Pilot implementation projects in low- and middle-income countries to guide surgical quality improvement using best
Lye-Yeng Wong1, Saad Hussain2, Michael Labib2
1Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA, United States.
Frontiers in Health Services
|July 2, 2025
Summary
Implementing best practice recommendations (BPRs) in low- and middle-income countries (LMICs) through local partnerships improves surgical care. Pilot projects in Laos, Nigeria, and Ethiopia focused on hand hygiene, antimicrobial stewardship, and trauma care, respectively.
Area of Science:
- Global Health
- Surgical Safety
- Healthcare Improvement
Background:
- Adherence to Best Practice Recommendations (BPRs) is crucial for reducing morbidity and mortality in surgical care.
- Low- and middle-income countries (LMICs) face significant challenges in implementing standardized surgical healthcare delivery.
- International collaboration and local stakeholder engagement are key to successful BPR implementation.
Purpose of the Study:
- To pilot the implementation of Best Practice Recommendations (BPRs) in surgical healthcare delivery across three distinct low- and middle-income countries (LMICs).
- To establish a scalable framework for optimizing and standardizing safe and quality surgical care in LMICs through collaborative, locally-driven initiatives.
Main Methods:
- Three LMIC healthcare centers in Laos, Nigeria, and Ethiopia participated in implementation pilots.
- Local teams conducted needs assessments to tailor BPR implementation strategies.
- Descriptive analysis of preliminary data was used to evaluate ongoing projects.
Main Results:
- In Laos, a baseline assessment revealed 56.1% of hand hygiene opportunities were missed in a pediatric hospital.
- In Nigeria, 81.2% of antibiotic use in surgical patients was for prophylaxis rather than empiric treatment.
- An enhanced emergency medical technician curriculum was developed in Ethiopia, incorporating advanced life support and quality standards.
Conclusions:
- International collaboration, led by local stakeholders, successfully initiated needs assessments to guide BPR implementation projects.
- These scalable pilot projects provide a foundational framework for enhancing surgical care quality and standardization in LMICs.
- The findings underscore the potential for localized BPR implementation to drive significant improvements in surgical outcomes in resource-limited settings.
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