Safety First - Voices of One Surgery - Issue 4: December 2018

VOICES • THREE • SURGERY • 34
The delivery of safe surgical care is contingent on
various factors in the surgical timeline, from
pre-operative preparation, surgical intervention, to
post-operative care, such as human and physical
resources, as well as environment. Particularly for
low-income and middle-income countries (LMICs)
with scarce resources and poor infrastructure,
addressing all barriers to safe surgery proves to be
challenging. Instead, improving existing standards
of surgical safety with the universal implementation
of checklists and evidence-based international
guidelines was deemed the most effective initial
intervention [1].
Surgical site infection (SSI), one of the ten essential
objectives highlighted in the WHO safe surgery
guidelines, has garnered increasing attention. SSI is
an infection, often by patients’ normal flora, that
occurs at the site of surgical operation which could
either involve the area of incision or involved
organ/space [1]. These nosocomial infections are
preventable, yet remain a substantial cause of
morbidity and
mortality, and associated with an enormous
economic burden [1-3].
A recent prospective, international, multicentre
cohort study on the burden of SSIs after
gastrointestinal surgery illustrates the urgent
need to further reduce SSIs in the global surgery
agenda. However, what is equally alarming, is the
administration of prophylactic and post-operative
antibiotics, which is higher in LMICs with a longer
course of treatment [3]. Exacerbating the issue
further is the fact that the causative organisms are
often resistant to the antibiotics given, hinting at
the wider problem of antimicrobial resistance and
overuse [3,4]. This certainly does not preclude
antimicrobial use in the prevention and
treatment of SSIs, since mortality from lack of or
delayed access to antibiotics is still greater
that due to antibiotic-resistance bacteria, but the
limited high-quality evidence recommending
usage may make changing local practice and
culture more difficult [3,5,6].
PHOTO BY AL SOOT ON UNSPLASH