Delphi prioritization and development of global surgery guidelines for the prevention of surgical-site infection
Authors:   National Institute for Health Research Global Research Health Unit on Global Surgery, Nepogodiev Dmitri , Adisa Adewale , Abantanga Francis Atindaana , Ademuyiwa Adesoji , Chakrabortee Sohini , Ghosh Dhruva , Glasbey James , Lapitan Marie Carmela , Lawani Ismail , Maimbo Mayaba , Moore Rachel , Morton Dion , Ntirenganya Faustin , Qureshi Ahmad Uzair , Ramos-De la Medina Antonio , Tabiri Stephen , Pinkney Thomas , Bhangu Aneel , Ademuyiwa Adesoji , Adenekan Anthony , Adewunmi Abdus-sami , Adisa Adewale , Aguilera Maria Lorena , Bhangu Aneel , Biccard Bruce , Brocklehurst Peter , Chakrabortee Sohini , Costa Ainhoa , Cotton Philip , Davies Justine , Drake Thomas M , Garden O James , Ghosh Dhruv , Glasbey James , Haque Parvez David , Harrison Ewen M , Ingabire Jean De La Croix Allen , Knight Stephen R , Lapitan Marie Carmela , Lawani Ismail , Lilford Richard , Maimbo Mayaba , Martin Janet , Miguelena Luis Hernandez , Mittal Rohin , Moore Rachel , Morton Dion , Msosa Vanessa , Naqi Syed Asghar , Nepogodiev Dmitri , Ntirenganya Faustin , Olory-Togbe Jean Leon , Omar Omar Mohamed , Pinkney Thomas D , Qureshi Ahmad Uzair , Ramos-De la Medina Antonio , Salem Hosni Khairy , Smith Martin , Sundar Sudha , Tabiri Stephen , Yenli Edwin , Yepez Raul , Zoumenou Eugene , Abantanga Francis Atindaana , Ademuyiwa Adesoji , Adewunmi Abdus-sami , Adisa Adewale , Aguilera Maria Lorena , Bhangu Aneel , Biccard Bruce , Brocklehurst Peter , Chakrabortee Sohini , Costa Ainhoa , Drake Thomas M , Ghosh Dhruva , Glasbey James , Haque Parvez David , Harrison Ewen M , Ingabire Jean De La Croix Allen , Jones Conor S , Kajombo Chifundo , Knight Stephen R , Lapitan Marie Carmela , Lawani Ismail , Lawday Samuel , Maimbo Mayaba , Martin Janet , Miguelena Luis Hernandez , Mittal Rohin , Moore Rachel , Morton Dion , Msosa Vanessa , Naqi Syed Asghar , Nepogodiev Dmitri , Ntirenganya Faustin , Nyundo Martin , Olory-Togbe Jean Leon , Pinkney Thomas D , Qureshi Ahmad Uzair , la Medina Antonio Ramos-De , Parreno-Sacdalan Dione , Salem Hosni Khairy , Smith Martin , Tabiri Stephen , Yenli Edwin , Zoumenou Eugene 
Published: March 2020

Abstract

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.