Department of Surgery, Anadolu Medical Center, Kocaeli, Turkey.
S3 Global, Glasgow, United Kingdom.
Surg Infect (Larchmt). 2020 Sep;21(7):592-598. doi: 10.1089/sur.2020.163. Epub 2020 Jun 1.
In low- and middle-income countries (LMICs), infection is the most frequent complication in surgical procedures, and surgical site infections (SSIs) globally are the most frequent health-care-associated infections (HAIs). Preventing SSI is an important target for overall quality improvement and patient safety as well as supporting the infection prevention and control (IPC) global agenda. In 2018, the World Heath Organization (WHO) presented the first Global Guidelines for the Prevention of Surgical Site Infections. The WHO also simplified SSI surveillance materials and included process measures, critical to addressing the barriers existing in LMICs. Because surveillance activities alone will not lead to improvements and implementation is more challenging than guideline development, the WHO then outlined a novel, step by step approach for implementation based on its tried and tested improvement approach for IPC measures. These documents have been reviewed and summarized to achieve wider reach in the surgical community. The WHO implementation guidance notes examples of current practice against the WHO SSI prevention guideline recommendations and considers LMIC settings. It identifies the related problem that needs to be addressed if the recommendation is not being applied consistently and reliably. It breaks down the steps required to make an improvement applying key elements known as the multi-modal improvement strategy. Implementation of IPC guidance documents and tools published by global organizations and national governments continues to be a challenge, especially for LMICs. Successful approaches need to include a science-based approach to implementation and improvement, as well as joined up working and learning across IPC and surgical communities. Real improvements can be only achieved, based on WHO workforce recommendations, with IPC programs including the staff to execute these programs and using a proven approach.
在中低收入国家（LMICs），感染是手术过程中最常见的并发症，而全球手术部位感染（SSI）是最常见的医院获得性感染（HAI）。预防 SSI 是全面质量改进和患者安全的重要目标，也是支持感染预防和控制（IPC）全球议程的重要目标。2018 年，世界卫生组织（WHO）发布了首份全球预防手术部位感染指南。世界卫生组织还简化了 SSI 监测材料，并纳入了对解决 LMICs 现有障碍至关重要的流程措施。由于仅监测活动本身不会导致改进，而实施比制定指南更具挑战性，因此世界卫生组织随后根据其经过验证的 IPC 措施改进方法，概述了一种新的、逐步的实施方法。这些文件已经过审查和总结，以便在外科界获得更广泛的应用。WHO 实施指南指出了当前实践与 WHO SSI 预防指南建议之间的差异，并考虑了 LMIC 环境。它确定了如果不持续可靠地应用建议，需要解决的相关问题。它分解了应用称为多模式改进策略的关键要素来进行改进所需的步骤。全球组织和各国政府发布的 IPC 指导文件和工具的实施仍然是一个挑战，尤其是对 LMICs 而言。成功的方法需要包括实施和改进的基于科学的方法，以及 IPC 和外科界之间的协同工作和学习。根据世界卫生组织劳动力建议，只有包括执行这些计划的工作人员并使用经过验证的方法的 IPC 计划，才能实现真正的改进。
