Response to comment on 'Nurses' practice in preventing postoperative wound infections: An observational study' JWC January 2017; 26: 1.

We thank the reader for their thoughtful comments in relation to our study1 and in sharing their experiences in clinical practice. Our study findings have demonstrated the disparity that currently exists between clinical practice and the use of evidence-based clinical practice guidelines (CPGS) in preventing surgical site infections (SSI). Currently, the Australian Wound Management Association's (recently renamed Wounds Australia) wound care standards reflect the evidence based CPGs as published by the NICE,2 CDC3 and Anderson et al.4
The reader has rightly pointed out the inconsistencies in clinical practice when it comes to providing wound care for postoperative patients. Her reflections on her experiences with wound care audits conducted by the UK Nursing and Midwifery Council (NMC) suggest that there are necessarily situations where adherence is challenging because of a constantly changing practice landscape, and, more quietly, because of the inconsistencies in wound care information that nurses use to base their practice. However, to promote greater practice adherence with the guidelines, evidence-based CPGs need to be implemented in response to contextual barriers and facilitators.
We have subsequently undertaken a three-phased implementation study, informed by the findings we have reported in this paper. This implementation study was designed to enable greater adherence to recommended CPGs in preventing SSIs (unpublished data). In this subsequent study, we firstly identified barriers and facilitators to adhering to evidence based CPGs on SSI prevention (phase 1). In consultation with clinicians, implementation strategies were developed to address the barriers, assisted by the facilitators (phase 2). Finally, we evaluated whether these strategies worked effectively to improve adherence to evidence-based CPGs, and under what circumstances this occurred.
Clearly there is a lengthy lag period between when research evidence is reported and when it is used in clinical practice. In a paper published in 17-year gap from doing the research, through to publication and implementation in clinical practice was reported.5 These recognised lags in implementation of research into clinical practice has resulted in the translation of research evidence into clinical practice being high on the agenda of governments and organisations worldwide. Consistency in implementation remains an ongoing challenge for clinicians, researchers and policy makers