Nofal Maia R, Tesfaye Assefa, Gebeyehu Natnael, Starr Nichole, Arimino Sedera, Chaula Damiano, Harrell-Shreckengost Constance, Utam Terseer, Ambulkar Reshma, Rocabado Karoline, Taye Haile Sara, Mammo Tihitena Negussie, Weiser Thomas G
Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
Department of Surgery, Stanford University, Palo Alto, California.
JAMA Surg. 2025 Aug 13. doi: 10.1001/jamasurg.2025.2790.
Surgical site infections (SSI) are a leading cause of morbidity and mortality from surgery, with higher rates in low- and middle-income countries (LMICs). Clean Cut is a multimodal, adaptive quality improvement program that aims to reduce SSI by improving compliance with perioperative infection prevention standards. The program has been successfully implemented in Ethiopia at 12 hospitals with an associated 35% reduction in SSI.
To assess whether this surgical infection prevention program implemented in Ethiopia can be effectively scaled to a variety of geographical and socioeconomic settings.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was a quasi-experimental study of a surgical infection prevention program that was implemented in 1 hospital in each of 5 low-income countries (Liberia, Madagascar, Malawi, India, and Bolivia) from 2021 to 2024. Program introduction and scale-up relied on knowledge transfer from clinicians who had successfully implemented the same program in Ethiopia to build local expertise in each new setting. Participants were patients undergoing surgery who were followed up from their initial operation through discharge and for 30 days postoperatively using follow-up phone calls.
Implementation of a surgical infection prevention program.
The primary outcome was 30-day SSI rate. Secondary outcomes include compliance with infection prevention standards, death, reoperation, and length of stay.
Prospective data were collected for 1865 patients (mean [SD] age, 31.6 [17.5] years; 980 [52.5%] female and 885 [47.5%] male), 478 from the baseline period and 1387 from the intervention period. Thirty-day SSI rates were reduced from 28.4% to 12.1% (difference, 16.3%; 95% CI, 12.0%-20.6%; relative risk, 0.51; 95% CI, 0.38-0.67; P < .001). There were also significant improvements in use of the World Health Organization Surgical Safety Checklist, hand and skin antisepsis, antibiotic administration, instrument reprocessing, sterile field maintenance, and gauze counting.
A surgical infection prevention program previously validated in Ethiopia was successful in reducing SSI in 5 LMIC hospitals in 5 other countries. This study demonstrated the scalability and efficacy of this program in preventing SSI across a range of settings. This study also demonstrates a mechanism for scaling the program expertise needed to improve compliance with standards, a step that is crucial to wider implementation.
手术部位感染（SSI）是手术导致发病和死亡的主要原因，在低收入和中等收入国家（LMICs）发生率更高。“精准切割”是一项多模式、适应性质量改进计划，旨在通过提高围手术期感染预防标准的依从性来降低手术部位感染。该计划已在埃塞俄比亚的12家医院成功实施，手术部位感染率相应降低了35%。
评估在埃塞俄比亚实施的这一手术感染预防计划能否有效地推广到各种地理和社会经济环境。
设计、背景和参与者：这项队列研究是一项关于手术感染预防计划的准实验研究，于2021年至2024年在5个低收入国家（利比里亚、马达加斯加、马拉维、印度和玻利维亚）的各1家医院实施。计划的引入和推广依赖于曾在埃塞俄比亚成功实施同一计划的临床医生进行知识传授，以在每个新环境中培养当地专业知识。参与者为接受手术的患者，从初次手术开始随访至出院，并在术后30天通过随访电话进行跟踪。
实施手术感染预防计划。
主要结局是30天手术部位感染率。次要结局包括感染预防标准的依从性、死亡、再次手术和住院时间。
收集了1865例患者的前瞻性数据（平均[标准差]年龄为31.6[17.5]岁；女性980例[52.5%]，男性885例[47.5%]），其中478例来自基线期，1387例来自干预期。30天手术部位感染率从28.4%降至12.1%（差值为16.3%；95%置信区间为12.0%-20.6%；相对风险为0.51；95%置信区间为0.38-0.67；P < .001）。在世界卫生组织手术安全核对表的使用、手部和皮肤消毒、抗生素给药、器械再处理、无菌区域维护和纱布清点方面也有显著改善。
先前在埃塞俄比亚验证的手术感染预防计划在其他5个国家的5家低收入和中等收入国家医院成功降低了手术部位感染率。这项研究证明了该计划在一系列环境中预防手术部位感染的可扩展性和有效性。这项研究还展示了一种推广提高标准依从性所需计划专业知识的机制，这是更广泛实施的关键一步。
