Embracing robotic surgery in low- and middle-income countries: Potential benefits, challenges, and scope in the future

Robotic surgery has applications in many medical specialties, including urology, general surgery, and surgical oncology. In the context of a widespread resource and personnel shortage in Low- and Middle-Income Countries(LMICs), the use of robotics in surgery may help to reduce physician burnout, surgical site infections, and hospital stays. However, a lack of haptic feedback and potential socioeconomic factors such as high implementation costs and a lack of trained personnel may limit its accessibility and application. Specific improvements focused on improved financial and technical support to LMICs can help improve access and have the potential to transform the surgical experience for both surgeons and patients in LMICs. This review focuses on the evolution of robotic surgery, with an emphasis on challenges and recommendations to facilitate wider implementation and improved patient outcomes.

Appropriateness of surgical antimicrobial prophylaxis in a teaching hospital in Ghana : findings and implications

Background: Surgical site infections (SSIs) are among the most common infections seen in hospitalized patients in low- and middle-income countries (LMICs), accounting for up to 60% of hospital-acquired infections. Surgical antimicrobial prophylaxis (SAP) has shown to be an effective intervention for reducing SSIs and their impact. There are concerns of inappropriate use of SAP in Ghana and therefore our audit in this teaching hospital. Method: A retrospective cross sectional clinical audit of medical records of patients undergoing surgery over a 5-month duration from January to May 2021 in Ho Teaching Hospital. Data collection form was designed to collect key information including the age and gender of patient, type and duration of surgery, choice and duration of SAP. Data collected were assessed for the proportion of SAP compliance with Ghana standard treatment guidelines (STG) and its association with various patient, surgical wound and drug characteristics. Results: Of the 597 medical records assessed, the mean age of patients was 35.6± 12.2 years with 86.8% (n=518) female. Overall SAP compliance with the STG was 2.5% (n=15). SAP compliance due to appropriate choice of antimicrobials was 67.0% (n=400) and duration at 8.7% (n=52). SAP compliance was predicted by duration of SAP (pConclusion: SAP compliance rate was suboptimal, principally due to a longer duration of prescription. Quality improvement measures such as education and training of front-line staff on guideline compliance, coupled with clinical audit and regular updates, are urgently needed to combat inappropriate prescribing and rising resistance rates.

The Effect and Feasibility of mHealth-Supported Surgical Site Infection Diagnosis by Community Health Workers After Cesarean Section in Rural Rwanda: Randomized Controlled Trial

Background:
The development of a surgical site infection (SSI) after cesarean section (c-section) is a significant cause of morbidity and mortality in low- and middle-income countries, including Rwanda. Rwanda relies on a robust community health worker (CHW)–led, home-based paradigm for delivering follow-up care for women after childbirth. However, this program does not currently include postoperative care for women after c-section, such as SSI screenings.

Objective:
This trial assesses whether CHW’s use of a mobile health (mHealth)–facilitated checklist administered in person or via phone call improved rates of return to care among women who develop an SSI following c-section at a rural Rwandan district hospital. A secondary objective was to assess the feasibility of implementing the CHW-led mHealth intervention in this rural district.

Methods:
A total of 1025 women aged ≥18 years who underwent a c-section between November 2017 and September 2018 at Kirehe District Hospital were randomized into the three following postoperative care arms: (1) home visit intervention (n=335, 32.7%), (2) phone call intervention (n=334, 32.6%), and (3) standard of care (n=356, 34.7%). A CHW-led, mHealth-supported SSI diagnostic protocol was delivered in the two intervention arms, while patients in the standard of care arm were instructed to adhere to routine health center follow-up. We assessed intervention completion in each intervention arm and used logistic regression to assess the odds of returning to care.

Results:
The majority of women in Arm 1 (n=295, 88.1%) and Arm 2 (n=226, 67.7%) returned to care and were assessed for an SSI at their local health clinic. There were no significant differences in the rates of returning to clinic within 30 days (P=.21), with high rates found consistently across all three arms (Arm 1: 99.7%, Arm 2: 98.4%, and Arm 3: 99.7%, respectively).

