Global guidelines on the prevention of SSI

Surgical site infections (SSIs) are continuing to cause patients substantial harm and are probably the most preventable of all healthcare-associated infections. Their presence interrupts and affects the health and lives of millions of people around the world every year. The exact number of people affected is unreliably counted in many countries but it is estimated that in low and middle income countries 11% of all those who undergo surgery are infected during the process. In Africa, up to 20% of the women who have a C-section on the continent, contract a wound infection – and it is probably the most commonly undertaken surgical procedure in Africa.  Surgical site infections are, as regular readers of this journal will know, not just applicable in African countries, but in every country. We all need to review the recommendations; all 29 of them and incorporate them into our practice and national standards. 

The World Health Organization has recently launched the very first Global Guidelines for the prevention of surgical site infection1, applicable in high, middle and low income countries to reduce SSIs. The WHO guidelines are valid in all countries and are suitable for local adaptation. They review all the most up to date evidence that is available, taking account of the strength of the available scientific evidence, the cost and resource implications as well as patient values and preferences. The guidelines are designed to address the ever increasing burden of healthcare-associated infections on both patients and healthcare systems globally.

Resistance to new practice? The global guidelines are said to be complementary to the elements of practice in the safe surgery saves lives checklist2 which relate to infection control practices. One of the aspects of the introduction of the checklist in 2009, which is still being implemented in many countries and has been totally ignored by others, is that the guidelines fundamentally affect many practices which have been in place for years. It takes multidisciplinary education and training to ensure that the new practice is owned and believed in by everyone in the team. There will be many hospitals and surgical teams that do not respect the WHO checklist or practise it well on every single occasion and will find it equally difficult to change practice to reduce surgical site infections. The NICE Guidance has been a strongly evidence based set of recommendations, in place in the UK since 2008 and these are not universally practised.3