complications. Moreover, additional medical innovations


were able to open up, for example, the use of antibiotics, improvements on surface design (and materials), use of cleaning and sterilisation of surfaces, innovations in surgical tools, use of disinfectants, operating design, and surgical safety – all contributory factors in infection occurrence once this initial change was able to be systematically introduced and accepted. However, despite these improvements, infection continues to be a major problem and current research highlights that infections in surgery impacts the NHS at a cost of £700 million a year and surgical site infections continue to occur.3


So, what else may account for these persistent rates of infection?


Psychological contamination There are invisible worlds until we are taught how to see them and understand their unique


and special ecosystems and, until we have this knowledge, we will be ignorant of their meaning and impact. As with invisible microbes, the medical environment has largely regarded human behaviour to be one of these equally intangible and misunderstood phenomena. This paper would like to change how human


behaviour is considered and these initial steps advocate for the emotional milieu to be as significant as the interaction of microbes. Both are essential factors to be ‘seen’ and understood as necessary factors of effect within surgical care. 1. First, belief systems affect perception and then alter actions. In many psychological surgical assessments I have undertaken, I have observed the impact of psychological belief systems (about the patient themselves and their perception of the world), which directly contributes to self-sabotaging health behaviour. In extreme cases, without professional intervention, negative self- beliefs can jeopardise the operation’s safety outcome. For example, the patient’s negative self-appraisal may manifest through their acting out with high-risk socialising (as seen during recent post COVID conditions) before their surgery – making their risk higher and increasing multiple kinds of infection risks, while reducing their overall health and resiliency.


2. Second, the presence or absence of empathy is one of the foundational determinants for staff, as well as patients, to feel safe. This, in turn, profoundly affects all aspects of the other psychological behaviour in terms of interaction within the surgical environment, and interaction with everyone within these environments. Simple steps, such as helping connect empathetic concern for the patient’s well-being, will support staff in their thinking about – and engagement with – patients and each other.


3. Third, the first two principles will impact on health-related behaviour for both surgical


September 2024 I www.clinicalservicesjournal.com 71


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