Joe was passionate about country implementation…

May 2025

By: Claire Kilpatrick

In Dublin, at the 2025 Surgical Site Infection-Europe (SIS-E) congress, I was delighted and privileged to speak in the Joe Solomkin Memorial Symposium which now closes the conference every year. I started by quoting the late Prof Joseph (Joe) Solomkin.

"The critical element in having guidelines implemented is to have an institutional commitment to infection prevention and control”

Joe was passionate about country implementation and improvement. His concerns were quoted in an interview “with the disparity between surgical outcomes in high-income and low- and middle-income countries, Joe founded the World Surgical Infection Society (WSIS) where he organized education, quality improvement and scientific projects around the world to build towards a world with safe surgery for all. Joe was the driving force behind the development of the first World Health Organization (WHO) Guidelines for the prevention of surgical site infection issued in 2016 and he brought together giants in the field of surgical infection from all corners of the world, to serve all corners of the world.”

Personally, as a member of the WHO team, developing the guidelines and all of the SSI implementation resources, and a founding member of the WSIS board – I have Joe’s abundance and leadership to thank for such great experiences.

What I outlined next in the SIS-E presentation was focused on reflections of a journey. There have been a number of influences on global SSI prevention strategies in the last 10 years in particular – a lot based on Joe’s activism – as well as examples of country and health care facility implementation and advocacy for SSI prevention.

I firstly highlighted for the audience the rapid expansion of Infection Prevention and Control (IPC)/surgery related resources and tools from different organizations over this time. For example:

• A range of WHO guidelines, such as the IPC core components & other guidelines, e.g. SSI prevention, blood stream infection prevention and implementation manuals – for acute & primary care, applicable to all income levels;

• SHEA/IDSA/APIC strategies for SSI reduction and guidance on HAI reduction;

• ISID guidance on hand hygiene and an implementation statement on SSI surveillance.

Next, I highlighted that for me, the common thread is ultimately implementation for global good. A recent publication by members of the WSIS board - Global surgery is stronger when infection prevention and control is incorporated: a commentary and review of the surgical infection landscape - noted the following:

• Safe and timely global surgery is integral to achieving the Sustainable Development Goals (SDGs), which apply to all countries, particularly within the broader context of universal health coverage and reducing health inequalities.

• Implementing IPC measures to support the SDGs means strengthened health systems, in all countries.

• The success of surgical interventions within strengthened health systems is inextricably linked to effective IPC – in all countries.

• Where IPC guidelines are weak or absent, surgical outcomes worsen, infections spread, and health systems face additional strain – in all countries.

• Although many IPC documents are not specific to surgery, they can be implemented within the surgical space, in all countries, to ensure safe care.

I then reminded the audience of SIS-E that; implementation science is the scientific study of methods and strategies that facilitate the uptake of evidence-based practice and research into regular use by practitioners and policymakers. The field of implementation science seeks to systematically close the gap between what we know and what we do, and how, by identifying and addressing the barriers that slow or halt the uptake of proven health interventions and evidence-based practices.

As such, the WHO implementation manual that was issued in 2018 is rich in information relevant to all countries and health care facilities (and I believe underused), such as:

• Introducing the WHO stepwise approach to implementation; 

• Explaining how SSI prevention relates to the core components for IPC;

• Key questions and answers on implementation of preventative measures;

• Practical implementation approaches for each SSI evidence based recommendation; 

• Outlining common scenarios, problems and frequent challenges that might contribute to failure;

• Highlighting key points on building a team and collaborations including real life examples and specific implementation scenarios, giving suggestions for making improvements at local level –
”how do I change the situation to meet the evidence-based recommendation - case studies for multimodal thinking.”;

• Signposting to other tools;

• National level considerations - factors that might influence health care facility success.

I then outlined an article by Kilpatrick and Chiwera in the World Journal of Surgical Infection on application of the WHO five-step implementation cycle, describing the learnings from a London teaching hospital. This article explains the specific actions taken to achieve implementation success and will be of interest to many.

To end my SIS-E presentation, I announced a new call to action – for people to analyse and share implementation journeys. SSI prevention is not just about quantitative analysis and outcomes but also about telling the story of closing the gap between evidence action - between what we know and what we do, and how we achieve it!

I proposed a template of what we need to ask ourselves in order to share these stories – to start to consider how we might publish on implementation research:

• Who needs to be involved to ensure SSI prevention success?

• Which leaders and stakeholders are critical?

• Who should lead?

• What capacity building is required?

• What budget is required?

• What accountability, governance and engagement mechanisms exist/are required?

• Do relevant targets and indicators exist (global, regional, country) to outline expected outputs/outcomes?

• What guidelines and tools already exist?

• How much time will implementation of the intervention take, including situational assessments, prioritization, action planning, evaluation and sustainability?

• Have the key barriers and facilitators/critical success factors being explored/identified?

For me, SIS-E was a great conference – it was personal and intimate and allowed for a lot engagement. WSIS is dedicated to supporting SSI prevention work going forward and for sure has a role to play in global engagement and sharing of information, including through these blogs, across different societies and groups, as Joe outlined when he set it up. Because:

"It makes no sense at any level of the health system for IPC or surgery to be considered in a vacuum. Collaborations can be a game changer in achieving the SDGs, IPC and surgery can play a key role.”