Clinical Leadership, Evaluation, and Action Network for surgical site infection control: protocol enhancement in...

Surgical site infections (SSIs) represent the most prevalent healthcare-associated illnesses in developing countries. As a frequent and sometimes severe complication of surgery, SSIs contribute substantially to the global burden of healthcare-associated infections, both historically and in contemporary practice.

A national, multicenter clinical audit with a two-cycle before-and-after design was conducted in 10 public teaching hospitals. Perioperative care providers completed a structured questionnaire aligned with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) SSI prevention guidelines. After the baseline assessment, targeted feedback and educational interventions were implemented, followed by a re-audit after 2 months. Adherence rates were compared using chi-square tests (P < 0.05).

Analysis included 600 responses (300 per cycle). Significant improvements were observed in most domains. Preoperative practices improved in glycemic control (83-96%), methicillin-resistant Staphylococcus aureus (MRSA) decolonization (23-51%), and antimicrobial prophylaxis compliance (all P < 0.001). Intraoperative adherence increased for sterile technique (89%-97%), normothermia (78%-86%), glycemic control (80%-90%), oxygen therapy (81%-92%), and surgical site protection (P < 0.01). Postoperative improvements were noted in SSI surveillance (58%-86%) and dressing protocols (86%-94%) (P ≤ 0.001). Strengthening of infection prevention and control (IPC) systems was evident, with increases in training (30%-68%), bundle implementation (35%-57%), safety culture (35%-60%), and data-driven monitoring (31%-59%) (all P < 0.001).

Strengthening IPC systems and adherence to SSI prevention measures was achieved through a structured audit-feedback approach. This model provides a practical pathway for advancing surgical quality in resource-limited settings.