Conclusions:
Home-based post–c-section follow-up is feasible in rural Africa when performed by mHealth-supported CHWs. In this study, we found no difference in return to care rates between the intervention arms and standard of care. However, given our previous study findings describing the significant patient-incurred financial burden posed by traveling to a health center, we believe this intervention has the potential to reduce this burden by limiting patient travel to the health center when an SSI is ruled out at home. Further studies are needed (1) to determine the acceptability of this intervention by CHWs and patients as a new standard of care after c-section and (2) to assess whether an app supplementing the mHealth screening checklist with image-based machine learning could improve CHW diagnostic accuracy.

The practices of aseptic technique of perioperative nurses in operation room to prevent surgical site infection : integrative literature review

Surgical site infections are the most common preventable health care-associated infections. However, the complications of SSIs are associated with additional inpatient stay costs, morbidity, and mortality. Perioperative nurses must be well-educated and well-trained to perform aseptic technique for preventing SSIs as well as facilitating safe surgical procedures for patients. Aseptic technique practices involve the performance of hand hygiene, donning gloves, applying surgical attire, preoperative aseptic skin preparation, aseptic instrument preparation, and aseptic environment maintenance.

The thesis aims to explore which elements are related to the perioperative nurses’ practices in aseptic technique in operation room, regarding the prevention of SSIs and how these practices affect to the outcomes of SSIs.

The purpose of this thesis is to promote understanding and awareness of aseptic technique in operation room, which contributes to SSI prevention. Particularly, the study is beneficial for senior nursing students and graduated nurses as a holistic picture of aseptic technique for further specific research related to this topic.

A combination of qualitative and quantitative methods was executed in this literature review. The data search and collection processes are mainly from electronic databases as EBSCO, SAGE, and PubMed in association with the consideration of inclusion and exclusion criteria. The year publication was from 2010 to 2020 in order to meet the requirement of timely and update knowledge provision. Inductive content analysis was conducted to analyse collected data and generate appropriate categories relevant to research questions.

Regard of SSI prevention, double set of sterile gloves is recommended in clinical practice to decrease the possibility of inner gloving perforation and bacterial transmission inside out. Surgical hand rubbing with alcohol-based disinfection solution is more preferred than traditional scrubbing. Despite insufficient evidence, surgical attire, including gown, surgical headgear, and SMs is routinely recommended in clinical practice compliance. If necessary, hair removal with clippers is preferable than razors. Shoe covers, a back-and-forth technique in skin preparation, adhesive surgical drapes were supported by a very low level of evidence. Meanwhile, staff movements, door openings, temperature, and airflow have been suggested to affect the integrity of the sterile field by a moderate amount of evidence. A minor point was also pointed out that 30-47% of entries and exits from the OR are unnecessary.

Surgical Site Infection and Costs in Low- And Middle-Income Countries: A Systematic Review of the Economic Burden

Background: Surgical site infection (SSI) is a worldwide problem which has morbidity, mortality and financial consequences. The incidence rate of SSI is high in Low- and Middle-Income countries (LMICs) compared to high income countries, and the costly surgical complication can raise the potential risk of financial catastrophe.

Objective: The aim of the study is to critically appraise studies on the cost of SSI in a range of LMIC studies and compare these estimates with a reference standard of high income European studies who have explored similar SSI costs.

Methods: A systematic review was undertaken using searches of two electronic databases, EMBASE and MEDLINE In-Process & Other Non-Indexed Citations, up to February 2019. Study characteristics, comparator group, methods and results were extracted by using a standard template.

Results: Studies from 15 LMIC and 16 European countries were identified and reviewed in full. The additional cost of SSI range (presented in 2017 international dollars) was similar in the LMIC ($174-$29,610) and European countries ($21-$34,000). Huge study design heterogeneity was encountered across the two settings.

Discussion: SSIs were revealed to have a significant cost burden in both LMICs and High Income Countries in Europe. The magnitude of the costs depends on the SSI definition used, severity of SSI, patient population, choice of comparator, hospital setting, and cost items included. Differences in study design affected the comparability across studies. There is need for multicentre studies with standardized data collection methods to capture relevant costs and consequences of the infection across income settings.