Evaluating and Improving Surgical Site Infection Prevention: Outcomes of a Two-Cycle Audit and Targeted Interventions in a Low-Resource Setting.

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  • Author(s): Busada BJ;Busada BJ
  • Source:
    Cureus [Cureus] 2024 Dec 18; Vol. 16 (12), pp. e75962. Date of Electronic Publication: 2024 Dec 18 (Print Publication: 2024).
  • Publication Type:
    Journal Article
  • Language:
    English
  • Additional Information
    • Source:
      Publisher: Cureus, Inc Country of Publication: United States NLM ID: 101596737 Publication Model: eCollection Cited Medium: Print ISSN: 2168-8184 (Print) Linking ISSN: 21688184 NLM ISO Abbreviation: Cureus Subsets: PubMed not MEDLINE
    • Publication Information:
      Original Publication: Palo Alto, CA : Cureus, Inc.
    • Abstract:
      Background Surgical site infections (SSIs) are among the most common healthcare-associated infections (HAIs), leading to significant morbidity, mortality, and increased healthcare costs. Despite the existence of international guidelines, adherence to best practices remains inconsistent, particularly in low- and middle-income countries (LMICs).  Objective The objectives of this study are to evaluate compliance with SSI prevention guidelines among medical professionals at Kasr El Ainy Teaching Hospital in Cairo, Egypt, identify gaps in practice and knowledge, and implement targeted interventions to improve outcomes.  Methods A prospective two-cycle audit was conducted over a period of eight months involving 225 elective surgical patients and 229 healthcare providers. Questionnaires were distributed to foundation year (FY) doctors and surgical residents to assess their knowledge and practices related to SSI prevention across the preoperative, intraoperative, and postoperative phases. Patients were followed up to monitor the incidence of SSIs. Interventions implemented included educational sessions, dissemination of posters, and hands-on training to enhance adherence to best practices. Results The initial audit revealed an SSI rate of 12.6% and significant gaps in guidelines knowledge, including improper preoperative hair removal methods and prolonged postoperative antibiotic use (85.7%). Post-intervention, SSI rates decreased to 6.6%, with the questionnaire results showing marked improvements in understanding of key components in SSI prevention: 100% became aware of appropriate intraoperative surgical antibiotic prophylaxis (SAP) (compared to 72.3%), a significant increase (p < 0.05) in the use of clippers (rather than razors) for hair removal (72.1% vs. 33.7%) and intraoperative (rather than preoperative) hair removal (91.8% vs. 10%) (p < 0.05), as well as the need for intraoperative warming practices (87.7% vs. 47.7%) (p < 0.05). Knowledge and adherence to aseptic techniques improved across all staff groups, with awareness increasing from 36.3% to 81.9% among junior doctors, representing a significant improvement (p < 0.05). Conclusion Targeted interventions, including education and practice standardization, significantly reduced SSI rates and improved compliance with prevention guidelines. These findings highlight the value of structured audits and educational programs in enhancing surgical outcomes and reducing the burden of SSI, particularly in resource-limited settings.
      Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
      (Copyright © 2024, Busada et al.)
    • Contributed Indexing:
      Keywords: antibiotics; audit; developing countries; guideline compliance; low income countries; medical education; ssi; ssi prevention; who guidelines
    • Publication Date:
      Date Created: 20241219 Latest Revision: 20241219
    • Publication Date:
      20241219
    • Accession Number:
      PMC11655079
    • Accession Number:
      10.7759/cureus.75962
    • Accession Number:
      39698193