Context of the research

Antibiotics are important to prevent infections after several types of surgery. The growing number of infections that cannot be treated with antibiotics may mean that many basic types of surgeries cannot continue. Around the world, a large amount of all antibiotics are used during the surgical process. Antibiotics in surgery are used to prevent infections from happening after surgery (it is called 'prophylaxis') and for the treatment of infections after surgery. Infection after surgery is a growing concern in many countries. 23 million infections after surgery (or 'surgical site infections', SSIs) lead to 2 million deaths every year. Using antibiotics in the right manner is a sure way of preventing infections after surgery. For example, if the right antibiotics are given at the right time before surgery, then up to seven times fewer antibiotics are needed after surgery because fewer people get infections.

Overarching research question

How can antibiotic use be optimised along the entire surgical pathway through context-specific, (at country and organisational level) behavioural and organisational interventions aimed at providers and patients?

The question is answered through the following objectives, and the project delivered through five work-packages (WPs) with research in England, Scotland, India, South Africa and learning from Rwanda.

1. Investigating the macro-level economic, regulatory and policy drivers and constraints which result in prioritisation, competition or integration of Infection Control (IC) and Antimicrobial Stewardship (AS) at each point in the care pathway at the organisational level. (WP1)
2. Characterising cultural norms, established hierarchies, team roles and methods of communication around AS and IC which operate within specific surgical/healthcare environments (WP 1 & 2).
3. An assessment of patient-provider co-production models which may be supported by the outer and inner contexts investigated through objectives 1 and 2. (WP1, 3, 5)
4. Development of theory-based innovative solutions (WP3).
5. Evaluating the operational and cost effectiveness of existing and new interventions using a systems thinking modelling approach (WP 2, 3 & 4).