Delphi prioritization and development of global surgery guidelines for the prevention of surgical‐site infection

• Published in: British journal of surgery Vol. 107; no. 8; pp. 970 - 977
• Main Authors: Nepogodiev, Dmitri, Adisa, Adewale, Abantanga, Francis Atindaana, Ademuyiwa, Adesoji, Ghosh, Dhruva, Glasbey, James, Lapitan, Marie Carmela, Lawani, Ismail, Maimbo, Mayaba, Moore, Rachel, Morton, Dion, Qureshi, Ahmad Uzair, Ramos‐De la Medina, Antonio, Tabiri, Stephen, Pinkney, Thomas, Bhangu, Aneel, Adenekan, Anthony, Adewunmi, Abdus‐sami, Biccard, Bruce, Brocklehurst, Peter, Chakrabortee, Sohini, Cotton, Philip, Davies, Justine, Drake, Thomas M., Garden, O. James, Haque, Parvez David, Harrison, Ewen M., Ingabire, Jean De La Croix Allen, Knight, Stephen R., Lilford, Richard, Martin, Janet, Miguelena, Luis Hernandez, Mittal, Rohin, Msosa, Vanessa, Naqi, Syed Asghar, Ntirenganya, Faustin, Olory‐Togbe, Jean Leon, Omar, Omar Mohamed, Pinkney, Thomas D., Salem, Hosni Khairy, Smith, Martin, Sundar, Sudha, Yenli, Edwin, Yepez, Raul, Zoumenou, Eugene, Aguilera, Maria Lorena, Jones, Conor S, Kajombo, Chifundo, Lawday, Samuel, Nyundo, Martin, la Medina, Antonio Ramos‐De, Parreno‐Sacdalan, Dione
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.07.2020; Oxford University Press
• Subjects: Delphi Technique; Developing Countries; Global Health; Humans; Infections; Lower GI; Original; Perioperative Care - methods; Perioperative Care - standards; Practice Guidelines as Topic; Prevention; Surgery; Surgical site infections; Surgical Wound Infection - prevention & control; Upper GI
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1002/bjs.11530

Background Most clinical guidelines are developed by high‐income country institutions with little consideration given to either the evidence base for interventions in low‐ and middle‐income countries (LMICs), or the specific challenges LMIC health systems may face in implementing recommendations. The aim of this study was to prioritize topics for future global surgery guidelines and then to develop a guideline for the top ranked topic. Methods A Delphi exercise identified and prioritized topics for guideline development. Once the top priority topic had been identified, relevant existing guidelines were identified and their recommendations were extracted. Recommendations were shortlisted if they were supported by at least two separate guidelines. Following two voting rounds, the final recommendations were agreed by an international guideline panel. The final recommendations were stratified by the guideline panel as essential (baseline measures that should be implemented as a priority) or desirable (some hospitals may lack these resources at present, in which case they should plan for future implementation). Results Prevention of surgical‐site infection (SSI) after abdominal surgery was identified as the highest priority topic for guideline development. The international guideline panel reached consensus on nine essential clinical recommendations for prevention of SSI. These included recommendations concerning preoperative body wash, use of prophylactic antibiotics, decontamination of scrub teams' hands, use of antiseptic solutions for surgical site preparation and perioperative supplemental oxygenation. In addition, three desirable clinical recommendations and four recommendations for future research were agreed. Conclusion This process led to the development of a global surgery guideline for the prevention of SSI that is both clinically relevant and implementable in LMICs. Antecedentes La mayoría de las guías clínicas están desarrolladas por instituciones de países con altos ingresos, con poca consideración respecto a las bases de la evidencia para intervenciones en países con ingresos bajos y medios (low‐ and middle‐income countries, LMIC) o a los desafíos específicos que los sistemas de salud de LMIC pueden enfrentarse al implementar las recomendaciones. El objetivo de este estudio fue priorizar los temas para futuras guías quirúrgicas globales y seguidamente desarrollar una guía para el tema categorizado en primer lugar. Métodos Un proceso tipo Delphi identificó y priorizó los temas para el desarrollo de las guías. Una vez identificado el tema de máxima prioridad, se seleccionaron las guías existentes más relevantes y se extrajeron sus recomendaciones. Las recomendaciones fueron preseleccionadas si estaban respaldadas por al menos dos guías distintas. Después de dos rondas de votación, las recomendaciones finales fueron acordadas por un panel internacional de expertos en guías. Las recomendaciones finales fueron estratificadas por el panel como esenciales (medidas básicas que deberían implementarse como una prioridad) o deseables (algunos hospitales pueden carecer de estos recursos en este momento, en cuyo caso deberían plantear una implementación futura). Resultados El método Delphi identificó la prevención de la infección del sitio quirúrgico (surgical‐site infection, SSI) después de la cirugía abdominal como el tema de máxima prioridad para el desarrollo de guías. El borrador inicial de las recomendaciones se desarrolló en base a cinco guías existentes que abordaban la prevención de SSI. Después de dos rondas de votación, el panel internacional acordó una lista de nueve recomendaciones clínicas esenciales y tres deseables. Además, se hicieron cuatro recomendaciones para futuras investigaciones. Conclusión Este proceso desarrolló una guía quirúrgica global para la prevención de SSI que es clínicamente relevante y además se puede implementar en los LMICs. A global surgery guideline for the prevention of surgical‐site infection has been developed that is both clinically relevant and implementable in low‐ and middle‐income countries (LMICs). This guideline includes nine essential and three desirable clinical recommendations. Usable worldwide