In 2010, following the World Health Organization (WHO) recommendations, many hospitals implemented a surgical safety programme centered around a surgical safety checklist.

The present study compared the indicators of surgical site infection, antimicrobial usage, antimicrobial resistance, costs, and in-hospital mortality before (Jan2006 to Jul2010) and after (Aug2010 to Dec2014) implementation of the programme.

This case-control study matched the patients with surgical site infection (SSI) to surgical patients without infection to examine the impact of the intervention.

The investigators found an association between using the surgical checklist and a significant reduction in SSI. 

In comparing the two time periods, they found-

• A decrease in infections due to micro-organisms in the ESKAPE group (from 90.7% to 73.9%),
• A reduction of SSI in patients with contaminated, infected, and potentially contaminated wounds and for those who discontinued perioperative antimicrobial prophylaxis in less than 48 hours. 

Overall, the investigators found a reduction in antimicrobial resistance, though there was an increase in resistance to carbapenems, glycopeptides for Enterococcus faecium, and clindamycin for Staphylococcus aureus. They also detected increased antimicrobial consumption of second-and third-generation cephalosporins and clindamycin and noted a reduction in hospital deaths from 6.4% to 3.2%, without any cost reduction.

Thus, it is clear that implementing a surgical checklist is an independent predictor of SSI reduction and is also associated with a decrease in antimicrobial resistance and a reduction in in-hospital mortality.

de Almeida SM, de Menezes FG, Martino MDV, Tachira CR, Toniolo ADR, Fukumoto HL, Edmond MB, Marra AR. Impact of a surgical safety checklist on surgical site infections, antimicrobial resistance, antimicrobial consumption, costs and mortality. J Hosp Infect. 2021 Oct;116:10-15. doi: 10.1016/j.jhin.2021.05.003. Epub 2021 May 15. PMID: 34004223.