Global Scaling of a Surgical Infection Prevention Program to 5 Low-Resource Countries

Area of Science:

• Global Health
• Infectious Disease Prevention
• Surgical Quality Improvement

Background:

• Surgical site infections (SSI) are a major cause of surgical morbidity and mortality, particularly in low- and middle-income countries (LMICs).
• The Clean Cut program, a multimodal quality improvement initiative, has previously shown success in reducing SSI rates in Ethiopia.

Purpose of the Study:

• To evaluate the scalability and effectiveness of the Clean Cut surgical infection prevention program in diverse LMIC settings.
• To assess the program's impact on SSI rates and adherence to infection prevention standards across different geographical and socioeconomic contexts.

Main Methods:

• A quasi-experimental cohort study involving 1865 surgical patients across five hospitals in Liberia, Madagascar, Malawi, India, and Bolivia from 2021 to 2024.
• Implementation involved knowledge transfer from Ethiopian clinicians to build local expertise, focusing on improving compliance with perioperative infection prevention standards.
• Data on 30-day SSI rates, compliance with infection prevention practices, death, reoperation, and length of stay were collected prospectively.

Main Results:

• The 30-day SSI rate decreased significantly from 28.4% at baseline to 12.1% after program implementation (a 16.3% reduction).
• The study observed significant improvements in adherence to key infection prevention standards, including the WHO Surgical Safety Checklist, hand and skin antisepsis, and sterile field maintenance.
• The relative risk of SSI was reduced by 49% (RR, 0.51; 95% CI, 0.38-0.67; P < .001).

Conclusions:

• The Clean Cut surgical infection prevention program is scalable and effective in reducing SSI rates in diverse LMIC hospital settings.
• The study highlights a successful mechanism for transferring expertise to improve compliance with infection prevention standards, crucial for broader implementation.
• This program offers a viable strategy to combat the burden of surgical site infections globally.