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. 2022 Mar 17;17(1):17.
doi: 10.1186/s13017-022-00420-4.

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  1 , Francesco M Labricciosa  2 , Federico Coccolini  3 , Raul Coimbra  4 , Fikri M Abu-Zidan  5 , Luca Ansaloni  6 , Majdi N Al-Hasan  7 , Shamshul Ansari  8 , Philip S Barie  9 , Miguel Angel Caínzos  10 , Marco Ceresoli  11 , Massimo Chiarugi  3 , Jeffrey A Claridge  12 , Enrico Cicuttin  3 , Evan Patchen Dellinger  13 , Donald E Fry  14 , Xavier Guirao  15 , Timothy Craig Hardcastle  16 , Andreas Hecker  17 , Ari K Leppäniemi  18 , Andrey Litvin  19 , Sanjay Marwah  20 , Emilio Maseda  21 , John E Mazuski  22 , Ziad Ahmed Memish  23 , Andrew W Kirkpatrick  24 , Leonardo Pagani  25 , Mauro Podda  26 , Huseyin Kemal Rasa  27 , Boris E Sakakushev  28 , Robert G Sawyer  29 , Fabio Tumietto  30 , Yonghong Xiao  31 , Wedad Faraj Aboubreeg  32 , Harissou Adamou  33 , Lali Akhmeteli  34 , Emrah Akin  35 , Maria Grazia Alberio  36 , Felipe Alconchel  37 , Ibrahim Amadou Magagi  33 , Ana Belén Araúz  38 , Giulio Argenio  39 , Boyko C Atanasov  40 , Semra Demirli Atici  41 , Selmy Sabry Awad  42 , Efstratia Baili  43 , Lovenish Bains  44 , Miklosh Bala  45 , Oussama Baraket  46 , Suman Baral  47 , Vladislav A Belskii  48 , Moussa Benboubker  49 , Offir Ben-Ishay  50 , Pierpaolo Bordoni  51 , Abdalia Boumédiène  52 , Giuseppe Brisinda  53 , Laura Cavazzuti  54 , Sujith J Chandy  55 , Maria Michela Chiarello  56 , Nicola Cillara  57 , Guglielmo Clarizia  51 , Maria-Elena Cocuz  58 , Iuliu Gabriel Cocuz  59 , Luigi Conti  60 , Raffaella Coppola  61 , Yunfeng Cui  62 , Jacek Czepiel  63 , Fabrizio D'Acapito  64 , Dimitrios Damaskos  65 , Koray Das  66 , Belinda De Simone  67 , Samir Delibegovic  68 , Zaza Demetrashvili  69 , Dzemail S Detanac  70 , Sameer Dhingra  71 , Stefano Di Bella  72 , Evgeni N Dimitrov  73 , Agron Dogjani  74 , Mario D'Oria  75 , Irina Magdalena Dumitru  76 , Mutasim M Elmangory  77 , Octavian Enciu  78 , Massimo Fantoni  79 , Daniela Filipescu  80 , Francesco Fleres  51 , Domitilla Foghetti  81 , Pietro Fransvea  53 , Mahir Gachabayov  82 , Rita Galeiras  83 , Gianni Gattuso  84 , Wagih M Ghannam  85 , Valeria Ghisetti  86 , Giorgio Giraudo  87 , Kebebe Bekele Gonfa  88 , Emre Gonullu  89 , Yousif Tag Elsir Y Hamad  90 , Matthias Hecker  91 , Arda Isik  92 , Nizar Ismail  93 , Azzain Ismail  94 , Sumita Agarwal Jain  95 , Souha S Kanj  96 , Garima Kapoor  97 , Ilias Karaiskos  98 , Alfie J Kavalakat  99 , Jakub Kenig  100 , Faryal Khamis  101 , Vladimir Khokha  102 , Ronald Kiguba  103 , Jae Il Kim  104 , Yoshiro Kobe  105 , Kenneth Yuh Yen Kok  106 , Bojan M Kovacevic  107 , Igor Andreevich Kryvoruchko  108 , Akira Kuriyama  109 , Aitor Landaluce-Olavarria  110 , Konstantinos Lasithiotakis  111 , Varut Lohsiriwat  112 , Eftychios Lostoridis  113 , Davide Luppi  114 , Gustavo Miguel Machain Vega  115 , Marc Maegele  116 , Athanasios Marinis  117 , Gennaro Martines  118 , Aleix Martínez-Pérez  119 , Damien Massalou  120 , Cristian Mesina  121 , Gökhan Metan  122 , María Guadalupe Miranda-Novales  123 , Shyam Kumar Mishra  124 , Mohaned Ibrahim Hussein Mohamed  125 , Ali Yasen Y Mohamedahmed  126 , Ismael Mora-Guzmán  127 , Francesk Mulita  128 , Ana-Maria Musina  129 , Pradeep H Navsaria  130 , Ionut Negoi  131 , Gabriela Elisa Nita  114 , Donal B O'Connor  132 , Carlos Alberto Ordoñez  133 , Desiré Pantalone  134 , Arpád Panyko  135 , Aristeidis Papadopoulos  136 , Nikolaos Pararas  137 , Francesco Pata  138 , Tapan Patel  139 , Gianluca Pellino  140 , Teresa Perra  141 , Gennaro Perrone  142 , Antonio Pesce  143 , Tadeja Pintar  144 , Georgi Ivanov Popivanov  145 , Alberto Porcu  141 , Martha Alexa Quiodettis  146 , Razrim Rahim  147 , Ashrarur Rahman Mitul  148 , Martin Reichert  17 , Miran Rems  149 , Glendee Yolande Reynolds Campbell  150 , Nuno Rocha-Pereira  151 , Gabriel Rodrigues  152 , Gustavo Eduardo Roncancio Villamil  153   154 , Stefano Rossi  155 , Ibrahima Sall  156 , Hossein Samadi Kafil  157 , Diego Sasia  87 , Jeremiah Seni  158 , Charalampos Seretis  159 , Mario Serradilla-Martín  160 , Vishal G Shelat  161 , Boonying Siribumrungwong  162 , Mihail Slavchev  163 , Leonardo Solaini  164 , Boun Kim Tan  165 , Antonio Tarasconi  142 , Dario Tartaglia  3 , Elena Adelina Toma  78 , Gia Tomadze  166 , Adriana Toro  167 , Marcos Roberto Tovani-Palone  168 , Harry van Goor  169 , Alin Vasilescu  170 , Andras Vereczkei  171 , Massimiliano Veroux  172 , Sergio Alberto Weckmann  173 , Lukas Werner Widmer  174 , AliIbrahim Yahya  175 , Sanoop K Zachariah  176 , Andee Dzulkarnaen Zakaria  177 , Nadezhda Zubareva  178 , Wietse P Zuidema  179 , Isidoro Di Carlo  172 , Francesco Cortese  180 , Gian Luca Baiocchi  181   182 , Ronald V Maier  183 , Fausto Catena  184
Affiliations

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 et al. World J Emerg Surg. .

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.

Keywords: Antibiotic prescribing; Antibiotic resistance; Antimicrobial stewardship; Cross-sectional survey; Infection prevention and control.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

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Fig. 1
Patient care
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Fig. 2
Participants’ perceptions of importance of teamwork, patient safety and evidence-based medicine culture in their hospitals. EBM Evidence-based medicine
Fig. 3
Fig. 3
Participants’ perception of the role of COVID-19 pandemic. IPC Infection prevention and control, AMP antimicrobial prescription
See this image and copyright information in PMC

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