Figure 1
Cycle of evidence gaps and systemic barriers contributing to surgical site infections (SSIs) in Mozambique.
Table 1
Key recommendations for strengthening SSI prevention and control in Mozambique.
| Recommendations A coordinated combination of system‑level improvements and targeted research should enable Mozambique to begin bridging the knowledge and control gaps in SSI. These recommendations require international cooperation and support from the WHO and NGOs to be implemented. | ||
| 1 | Improve infection prevention by alleviating pre‑, intra‑, and postoperative practices. | This incorporates the implementation of WHO surgical safety checklists, strict hand and skin antisepsis, sterile technique, and operating room maintenance. Training and auditing should be increased, such as following the practices outlined in the compliance study and enhancing hand hygiene facilities. |
| 2 | Antibiotic stewardship | Revise national antibiotic prophylaxis guidelines to minimize broad‑spectrum use without compromising protection and to reduce unnecessary antibiotic administration after an operation. |
| 3 | Surveillance implementation | Implement a national SSI surveillance system. To begin with, SSI cases, as documented through a standardized definition, will need to be reported in sentinel hospitals, such as provincial referral centers, and submitted to Ministério da Saúde (MISAU). It is essential to train infection control teams to operate subcutaneous site monitoring, perhaps using CDC or WHO SSI event criteria. Mozambique will be able to experiment with surveillance at large hospitals and progressively apply it countrywide. Surveillance data will be used to describe the location of hotspots and assess the impact of interventions. |
| 4 | Laboratory capacity and AMR monitoring | Ongoing development of SSI pathogen network. Areas of laboratory capacity should be developed to enable the identification and susceptibility testing of SSI pathogens, as in GLASS work. This educates treatment and monitors the trends of resistance. Basic cultures of wound samples require an investment in lab reagents and staff training. |
| 5 | Address underlying risks | Due to high HIV and anemia in Mozambique, strong SSI prevention should include preoperative optimization, such as malnutrition and anemia, and prophylaxis in immunocompromised patients. Indirectly, SSI risk could be reduced by public health measures to control HIV, for example, by keeping people on ART. |
Table 2
Operational framework for strengthening SSI prevention and control in Mozambique.
| ACTION AREA | KEY INTERVENTIONS | LEAD ACTORS | REQUIRED RESOURCES | EXPECTED OUTPUTS |
|---|---|---|---|---|
| Infection prevention | Implement WHO Surgical Safety Checklists; strengthen hand and skin antisepsis; improve sterilization and operating room maintenance; regular IPC audits and staff training | Ministry of Health (MISAU); Hospital IPC Teams; WHO Country Office | Training materials, monitoring tools, supervision visits | Improved IPC compliance rates; reduction in intraoperative contamination |
| Antibiotic stewardship | Revise national surgical antibiotic prophylaxis guidelines; promote rational antibiotic use and reduce unnecessary postoperative prescriptions | MISAU; National AMR Committee; hospital pharmacy units | Technical expertise, local antibiogram data, stewardship training | Updated national prophylaxis policy; reduced broad‑spectrum antibiotic consumption |
| Surveillance implementation | Establish sentinel hospital SSI reporting network using standardized WHO/CDC definitions; develop electronic reporting to MISAU; regular feedback to facilities | MISAU; WHO; National IPC Program | IT infrastructure, data officers, IPC focal points | National SSI dataset established; periodic surveillance reports |
| Laboratory capacity and AMR monitoring | Strengthen microbiology laboratories to perform culture and susceptibility testing; integrate SSI pathogens into the national AMR surveillance system (GLASS) | National Laboratory Network; WHO GLASS Focal Point | Laboratory reagents, equipment, training | Functional AMR testing in sentinel hospitals; local antibiogram reports |
| Address underlying risks | Integrate screening and management of malnutrition, anemia, and HIV into preoperative care; reinforce ART and nutrition programs for surgical patients | Hospitals; NGOs; community health services | ART supply, nutrition supplements, outreach teams | Improved preoperative optimization; lower SSI risk among vulnerable patients |