Surgical care experts presented two studies in Lancet this will help ensure safer surgeries for thousands of patients around the world, especially in low- and middle-income countries (LMIC).

Researchers have found that a routine change of gloves and instruments just before wound closure can significantly reduce surgical site infection (SSI), the world’s most common postoperative complication. Second, they tested a new set of tools that could make hospitals better prepared for pandemics, heat, winter pressures and natural disasterswhich could reduce the number of cancellations of planned procedures worldwide.

Surgical infections

Patients in LMICs are disproportionately exposed to wound infections, but after trials of the procedure in Benin, Ghana, India, Mexico, Nigeria, Rwanda and South Africa, researchers found that a routine change of gloves and instruments during abdominal wound closure could prevent as many as 1 in 8 cases of SSI.

Study co-author Anil Bhangu, from the University of Birmingham, commented: “Surgical site infection is the world’s most common post-operative complication – a huge burden for both patients and health care systems. Our work demonstrates that routine glove and instrument changes are not only available worldwide, but also reduce infection rates in a variety of surgical settings. Taking this simple step can reduce SSI by 13%—simple and cost-effective.”

Patients who develop an SSI experience pain, disability, poor healing with risk of wound breakdown, long recovery times, and psychological problems. In healthcare systems where patients must pay for treatment, this can be disastrous and increases the risk that patients will end up in poverty after treatment. The simple and inexpensive practice of changing gloves and instruments just before wound closure is something that surgeons in any hospital can do, with enormous potential impact.

Surgical Readiness Index

Experts from the NIHR’s Global Medical Research Unit on Global Surgery also launched their ‘Surgical Readiness Index’ (SPI) today at Lancet— a key study to assess how well hospitals around the world have been able to continue elective surgery during COVID-19.

The researchers identified various characteristics of hospitals that made them more or less “prepared” for periods of increased pressure. They used COVID-19 as an important example, but emphasized that health systems are strained every year for a variety of reasons, from seasonal pressures to natural disasters and military operations. A group of clinicians from 32 countries developed the SPI, which rates hospitals based on their infrastructure, equipment, staff and processes used for elective surgery. The higher the final SPI score, the more prepared the hospital is for disruptions.

After creating the SPI tool, experts asked 4,714 clinicians in 1,632 hospitals in 119 countries around the world to rate the readiness of their local surgical department. Overall, most hospitals around the world were ill-prepared and suffered a significant drop in the number of procedures they were able to perform during COVID-19. The team found that a 10-point increase in SPI score corresponded to 4 more patients undergoing surgery per 100 patients on the waiting list.

Lead author James Glasby, from the University of Birmingham, commented: “Our new tool will help hospitals internationally improve their preparedness for external stresses, from pandemics to heat waves, winter pressures and natural disasters. We believe it will help hospitals get through waiting lists more quickly. and prevent further delays for patients The tool can be easily completed medical workers and managers working in any hospital around the world – when used regularly, it can protect hospitals and patients from future failures.”

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: “While not all post-operative deaths are avoidable, many can be prevented by increased investment in research, staff training, equipment and better hospital objects. We must invest in improving the quality of surgery worldwide.”

Dr Sarah Puddicombe, Assistant Director for Global Health at the NIHR Coordination Centre, said: “This important research is helping to pave the way to making surgery much safer for thousands of patients around the world. This is just one of many exciting findings that are beginning to emerge from NIHR-funded Global Health Research Units, groups and projects working with partners around the world. We are committed to research that contributes to the health and wealth of the nation and benefits people and communities around the world.”