Delphi prioritization and development of global surgery guidelines for the prevention of surgical-site infection
Dmitri Nepogodiev, Adewale Adisa, Francis Abantanga, Adesoji Ademuyiwa, Sohini Chakrabortee, Dhruva Ghosh, James Glasbey, Marie Carmela Lapitan, Ismaïl Lawani, Mayaba Maimbo, Rachel Moore, Dion Morton, Faustin Ntirenganya, Ahmad Uzair Qureshi, Antonio Ramos‐De la Medina, Stephen Tabiri, Thomas Pinkney, Aneel Bhangu, Adesoji Ademuyiwa, AT Adenekan, Abdus-sami Adewunmi, Adewale Adisa, María Lorena Aguilera, Aneel Bhangu, Bruce Biccard, Peter Brocklehurst, Sohini Chakrabortee, Ainhoa Costa, Philip Cotton, Justine Davies, Thomas M Drake, O. James Garden, Dhruv Ghosh, James Glasbey, Parvez Haque, Ewen M. Harrison, JC Allen Ingabire, Stephen R Knight, Marie Carmela Lapitan, Ismaïl Lawani, Richard Lilford, Mayaba Maimbo, Janet Martin, Luis Hernández Miguelena, Rohin Mittal, Rachel Moore, Dion Morton, Vanessa Msosa, Syed Asghar Naqi, Dmitri Nepogodiev, Faustin Ntirenganya, Jean Léon Olory-Togbe, Omar Mohamed Omar, Thomas Pinkney, Ahmad Uzair Qureshi, Antonio Ramos‐De la Medina, Hosni Salem, Martin Smith, Sudha Sundar, Stephen Tabiri, Edwin Mwintiereh Ta-ang Yenli, Raul Yepez, Eugène Zoumènou, Francis Abantanga, Adesoji Ademuyiwa, Abdus-sami Adewunmi, Adewale Adisa, María Lorena Aguilera, Aneel Bhangu, Bruce Biccard, Peter Brocklehurst, Sohini Chakrabortee, Ainhoa Costa, Thomas M Drake, Dhruva Ghosh, James Glasbey, Parvez Haque, Ewen M. Harrison, JC Allen Ingabire, Conor Jones, Chifundo Kajombo, Stephen R Knight, Marie Carmela Lapitan, Ismaïl Lawani, Samuel Lawday, Mayaba Maimbo, Janet Martin, Luis Hernández Miguelena, Rohin Mittal, Rachel Moore, Dion Morton, Vanessa Msosa, Syed Asghar Naqi, Dmitri Nepogodiev, Faustin Ntirenganya, Martin Nyundo, Jean Léon Olory-Togbe, Thomas Pinkney, Ahmad Uzair Qureshi, Antonio Ramos‐De la Medina
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.