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Trial in Nigeria, others found new toolkit could reduce surgical site infection

By Chukwuma Muanya
14 November 2022   |   2:41 am
Surgical care experts, yesterday, unveiled two studies conducted in Benin, Ghana, India, Mexico, Nigeria, Rwanda and South Africa and published in The Lancet journal that will help to provide safer surgery for thousands

Surgical care experts, yesterday, unveiled two studies conducted in Benin, Ghana, India, Mexico, Nigeria, Rwanda and South Africa and published in The Lancet journal that will help to provide safer surgery for thousands of patients around the world – particularly in Low- and Middle-income Countries (LMIC).

Researchers found that routinely changing gloves and instruments just before closing wounds could significantly reduce Surgical Site Infection (SSI) – the world’s most common postoperative complication. Secondly, they tested a new toolkit that can make hospitals better prepared for pandemics, heat waves, winter pressures and natural disasters that could reduce cancellations of planned procedures around the world.

According to the study, patients in LMICs are disproportionately affected by wound infections, but following a trial of the procedure in Benin, Ghana, India, Mexico, Nigeria, Rwanda and South Africa, researchers found that a routine switch of gloves and instruments during abdominal wound closures could prevent as many as one in eight cases of SSI.

The researchers said patients, who develop SSI experience pain, disability; poor healing and are at risk of wound breakdown, prolonged recovery times and psychological challenges. In health systems where patients have to pay for treatment, this can be a disaster and increases the risk of patients being plunged into poverty after their treatment. The simple and low-cost practice of changing gloves and instruments just before closing the wound is something which can be done by surgeons in any hospital around, meaning a huge potential impact.

The United Kingdom’s (UK’s) National Institute funded the ChEETAh trial for Health Research (NIHR). Publishing their findings, yesterday, in The Lancet journal, researchers are calling for the practice to be widely implemented – particularly in LMICs.

According to the co-author and national lead in Nigeria, Prof. Adesoji Ademuyiwa, from the College of Medicine, University of Lagos, the result of this study will positively impact change in the practice among surgeons across the world, especially in the LMICs.

Co-author and national coordinator of ChEETAh study, Dr. Rufus Ojewola, from the College of Medicine, University of Lagos and also a consultant urologist with the Lagos University Teaching Hospital, made this known in a statement that the study has shown the cost-effectiveness and positive outcome with simple and practicable steps among surgeons worldwide.

Co-author from the University of Birmingham, Mr. Aneel Bhangu, said: “Surgical site infection is the world’s most common postoperative complication – a major burden for both patients and health systems. Our work demonstrates that routine change of gloves and instruments is not only deliverable around the world, but also reduced infections in a range of surgical settings. Taking this simple step could reduce SSIs by 13 per cent – simply and cost-effectively.”

Experts from the NIHR Global Research Health Unit on Global Surgery also unveiled their ‘Surgical Preparedness Index’ (SPI) in The Lancet – a key study assessing the extent to which hospitals around the world were able to continue elective surgery during COVID-19.

Researchers identified different features of hospitals that made them more or less ‘prepared’ for times of increased pressure. They used COVID-19 as an important example but highlighted that health systems are put under stress for all sorts of reasons each year – from seasonal pressures to natural disasters, and warfare. A team of clinicians from 32 countries designed the SPI which scores hospitals based on their infrastructure, equipment, staff, and processes used to provide elective surgery. The higher the resulting SPI score, the more prepared a hospital is for disruptions.

After creating the SPI tool, the experts asked 4,714 clinicians in 1,632 hospitals across 119 countries to assess the preparedness of their local surgical departments. Overall most hospitals around the world were poorly prepared and suffered a big drop in the number of procedures they were able to provide during COVID-19.

The team found that a 10-point increase in the SPI score corresponded to four more patients that had surgery per 100 patients on the waitlist.

Lead author from the University of Birmingham, Mr. James Glasbey, said: “Our new tool will help hospitals internationally improve their preparation for external stresses ranging from pandemics to heat waves, winter pressures and natural disasters. We believe it helps hospitals to get through their waiting lists more quickly, and prevent further delays for patients. The tool can be completed easily by healthcare workers and managers working in any hospital worldwide – if used regularly, it could protect hospitals and patients against future disruptions.”

According to Professor Wale Adisa of the Obafemi Awolowo University, Ile-Ife who is the Deputy National Lead NIHR Lagos Hub, commented: “I was a part of the initial process of prioritising indicators of preparedness in elective surgical systems where a list of about 23 was generated from a very long list of suggestions. I was again one of those selected to provide elective surgical volume relative to the previous baseline records. I later reviewed the relevance of the selected indicators across some external shocks culminating in the final list of SPIs. It’s an absolutely interesting journey and I am delighted the paper has been published

Barling Chair of Surgery at the University of Birmingham and Director of Clinical Research at the Royal College of Surgeons of England, Prof. Dion Morton, said: “Although not all postoperative deaths are avoidable, many can be prevented by increasing investment in research, staff training, equipment, and better hospital facilities. We must invest in improving the quality of surgery around the world.”