The Lancet: Prevention of surgical site infection in low-resource settings

2 November, 2021

Citation, extracts and a comment from me below.

CITATION: Prevention of surgical site infection in low-resource settings

Bruce M Biccard et al. The Lancet 2021

Published: October 25, 2021 DOI:

Surgical care is an indivisible component of UHC, yet the outcomes in low-income countries are poor. Provision of quality surgical care in these countries is difficult because resources and finances are limited. International guidelines that are blind to these barriers can unwittingly compromise quality care elsewhere when scarce financial resources are wasted to comply with guidelines that have a poor evidence base...

Reported in The Lancet, the FALCON trial is an important surgical trial for advancing UHC in low-income settings. Surgical site infections (SSI) predominate perioperative complications,6 with a higher burden and more antibiotic resistance in low-income countries. The need for appropriate global guidelines for prevention of SSI is therefore important. However, some recommendations are based on little evidence, with a negative financial effect in low-income countries. The FALCON trial provides the evidence necessary to inform the appropriateness of the WHO recommendation of 2% alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent SSI in abdominal surgery in LMICs. Before this study, the evidence was generally weak, with little data from LMICs to support such a recommendation. The FALCON trial found that neither 2% alcoholic chlorhexidine skin preparation nor triclosan-coated sutures provided benefit when compared with povidone–iodine skin preparation and non-coated sutures. The implications of these findings are that cheaper skin preparations and sutures can be safely used in low-resource environments with equivalent efficacy to prevent SSI, freeing up funds to improve the quality of care elsewhere...

COMMENT (NPW): The study suggests that some international guidelines (and national adapatations) may recommend interventions that are not appropriate for low-resource settings. Presumably this research will eventually feed back to inform future international guidance on prevention of surgical wound infection. What can be done to improve not only the reliability but also the relevance (including affordability) of guidelines for low-resource settings?

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator,