SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

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Methods After training and attendance at the RCPCH Epilepsy Quality Improvement Programme (EQIP), a driver diagram, fishbone analysis, 5-whys methodology and patient questionnaire were used to understand the patient pathway. An EEG leaflet explaining the procedure is already sent to patients. However, it was noted that there was little information or avenue for families to ask questions or to allay fears and anxieties before attending. This highlighted the need for improved preparation in addition to the standard EEG leaflet before arrival to the hospital.A Model for Improvement with 4 PDSA (Plan, Do, Study, Act) cycles was employed to test change. Patient families were contacted several days before the EEG to discuss needs, anxieties and ways of working that might improve the experience and thereby the quality of the EEG recording eg room layout, staff in uniform, toys, Wifi availability etc.The later PDSA cycles highlighted logistical problems in telephoning all paediatric patients. Therefore, an addendum to the patient leaflet was sent to the patient. This signposted useful online material and other resources. Department photographs were also available on request. Results An improvement was seen in the number of quality EEGs recorded. The percentage of paediatric patients with full quality EEGs was seen to be consistently above 95% after introduction of the telephone call and leaflet addendum. No EEG recordings were abandoned. Very favourable feedback was gained from families about increased flexibility to tailor the EEG investigation. The Covid-19 pandemic unfortunately affected EEG wait times.This was a multidisciplinary quality improvement project resulting in rewarding, collaborative links to enable future dialogue and multidisciplinary working. Conclusions Quality of EEG recordings was improved by increased communication between families before appointment, either by discussion over the phone or