Delphi prioritization and development of global surgery guidelines for the prevention of surgical-site infection

Abstract

Background Most clinical guidelines are developed by high‐income country institutions with little consideration given to either the evidence base for interventions in low‐ and middle‐income countries (LMICs), or the specific challenges LMIC health systems may face in implementing recommendations. The aim of this study was to prioritize topics for future global surgery guidelines and then to develop a guideline for the top ranked topic. Methods A Delphi exercise identified and prioritized topics for guideline development. Once the top priority topic had been identified, relevant existing guidelines were identified and their recommendations were extracted. Recommendations were shortlisted if they were supported by at least two separate guidelines. Following two voting rounds, the final recommendations were agreed by an international guideline panel. The final recommendations were stratified by the guideline panel as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack these resources at present, in which case they should plan for future implementation). Results Prevention of surgical‐site infection (SSI) after abdominal surgery was identified as the highest priority topic for guideline development. The international guideline panel reached consensus on nine essential clinical recommendations for prevention of SSI. These included recommendations concerning preoperative body wash, use of prophylactic antibiotics, decontamination of scrub teams' hands, use of antiseptic solutions for surgical site preparation and perioperative supplemental oxygenation. In addition, three desirable clinical recommendations and four recommendations for future research were agreed. Conclusion This process led to the development of a global surgery guideline for the prevention of SSI that is both clinically relevant and implementable in LMICs.

Prevention of Prosthetic Joint Infection: From Traditional Approaches towards Quality Improvement and Data Mining

“…In one study, a positive correlation was found between microbial air contamination and the number of people in the operating room and number of door openings [120]. Global surgery guidelines for the prevention of SSI have been suggested [121], leading to an expectation among surgeons of 100% adherence to pre-established protocols (standards) throughout a surgery, although this bar is a difficult one for all personnel to meet [122][123][124].…”

Feasibility and diagnostic accuracy of Telephone Administration of an adapted wound heaLing QuestiONnaire for assessment for surgical site infection following abdominal surgery in low and middle-income countries (TALON): protocol for a study within a trial (SWAT)

“…The global burden of morbidity as a result of surgical infection has dramatic and wide-reaching effects on patients, providers, and health systems in LMICs [14,61,62]. SSI has therefore been recognised as the highest global priority in surgical research and is therefore a natural target for the TALON study [7,63]. Future work will be required to standard processes for outcome assessment across other common and severe postoperative complications [64].…”

Antibiotic prophylaxis in a global surgical context

“…Implementation of findings into 'Essential Global Surgical Guidelines' will help clinicians to influence care providers and hospital managers and deliver impactful SSI prevention measures across borders. 20 This will be the key step in reducing the volume of antimicrobial agents used in the perioperative setting, and mitigating against the rise of multi-drug resistance in years to come.…”