It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey
Authors: Sartelli Massimo , Labricciosa Francesco M. , Coccolini Federico , Coimbra Raul , Abu-Zidan Fikri M. , Ansaloni Luca , Al-Hasan Majdi N. , Ansari Shamshul , Barie Philip S. , Caínzos Miguel Angel , Ceresoli Marco , Chiarugi Massimo , Claridge Jeffrey A. , Cicuttin Enrico , Dellinger Evan Patchen , Fry Donald E. , Guirao Xavier , Hardcastle Timothy Craig , Hecker Andreas , Leppäniemi Ari K. , Litvin Andrey , Marwah Sanjay , Maseda Emilio , Mazuski John E. , Memish Ziad Ahmed , Kirkpatrick Andrew W. , Pagani Leonardo , Podda Mauro , Rasa Huseyin Kemal , Sakakushev Boris E. , Sawyer Robert G. , Tumietto Fabio , Xiao Yonghong , Aboubreeg Wedad Faraj , Adamou Harissou , Akhmeteli Lali , Akin Emrah , Alberio Maria Grazia , Alconchel Felipe , Magagi Ibrahim Amadou , Araúz Ana Belén , Argenio Giulio , Atanasov Boyko C. , Atici Semra Demirli , Awad Selmy Sabry , Baili Efstratia , Bains Lovenish , Bala Miklosh , Baraket Oussama , Baral Suman , Belskii Vladislav A. , Benboubker Moussa , Ben-Ishay Offir , Bordoni Pierpaolo , Boumédiène Abdalia , Brisinda Giuseppe , Cavazzuti Laura , Chandy Sujith J. , Chiarello Maria Michela , Cillara Nicola , Clarizia Guglielmo , Cocuz Maria-Elena , Cocuz Iuliu Gabriel , Conti Luigi , Coppola Raffaella , Cui Yunfeng , Czepiel Jacek , D’Acapito Fabrizio , Damaskos Dimitrios , Das Koray , De Simone Belinda , Delibegovic Samir , Demetrashvili Zaza , Detanac Dzemail S. , Dhingra Sameer , Di Bella Stefano , Dimitrov Evgeni N. , Dogjani Agron , D’Oria Mario , Dumitru Irina Magdalena , Elmangory Mutasim M. , Enciu Octavian , Fantoni Massimo , Filipescu Daniela , Fleres Francesco , Foghetti Domitilla , Fransvea Pietro , Gachabayov Mahir , Galeiras Rita , Gattuso Gianni , Ghannam Wagih M. , Ghisetti Valeria , Giraudo Giorgio , Gonfa Kebebe Bekele , Gonullu Emre , Hamad Yousif Tag Elsir Y. , Hecker Matthias , Isik Arda , Ismail Nizar , Ismail Azzain , Jain Sumita Agarwal , Kanj Souha S. , Kapoor Garima , Karaiskos Ilias , Kavalakat Alfie J. , Kenig Jakub , Khamis Faryal , Khokha Vladimir , Kiguba Ronald , Kim Jae Il , Kobe Yoshiro , Kok Kenneth Yuh Yen , Kovacevic Bojan M. , Kryvoruchko Igor Andreevich , Kuriyama Akira , Landaluce-Olavarria Aitor , Lasithiotakis Konstantinos , Lohsiriwat Varut , Lostoridis Eftychios , Luppi Davide , Vega Gustavo Miguel Machain , Maegele Marc , Marinis Athanasios , Martines Gennaro , Martínez-Pérez Aleix , Massalou Damien , Mesina Cristian , Metan Gökhan , Miranda-Novales María Guadalupe , Mishra Shyam Kumar , Mohamed Mohaned Ibrahim Hussein , Mohamedahmed Ali Yasen Y. , Mora-Guzmán Ismael , Mulita Francesk , Musina Ana-Maria , Navsaria Pradeep H. , Negoi Ionut , Nita Gabriela Elisa , O’Connor Donal B. , Ordoñez Carlos Alberto , Pantalone Desiré , Panyko Arpád , Papadopoulos Aristeidis , Pararas Nikolaos , Pata Francesco , Patel Tapan , Pellino Gianluca , Perra Teresa , Perrone Gennaro , Pesce Antonio , Pintar Tadeja , Popivanov Georgi Ivanov , Porcu Alberto , Quiodettis Martha Alexa , Rahim Razrim , Mitul Ashrarur Rahman , Reichert Martin , Rems Miran , Campbell Glendee Yolande Reynolds , Rocha-Pereira Nuno , Rodrigues Gabriel , Villamil Gustavo Eduardo Roncancio , Rossi Stefano , Sall Ibrahima , Kafil Hossein Samadi , Sasia Diego , Seni Jeremiah , Seretis Charalampos , Serradilla-Martín Mario , Shelat Vishal G. , Siribumrungwong Boonying , Slavchev Mihail , Solaini Leonardo , Tan Boun Kim , Tarasconi Antonio , Tartaglia Dario , Toma Elena Adelina , Tomadze Gia , Toro Adriana , Tovani-Palone Marcos Roberto , van Goor Harry , Vasilescu Alin , Vereczkei Andras , Veroux Massimiliano , Weckmann Sergio Alberto , Widmer Lukas Werner , Yahya AliIbrahim , Zachariah Sanoop K. , Zakaria Andee Dzulkarnaen , Zubareva Nadezhda , Zuidema Wietse P. , Di Carlo Isidoro , Cortese Francesco , Baiocchi Gian Luca , Maier Ronald V. , Catena Fausto 
Published: March 2022

Abstract
Background
The objectives of the study were to investigate the organizational characteristics of acute care facilities worldwide in preventing and managing infections in surgery; assess participants’ perception regarding infection prevention and control (IPC) measures, antibiotic prescribing practices, and source control; describe awareness about the global burden of antimicrobial resistance (AMR) and IPC measures; and determine the role of the Coronavirus Disease 2019 pandemic on said awareness.

Methods
A cross-sectional web-based survey was conducted contacting 1432 health care workers (HCWs) belonging to a mailing list provided by the Global Alliance for Infections in Surgery. The self-administered questionnaire was developed by a multidisciplinary team. The survey was open from May 22, 2021, and June 22, 2021. Three reminders were sent, after 7, 14, and 21 days.

Results
Three hundred four respondents from 72 countries returned a questionnaire, with an overall response rate of 21.2%. Respectively, 90.4% and 68.8% of participants stated their hospital had a multidisciplinary IPC team or a multidisciplinary antimicrobial stewardship team. Local protocols for antimicrobial therapy of surgical infections and protocols for surgical antibiotic prophylaxis were present in 76.6% and 90.8% of hospitals, respectively. In 23.4% and 24.0% of hospitals no surveillance systems for surgical site infections and no monitoring systems of used antimicrobials were implemented. Patient and family involvement in IPC management was considered to be slightly or not important in their hospital by the majority of respondents (65.1%). Awareness of the global burden of AMR among HCWs was considered very important or important by 54.6% of participants. The COVID-19 pandemic was considered by 80.3% of respondents as a very important or important factor in raising HCWs awareness of the IPC programs in their hospital. Based on the survey results, the authors developed 15 statements for several questions regarding the prevention and management of infections in surgery. The statements may be the starting point for designing future evidence-based recommendations.

Conclusion
Adequacy of prevention and management of infections in acute care facilities depends on HCWs behaviours and on the organizational characteristics of acute health care facilities to support best practices and promote behavioural change. Patient involvement in the implementation of IPC is still little considered. A debate on how operationalising a fundamental change to IPC, from being solely the HCWs responsibility to one that involves a collaborative relationship between HCWs and patients, should be opened.