Print “PDF version”
What’s New in the
Patient Safety World
December 2022
Game Changer to
Prevent SSI’s in Abdominal Surgery?
Surgical site
infections (SSI’s) remain a significant problem, particularly in abdominal
surgeries. What if we had a simple, inexpensive intervention that could reduce
SSI’s? Investigators recently completed a study that suggests we have one!
ChEETAh was a multicenter, cluster randomized trial
in seven low-income and middle-income countries (Benin, Ghana, India, Mexico,
Nigeria, Rwanda, South Africa), across a wide range of operation types,
hospital types, and countries. Investigators randomly assigned 81 surgery
locations to either the current practice group (n = 42) or the intervention
group (n = 39). The intervention was a change of sterile gloves and change to sterile instruments before
closure of the surgical incision in
a variety of abdominal surgical procedures.
Data was obtained on
over 13,000 patients. Glove and instrument change took place in 58 (0.8%) of
7157 patients in the current practice group and 6044 (98.3%) of 6144 patients
in the intervention group. The SSI rate was 18.9% in the current practice group
versus 16.0% in the intervention group (adjusted risk ratio: 0.87, p=0·0032).
The authors conclude
that ChEETah robustly shows that routine change of
gloves and instruments before wound closure reduced surgical site infections in
clean–contaminated, contaminated, and dirty surgery, which was consistent
across several sensitivity analyses. Lack of heterogeneity of effect across any
of the prespecified subgroups suggests that the effect is consistent across a
wide range of patients.
The accompanying editorial (Abiad 2022) notes some limitations of the study (cluster design, intention-to-treat analysis, lack of blinding, and failure to differentiate double-gloving from single-gloving). But it concludes that, despite these limitations, the results of the trial are plausible, meaningful, and impactful. Change of gloves and instruments before skin closure in clean–contaminated and contaminated–dirty abdominal procedures prevents one of every eight SSI’s, and the results are possibly if not probably generalizable globally and to non-abdominal surgery.
Although the study
had a pragmatic design and was done solely in low-income and middle-income
countries and the SSI rates were quite high in both the usual care group and
intervention group, we agree the results may well be generalizable. We’d like
to see this study replicated in the US and other high-income countries, and
perhaps in surgeries in addition to abdominal surgery. But this could well be a
game changer!
References:
NIHR Global Research Health Unit on Global Surgery. Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh): a pragmatic, cluster-randomised trial in seven low-income and middle-income countries. Lancet 2022; 400(10365): 1767-1776 November 19, 2022
Abiad MF, Kaafarani HMA. Changing gloves and switching instruments to decrease surgical site infection in abdominal surgery. Lancet 2022; 400(10365): 1742-1743 November 19, 2022
Print “PDF version”
http://www.patientsafetysolutions.com/
What’s New in
the Patient Safety World Archive