Infection Control Strategies for Preventing Methicillin-Resistant Staphylococcus aureus-Related Surgical Site Infections in Pakistan: A Mixed-Methods Analysis.

BACKGROUND

Methicillin-resistant (MRSA) significantly contributes to surgical site infections (SSIs) in Pakistan, with high prevalence rates among isolates, leading to increased morbidity and healthcare costs.

OBJECTIVE

This study assessed the effectiveness of infection control strategies in reducing MRSA-related SSIs in Pakistani healthcare facilities, identified implementation barriers, and proposed context-specific recommendations.

METHODS

A mixed-methods study, conducted from January to March 2025, surveyed 100 healthcare professionals (32% surgeons, 28% nurses, and 18% infection control specialists) across public, private, and rural hospitals in all Pakistani provinces. Quantitative data from a structured questionnaire were analyzed using chi-square tests and logistic regression, while qualitative responses were thematically analyzed using Braun and Clarke's framework.

RESULTS

Quantitatively, only 8% of facilities screened all surgical patients for MRSA, with 46% performing no screening, and 38% achieved 51-70% hand hygiene compliance, correlating with higher MRSA-SSI rates (odds ratio = 3.42, p < 0.001). Qualitatively, key themes included resource scarcity (e.g., "We often share a single dispenser"), staff resistance, and systemic inefficiencies.

CONCLUSION

Strengthening hand hygiene, selective MRSA screening, and surgical bundles, alongside improved training and resource allocation, can reduce MRSA-SSIs in Pakistan. Tailoring global guidelines to local constraints is essential for effective implementation. These findings guide strategies to enhance surgical safety in resource-limited settings.