Urgent changes needed to global guidelines designed to stop surgical infection: New study

October 25, 2021 0 By CH Unnikrishnan

The world’s largest wound infection trial carried out by researchers from leading global medical universities, including University of Birmingham and University of Lagos found that even the most relied guidelines by World Health Organisation and UK’s National Institute of Health Research to avoid post surgery infections do not give the recommended results.  

Wound infections are the most common problem after surgery, particularly in developing countries, but promised innovations to tackle the issue do not work and global guidance needs changing, a new study reveals. Publishing their findings today in The Lancet, the researchers participating in this study are calling for guidelines recommending use of alcoholic chlorhexidine skin preparation and triclosan coated sutures to prevent Surgical Site Infection (SSI) need to be revised. 

Both World Health Organisation (WHO) and the UK’s National Institute of Health Research guidelines recommend that surgeons use alcoholic chlorhexidine skin preparation and triclosan coated sutures to prevent Surgical Site Infection (SSI).

However, the world’s largest wound infection trial could not demonstrate superiority of these interventions over lower cost alternatives. 

Carried out in Benin, Ghana, India, Mexico, Nigeria, Rwanda and South Africa, the FALCON trial was funded by the UK’s National Institute for Health Research (NIHR). 

“Surgical site infection is the world’s most common postoperative complication – a major burden for both patients and health systems. We have delivered the biggest trial of its kind, where we could not demonstrate the superiority of these interventions over cheaper alternatives,” says the study co-author Aneel Bhangu, from the University of Birmingham. 

“Our findings are hugely important for a wide range of care providers in LMICs, as following existing WHO and NICE guidelines, which have significant cost implications for organisations which have limited resources,” he added. 

Patients who develop SSI experience pain, disability, poor healing with risk of wound breakdown, prolonged recovery times and psychological challenges. 

Those patients in LMICs are disproportionately affected by higher rates of SSI compared to those in high-income countries – increasing the risk of catastrophic expenditure, impoverishment, and wider negative community impact.

Co-author Professor Adesoji Ademuyiwa, from the University of Lagos, commented: “The overall SSI rate was very high at 22% – a preventable complication that is causing unnecessary suffering and burden to patients and systems. 

“It is clear that small randomised trials should now be avoided and should be replaced with larger trials that can provide more robust evidence on the incidence of SSI, ultimately leading to more effective measures to help tack this global healthcare challenge.”

The NIHR Global Research Health Unit on Global Surgery trial covered 5,788 patients from 54 hospitals in seven countries – a broad and representative range including adults and children undergoing contaminated/dirty surgery, emergency surgery and cesarean section.