Surgical site infection (SSI) is the commonest complication of surgery. Surgical site infection is unpleasant and harmful for patients, increases the cost of surgical care, contributes to the burden faced by patients and their relatives and it is an avoidable drain on meagre hospital resources. Various interventions have been postulated to reduce the incidence of SSI, but it has been difficult to obtain a magic bullet to end the scourge. Major agencies, such as the World Health Organisation, the Centers for Disease Control (USA) and the National Institute for Clinical Excellence (UK), have not been able to make a recommendation of changing sterile gloves and instruments to reduce SSI. This has largely been because most randomised controlled trials on SSI had hitherto been small, with moderate to high risk of bias. This study utilised a cluster randomised design among collaborating hospitals in low- and middle-income countries (LMICs) where the effect of any benefit is likely to be most efficacious and contamination between trial groups can be prevented. This is the largest, most comprehensive randomised controlled trial on SSI involving LMICs.
The ChEETAh study recruited 13,301 patients who underwent abdominal surgery (with a known risk of SSI) from 81 hospitals over a period of 22 months in seven countries (Benin, Ghana, India, Mexico, Nigeria, Rwanda and South Africa). The rate of SSI was significantly lower among patients for whom the closure of the abdominal wound involved a change of sterile gloves and instruments compared to those who received conventional care. We have provided the evidence to change practice in operating theatres across the world, with a simple behaviour change that is easy to implement. With this study, it is imperative that surgeons imbibe the results by changing their gloves and instruments when indicated to improve the outcome in their patients.
Dr Taiwo Lawal, MBBS (Ibadan), MSc (Epid and Med Stat), MD (Hannover), FWACS, FACS, FICS is the Lead Principal Investigator of the COMUI/UCH Spoke for the study. He is a Paediatric Surgeon and leads other from Anaesthesia, Obstetrics and Gynaecology, Surgery etc to conduct Global Surgery research at the twin institutions. He has over 130 publications in peer-reviewed journals. He has a Google Scholar citation of 5683, h-index of 33 and i10-index of 62. He serves on the Editorial Boards of the African Journal of Medicine and Medical Sciences (COMUI) and the Prime Medics Journal (UCH).
The Global Lead and Principal Investigator for the study – Professor Adesoji Ademuyiwa who doubles as the Nigerian Hub Director of the NIHR-Global Surgery Unit is also an alumnus of the COMUI. He is the Chief of Paediatric Surgery at the College of Medicine, University of Lagos/Lagos University Teaching Hospital, and has led various Global Surgery initiatives targeted at improving the outcome of surgical care.
Please read the full - length article at: https://www.thelancet.com/article/S0140-6736(22)01884-0/fulltext
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