Factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries: a mixed-method study

  • Muhammad Nasir Ayub KhanEmail author
  • Daniëlle M. L. Verstegen
  • Abu Bakar Hafeez Bhatti
  • Diana H. J. M Dolmans
  • Walther Nicolaas Anton van Mook
Original Article


The study aims to find the factors hindering the implementation of surgical site infection control guidelines in the operating rooms of low-income countries. The design of the study is a mixed-method sequential explanatory study. The setting is Shifa International Hospital and Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Participants are health care workers. A questionnaire and structured key informant interviews probed the perspectives and perceptions of different stakeholders regarding the factors which hinder the implementation of surgical site infection control guidelines. Two-hundred fifty-two health care workers took part in the survey. The response rate was 90%. The majority of the participants was based in private teaching hospitals (63.9%) and 36.1% in the public sector teaching hospitals. The factors of surveillance, knowledge, education, and culture had low scores. Qualitative data analysis revealed the hindering factors in the implementation of surgical site infection control guidelines in the operating rooms of low-income country. The important one are lack of a surveillance system, education, and culture of infection control. This study identified hindering factors regarding implementation of surgical site infection control guidelines in the operating rooms at the institutional and individual level involved in patient care. The identification of these hindering factors may help politicians, policy makers, and institutions to identify the strategies for overcoming these hindering factors. Education is the key factor for success. By offering training to health care workers, we significantly contribute to decrease the incidence of SSIs in the low-income country.


Surgical site infections Hindering factors Low-income country Evidence base guidelines ORs 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

My study has received ethical approval with reference number 760–035-2017 from IRB and EC of Shifa International Hospital.

Informed consent

I also confirmed that written and verbal consent was taken and retained for future reference.

Supplementary material

10096_2018_3327_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 18 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Health Professions EducationShifa International Hospital and Shifa Tameer-e-Millat UniversityIslamabadPakistan
  2. 2.School of Health Professions EducationMaastricht UniversityMaastrichtNetherlands
  3. 3.Department of Liver TransplantationShifa International HospitalIslamabadPakistan
  4. 4.School of Health Professions EducationMaastricht University Medical Centre+ and Maastricht UniversityMaastrichtNetherlands

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