SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

Background Healthcare workers (HCWs) are most at risk of contracting SARS-CoV-2 and COVID-19 infection. Their preparedness, as a result of provision and access to personal protective equipment (PPE), training programmes and awareness and practices on infection prevention and control measures, is integral for the prevention of infectious disease transmission. Objectives This study was conducted to assess the preparedness and practices of HCWs during COVID-19 first wave outbreak in Brunei Darussalam. Methods A cross-sectional study using a pre-designed and self-administered web-based questionnaire was conducted among HCWs from government and private health sectors ranging from primary to tertiary health facilities in Brunei Darussalam. Data were analysed using descriptive statistics, and chi-square test was used for statistical significance. Results A total of 511 HCWs participated in the study. Nurses (64%) and HCWs based at hospitals (66%) made up the majority of the study participants, with 74% having occupational exposure to COVID-19 cases. More than 99% of HCWs used respiratory PPE, and 94% used gloves. 74% had undergone respirator fit testing and 65% had received PPE awareness session within the last one year. Coverage in training programmes was found to be low among HCWs from private health facilities. Conclusions Majority of HCWs who had received updated training programmes and therefore were better prepared came from government health facilities. HCWs from private health facilities lacked preparedness training programmes and as such, there needs to be improvement to enhance preparedness measures in light of the ongoing COVID-19 pandemic and for future infectious disease outbreaks.

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Blood transfusion services (BTS) have the responsibility to collect and provide safe blood, and also to deliver sufficient quantity to their health systems. Among the key elements to ensure the safety and adequacy of the blood supply is the collection of blood from voluntary, non‐remunerated blood donors, with an established national system for blood donor selection criteria for all types of donations and a rigorous process to assess the suitability of prospective donors. Blood donors are healthy volunteers who give either whole blood or blood components by apheresis with altruistic motives. However, choosing the right criteria for blood donors’ health and safety is an extremely important issue that could have an impact on donors and blood donation. Therefore, regular assessment of donor suitability should be undertaken in accordance with the national criteria for blood donor selection. These criteria should be consistently applied in every blood donation establishment, on each occasion of donation, to all blood donors. If a truly evidence‐based approach were to be adopted, blood centres would continue to monitor donor reactions to validate the safety of the current approaches or modify them as appropriate. Careful evaluation and selection of blood donors involves proactive and protective measures in assuring donor health and safety and indirectly results in an effective outcome in BTS. This article focuses on donor selection criteria that exist for the purpose of protecting the donor. It consists a review of current international standards and practices.

Background: Migrant workers are at a high risk of exposure to COVID-19 due to their work and residential status. Surveillance for SARS-COV-2 in this group is important for early detection of infection and breaking the chain of disease transmission in the workplace and community. This report describes an enhanced active surveillance strategy for COVID-19 in migrant workers of Brunei Darussalam during the first wave of the outbreak in 2020. Methods: Active and phased surveillance of migrant workers for SARS-CoV-2 was conducted by the Ministry of Health on a total of 9443 workers, in 2020. Surveillance was carried out using a nasopharyngeal swab test for SARS-CoV-2 reverse transcription-polymerase chain reaction (RT PCR) in phases I and II, whilst a rapid antigen test was used in phase III. Results: Phase I included 7073 workers from 714 workplaces; phase II covered 860 workers from 190 workplaces; and phase III covered 1510 workers. Three positive cases were detected during phase I of the surveillance. No migrant worker was tested positive for SARS-CoV-2 during the second and third phases of surveillance. Conclusion: The number of positive cases detected was small; however, this strategy actively searched for the presence of SARS-CoV-2 among the migrant worker population in the country, and further confirmed the absence of any hidden local transmission of cases in this population.