It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey

Massimo Sartelli, Francesco M. Labricciosa, Federico Coccolini, Raul Coimbra, Fikri M. Abu-Zidan, Luca Ansaloni, Majdi N. Al-Hasan, Shamshul Ansari, Philip S. Barie, Miguel Angel Caínzos, Marco Ceresoli, Massimo Chiarugi, Jeffrey A. Claridge, Enrico Cicuttin, Evan Patchen Dellinger, Donald E. Fry, Xavier Guirao, Timothy Craig Hardcastle, Andreas Hecker, Ari K. LeppäniemiAndrey Litvin, Sanjay Marwah, Emilio Maseda, John E. Mazuski, Ziad Ahmed Memish, Andrew W. Kirkpatrick, Leonardo Pagani, Mauro Podda, Huseyin Kemal Rasa, Boris E. Sakakushev, Robert G. Sawyer, Fabio Tumietto, Yonghong Xiao, Wedad Faraj Aboubreeg, Harissou Adamou, Lali Akhmeteli, Emrah Akin, Maria Grazia Alberio, Felipe Alconchel, Ibrahim Amadou Magagi, Ana Belén Araúz, Giulio Argenio, Boyko C. Atanasov, Semra Demirli Atici, Selmy Sabry Awad, Efstratia Baili, Lovenish Bains, Miklosh Bala, Oussama Baraket, Suman Baral, Vladislav A. Belskii, Moussa Benboubker, Offir Ben-Ishay, Pierpaolo Bordoni, Abdalia Boumédiène, Giuseppe Brisinda, Laura Cavazzuti, Sujith J. Chandy, Maria Michela Chiarello, Nicola Cillara, Guglielmo Clarizia, Maria Elena Cocuz, Iuliu Gabriel Cocuz, Luigi Conti, Raffaella Coppola, Yunfeng Cui, Jacek Czepiel, Fabrizio D’Acapito, Dimitrios Damaskos, Koray Das, Belinda De Simone, Samir Delibegovic, Zaza Demetrashvili, Dzemail S. Detanac, Sameer Dhingra, Stefano Di Bella, Evgeni N. Dimitrov, Agron Dogjani, Mario D’Oria, Irina Magdalena Dumitru, Mutasim M. Elmangory, Octavian Enciu, Massimo Fantoni, Daniela Filipescu, Francesco Fleres, Domitilla Foghetti, Pietro Fransvea, Mahir Gachabayov, Rita Galeiras, Gianni Gattuso, Wagih M. Ghannam, Valeria Ghisetti, Giorgio Giraudo, Kebebe Bekele Gonfa, Emre Gonullu, Yousif Tag Elsir Y. Hamad, Matthias Hecker, Arda Isik, Nizar Ismail, Azzain Ismail, Sumita Agarwal Jain, Souha S. Kanj, Garima Kapoor, Ilias Karaiskos, Alfie J. Kavalakat, Jakub Kenig, Faryal Khamis, Vladimir Khokha, Ronald Kiguba, Jae Il Kim, Yoshiro Kobe, Kenneth Yuh Yen Kok, Bojan M. Kovacevic, Igor Andreevich Kryvoruchko, Akira Kuriyama, Aitor Landaluce-Olavarria, Konstantinos Lasithiotakis, Varut Lohsiriwat, Eftychios Lostoridis, Davide Luppi, Gustavo Miguel Machain Vega, Marc Maegele, Athanasios Marinis, Gennaro Martines, Aleix Martínez-Pérez, Damien Massalou, Cristian Mesina, Gökhan Metan, María Guadalupe Miranda-Novales, Shyam Kumar Mishra, Mohaned Ibrahim Hussein Mohamed, Ali Yasen Y. Mohamedahmed, Ismael Mora-Guzmán, Francesk Mulita, Ana Maria Musina, Pradeep H. Navsaria, Ionut Negoi, Gabriela Elisa Nita, Donal B. O’Connor, Carlos Alberto Ordoñez, Desiré Pantalone, Arpád Panyko, Aristeidis Papadopoulos, Nikolaos Pararas, Francesco Pata, Tapan Patel, Gianluca Pellino, Teresa Perra, Gennaro Perrone, Antonio Pesce, Tadeja Pintar, Georgi Ivanov Popivanov, Alberto Porcu, Martha Alexa Quiodettis, Razrim Rahim, Ashrarur Rahman Mitul, Martin Reichert, Miran Rems, Glendee Yolande Reynolds Campbell, Nuno Rocha-Pereira, Gabriel Rodrigues, Gustavo Eduardo Roncancio Villamil, Stefano Rossi, Ibrahima Sall, Hossein Samadi Kafil, Diego Sasia, Jeremiah Seni, Charalampos Seretis, Mario Serradilla-Martín, Vishal G. Shelat, Boonying Siribumrungwong, Mihail Slavchev, Leonardo Solaini, Boun Kim Tan, Antonio Tarasconi, Dario Tartaglia, Elena Adelina Toma, Gia Tomadze, Adriana Toro, Marcos Roberto Tovani-Palone, Harry van Goor, Alin Vasilescu, Andras Vereczkei, Massimiliano Veroux, Sergio Alberto Weckmann, Lukas Werner Widmer, Ali Ibrahim Yahya, Sanoop K. Zachariah, Andee Dzulkarnaen Zakaria, Nadezhda Zubareva, Wietse P. Zuidema, Isidoro Di Carlo, Francesco Cortese, Gian Luca Baiocchi, Ronald V. Maier, Fausto Catena

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants’ perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness. Methods: A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days. Results: Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations. Conclusion: Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.

Original languageEnglish
Article number17
JournalWorld Journal of Emergency Surgery
Volume17
Issue number1
DOIs
StatePublished - Dec 2022

Keywords

  • Antibiotic prescribing
  • Antibiotic resistance
  • Antimicrobial stewardship
  • Cross-sectional survey
  • Infection prevention and control

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