Delphi prioritization and development of global surgery guidelines for the prevention of surgical-site infection

Research output: Contribution to journalArticlepeer-review

Authors

  • Dmitri Nepogodiev
  • Adewale Adisa
  • Francis Atindaana Abantanga
  • Adesoji Ademuyiwa
  • Sohini Chakrabortee
  • Dhruva Ghosh
  • James Glasbey
  • Marie Carmela Lapitan
  • Ismail Lawani
  • Mayaba Maimbo
  • Rachel Moore
  • Dion Morton
  • Faustin Ntirenganya
  • Ahmad Uzair Qureshi
  • Antonio Ramos-De la Medina
  • Stephen Tabiri
  • Adesoji Ademuyiwa
  • Anthony Adenekan
  • Abdus sami Adewunmi
  • Adewale Adisa
  • Maria Lorena Aguilera
  • Bruce Biccard
  • Sohini Chakrabortee
  • Ainhoa Costa
  • Philip Cotton
  • Thomas M. Drake
  • O. James Garden
  • Dhruv Ghosh
  • James Glasbey
  • Parvez David Haque
  • Ewen M. Harrison
  • Jean De La Croix Allen Ingabire
  • Stephen R. Knight
  • Marie Carmela Lapitan
  • Ismail Lawani
  • Richard Lilford
  • Mayaba Maimbo
  • Janet Martin
  • Luis Hernandez Miguelena
  • Rohin Mittal
  • Rachel Moore
  • Dion Morton
  • Vanessa Msosa
  • Syed Asghar Naqi
  • Dmitri Nepogodiev
  • Faustin Ntirenganya
  • Jean Leon Olory-Togbe
  • Omar Omar
  • Thomas Pinkney
  • Ahmad Uzair Qureshi
  • Antonio Ramos-De la Medina
  • Hosni Khairy Salem
  • Martin Smith
  • Sudha Sundar
  • Stephen Tabiri
  • Edwin Yenli
  • Raul Yepez
  • Eugene Zoumenou
  • Francis Atindaana Abantanga
  • Adesoji Ademuyiwa
  • Abdus sami Adewunmi
  • Adewale Adisa
  • Maria Lorena Aguilera
  • Aneel Bhangu
  • Bruce Biccard
  • Peter Brocklehurst
  • Sohini Chakrabortee
  • Ainhoa Costa
  • Thomas M. Drake
  • Dhruva Ghosh
  • James Glasbey
  • Parvez David Haque
  • Ewen M. Harrison
  • Jean De La Croix Allen Ingabire
  • Conor S. Jones
  • Chifundo Kajombo
  • Stephen R. Knight
  • Marie Carmela Lapitan
  • Ismail Lawani
  • Samuel Lawday
  • Mayaba Maimbo
  • Janet Martin
  • Luis Hernandez Miguelena
  • Rohin Mittal
  • Rachel Moore
  • Dion Morton
  • Vanessa Msosa
  • Syed Asghar Naqi
  • Dmitri Nepogodiev
  • Faustin Ntirenganya
  • Martin Nyundo
  • Jean Leon Olory-Togbe
  • Thomas Pinkney
  • Ahmad Uzair Qureshi
  • Antonio Ramos De la Medina
  • Dione Parreno-Sacdalan
  • Hosni Khairy Salem
  • Martin Smith
  • Stephen Tabiri
  • Edwin Yenli
  • Eugene Zoumenou

Abstract

Background: Most clinical guidelines are developed by high-income country institutions with little consideration given to either the evidence base for interventions in low- and middle-income countries (LMICs), or the specific challenges LMIC health systems may face in implementing recommendations. The aim of this study was to prioritize topics for future global surgery guidelines and then to develop a guideline for the top ranked topic. Methods: A Delphi exercise identified and prioritized topics for guideline development. Once the top priority topic had been identified, relevant existing guidelines were identified and their recommendations were extracted. Recommendations were shortlisted if they were supported by at least two separate guidelines. Following two voting rounds, the final recommendations were agreed by an international guideline panel. The final recommendations were stratified by the guideline panel as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack these resources at present, in which case they should plan for future implementation). Results: Prevention of surgical-site infection (SSI) after abdominal surgery was identified as the highest priority topic for guideline development. The international guideline panel reached consensus on nine essential clinical recommendations for prevention of SSI. These included recommendations concerning preoperative body wash, use of prophylactic antibiotics, decontamination of scrub teams' hands, use of antiseptic solutions for surgical site preparation and perioperative supplemental oxygenation. In addition, three desirable clinical recommendations and four recommendations for future research were agreed. Conclusion: This process led to the development of a global surgery guideline for the prevention of SSI that is both clinically relevant and implementable in LMICs.

Bibliographic note

Funding Information: The authors acknowledge the Global Surgery Policy Consortium Group at the Royal College of Surgeons, England. This report was funded by a National Institute for Health Research (NIHR) Global Health Research Unit grant (NIHR 16·136·79). The funder had no role in the study design, data collection, analysis and interpretation, or writing of this report. The funder has approved the submission of this report for publication. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the UK Department of Health and Social Care. Publisher Copyright: © 2020 The Authors. British Journal of Surgery published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.

Details

Original languageEnglish
Pages (from-to)970-977
Number of pages8
JournalBritish Journal of Surgery
Volume107
Issue number8
Publication statusPublished - 1 Jul 2020

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