Surgical care experts have unveiled two studies in The Lancet that will help to provide safer surgery for thousands of patients around the world – particularly in the global south.
Researchers found that routinely changing gloves and instruments just before closing wounds could significantly reduce Surgical Site Infection (SSI) – the world’s most common postoperative complication. Secondly, they tested a new toolkit that can make hospitals better prepared for pandemics, heatwaves, winter pressures and natural disasters that could reduce cancellations of planned procedures around the world.
📌 Surgical infections
Patients in LMICs are disproportionately affected by wound infections, but following a trial of the procedure in India, Benin, Ghana, Mexico, Nigeria, Rwanda and South Africa, researchers found that a routine switch of gloves and instruments during abdominal wound closures could prevent as many as 1 in 8 cases of SSI.
The ChEETAh trial was funded by the UK’s National Institute for Health Research (NIHR). Publishing their findings in The Lancet, researchers are calling for the practice to be widely implemented especially in countries where SSIs are a huge problem.
Co-author Mr Aneel Bhangu, from the University of Birmingham, commented: “Surgical site infection is the world’s most common postoperative complication – a major burden for both patients and health systems. Our work demonstrates that routine change of gloves and instruments is not only deliverable around the world, but also reduced infections in a range of surgical settings. Taking this simple step could reduce SSIs by 13% – simply and cost-effectively.”
According to Co-author Dr Dhruva Ghosh from the Global Surg India Hub, “patients who develop SSI experience pain, disability, poor healing with risk of wound breakdown, prolonged recovery times and psychological challenges. In health systems where patients have to pay for treatment this can be a disaster and increases the risk of patients being plunged into poverty after their treatment. The simple and low-cost practice of changing your gloves and instruments just before closing the wound is something which can be done by surgeons in any hospital around, meaning a huge potential impact.”
📌 Surgical Preparedness Index
Experts from the NIHR Global Research Health Unit on Global Surgery also unveiled their ‘Surgical Preparedness Index’ (SPI) in The Lancet – a key study assessing the extent to which hospitals around the world were able to continue elective surgery during COVID-19.
Researchers identified different features of hospitals that made them more or less ‘prepared’ for times of increased pressure. They used COVID-19 as an important example, but highlighted that health systems are put under stress for all sorts of reasons each year – from seasonal pressures, to natural disasters, and warfare. A team of clinicians from 32 countries designed the SPI which scores hospitals based on their infrastructure, equipment, staff, and processes used to provide elective surgery. The higher the resulting SPI score, the more prepared a hospital is for disruptions.
After creating the SPI tool, the experts asked 4,714 clinicians in 1,632 hospitals across 119 countries to assess the preparedness of their local surgical department. Professor Parvez Haque from the Christian Medical College Ludhiana and one of the authors of this paper said that “overall most hospitals around the world were poorly prepared, and suffered a big drop in the number of procedures they were able to provide during COVID-19. Dr Haque further said that our team found that a 10-point increase in the SPI score corresponded to four more patients that had surgery per 100 patients on the waitlist.”
Lead author Mr. James Glasbey, from the University of Birmingham, commented: “Our new tool will help hospitals internationally improve their preparation for external stresses ranging from pandemics, to heatwaves, winter pressures and natural disasters. We believe it help hospitals to get through their waiting lists more quickly, and prevent further delays for patients. The tool can be completed easily by healthcare workers and managers working in any hospital worldwide – if used regularly, it could protect hospitals and patients against future disruptions.”
Professor Dion Morton, Barling Chair of Surgery at the University of Birmingham and Director of Clinical Research at the Royal College of Surgeons of England commented: “Although not all postoperative deaths are avoidable, many can be prevented by increasing investment in research, staff training, equipment, and better hospital facilities. We must invest in improving the quality of surgery around the world.”
📌 Notes for editors (to be used if needed)
‘Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection: pragmatic, cluster randomised trial in seven low and middle-income countries (ChEETAh)’ – NIHR Global Research Health Unit on Global Surgery, and ‘Elective surgery system strengthening: development, measurement, and validation of the Surgical Preparedness Index (SPI) across 1,632 hospitals in 119 countries’ – NIHR Global Health Unit on Global Surgery, COVIDSurg Collaborative are published by The Lancet.
📌 About NIHR: The NIHR was established in 2006 to create a health research system in which the NHS supports outstanding individuals, working in world-class facilities, conducting leading-edge research focused on the needs of patients and the public whilst enabling and delivering world-leading health and social care research that improves people’s health and wellbeing and promotes economic growth whilst focusing on early translational research, clinical research and applied health and social care research. Centred in England, NIHR is a major funder of applied health research in low and middle-income countries, work that is principally funded through UK aid from the UK government.
The NIHR Global Health Research Unit on Global Surgery intends on improving surgical outcomes through collaborative research and equitable partnerships between local country health providers, the NHS, universities, local government, other research funders, patients, and the public. Over the last 4.5 years, NIHR has set up seven surgical research Hubs in India, Benin, Ghana, Mexico, Nigeria, Rwanda and South Africa with an extensive network of urban and rural ‘Spoke’ hospitals. This network prioritised the surgical topics that needed research and has performed multiple surgical studies. Through bespoke training, NIHR is building capacity across the network to undertake surgical and other clinical research.
The India Hub of the NIHR Global Health Research Unit on Global Surgery along with its partner spokes across India and its UK partners assists in building capacity and sustainable surgical research infrastructures across partner institutes and hospitals in India. The India hub works closely together with its India and UK partners to deliver robust research studies and disseminate the findings.