Surgical site infections are caused by bacteria that get in through incisions made during surgery. They threaten the lives of millions of patients each year and contribute to the spread of antibiotic resistance. In low- and middle-income countries, 11% of patients who undergo surgery are infected in the process. In Africa, up to 20% of women who have a caesarean section contract a wound infection, compromising their own health and their ability to care for their babies. But surgical site infections are not just a problem for poor countries. In the United States, they contribute to patients spending more than 400 000 extra days in hospital at a cost of an additional US $10 billion per year. No international evidence-based guidelines had previously been available before WHO launched its global guidelines on the prevention of surgical site infection on 3 November 2016, and there are inconsistencies in the interpretation of evidence and recommendations in existing national guidelines. These new WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.

Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital. SSIs are associated with considerable morbidity and it has been reported that over one-third of postoperative deaths are related, at least in part, to SSI. However, it is important to recognise that SSIs can range from a relatively trivial wound discharge with no other complications to a life-threatening condition. Other clinical outcomes of SSIs include poor scars that are cosmetically unacceptable, such as those that are spreading, hypertrophic or keloid, persistent pain and itching, restriction of movement, particularly when over joints, and a significant impact on emotional wellbeing. SSI can double the length of time a patient stays in hospital and thereby increase the costs of health care. Additional costs attributable to SSI of between £814 and £6626 have been reported depending on the type of surgery and the severity of the infection. The main additional costs are related to re-operation, extra nursing care and interventions, and drug treatment costs. The indirect costs, due to loss of productivity, patient dissatisfaction and litigation, and reduced quality of life, have been studied less extensively.

The WHO Guidelines on Hand Hygiene in Health Care provide health-care workers (HCWs), hospital administrators and health authorities with a thorough review of evidence on hand hygiene in health care and specific recommendations to improve practices and reduce transmission of pathogenic microorganisms to patients and HCWs. The present Guidelines are intended to be implemented in any situation in which health care is delivered either to a patient or to a specific group in a population. Therefore, this concept applies to all settings where health care is permanently or occasionally performed, such as home care by birth attendants. Definitions of health-care settings are proposed in Appendix 1. These Guidelines and the associated WHO Multimodal Hand Hygiene Improvement Strategy and an Implementation Toolkit (http://www.who.int/gpsc/en/) are designed to offer health-care facilities in Member States a conceptual framework and practical tools for the application of recommendations in practice at the bedside. While ensuring consistency with the Guidelines recommendations, individual adaptation according to local regulations, settings, needs, and resources is desirable. This extensive review includes in one document sufficient technical information to support training materials and help plan implementation strategies. The document comprises six parts.

A clear, hands-on outline of best practices for infection prevention that directly improve patient outcomes across the healthcare continuum.

Although most clinicians are aware of the problem of antimicrobial resistance, most also underestimate its significance in their own hospital. The incorrect and inappropriate use of antibiotics and other antimicrobials, as well as poor prevention and poor control of infections, are contributing to the development of such resistance. Appropriate use of antibiotics and compliance with infection prevention and control measures should be integral aspects of good clinical practice and standards of care. However, these activities are often inadequate among clinicians, and there is a considerable gap between the best evidence and actual clinical practice. In hospitals, cultural determinants influence clinical practice, and improving behaviour in terms of infection prevention and antibiotics-prescribing practice remains a challenge. Despite evidence supporting the effectiveness of best practices, many clinicians fail to implement them, and evidence-based processes and practices that are known to optimize both the prevention and the treatment of infections tend to be underused. Addressing precisely this problem, this volume offers an essential toolkit for all surgeons and intensivists interested in improving their clinical practices.

Confronted with worldwide evidence of substantial public health harm due to inadequate patient safety, the World Health Assembly (WHA) in 2002 adopted a resolution (WHA55.18) urging countries to strengthen the safety of health care and monitoring systems. The resolution also requested that WHO take a lead in setting global norms and standards and supporting country efforts in preparing patient safety policies and practices. In May 2004, the WHA approved the creation of an international alliance to improve patient safety globally; WHO Patient Safety was launched the following October. For the first time, heads of agencies, policy-makers and patient groups from around the world came together to advance attainment of the goal of "First, do no harm" and to reduce the adverse consequences of unsafe health care. The purpose of WHO Patient Safety is to facilitate patient safety policy and practice. It is concentrating its actions on focused safety campaigns called Global Patient Safety Challenges, coordinating Patients for Patient Safety, developing a standard taxonomy, designing tools for research policy and assessment, identifying solutions for patient safety, and developing reporting and learning initiatives aimed at producing 'best practice' guidelines. Together these efforts could save millions of lives by improving basic health care and halting the diversion of resources from other productive uses. The Global Patient Safety Challenge, brings together the expertise of specialists to improve the safety of care. The area chosen for the first Challenge in 2005-2006, was infection associated with health care. This campaign established simple, clear standards for hand hygiene, an educational campaign and WHO's first Guidelines on Hand Hygiene in Health Care. The problem area selected for the second Global Patient Safety Challenge, in 2007-2008, was the safety of surgical care. Preparation of these Guidelines for Safe Surgery followed the steps recommended by WHO. The groundwork for the project began in autumn 2006 and included an international consultation meeting held in January 2007 attended by experts from around the world. Following this meeting, expert working groups were created to systematically review the available scientific evidence, to write the guidelines document and to facilitate discussion among the working group members in order to formulate the recommendations. A steering group consisting of the Programme Lead, project team members and the chairs of the four working groups, signed off on the content and recommendations in the guidelines document. Nearly 100 international experts contributed to the document (see end). The guidelines were pilot tested in each of the six WHO regions--an essential part of the Challenge--to obtain local information on the resources required to comply with the recommendations and information on the feasibility, validity, reliability and cost-effectiveness of the interventions.

Health care-associated infections (HAI) are one of the most common adverse events in care delivery and a major public health problem with an impact on morbidity, mortality and quality of life. At any one time, up to 7% of patients in developed and 10% in developing countries will acquire at least one HAI. These infections also present a significant economic burden at the societal level. However, a large percentage are preventable through effective infection prevention and control (IPC) measures. These new guidelines on the core components of IPC programmes at the national and facility level will enhance the capacity of Member States to develop and implement effective technical and behaviour modifying interventions. They form a key part of WHO strategies to prevent current and future threats from infectious diseases such as Ebola, strengthen health service resilience, help combat antimicrobial resistance (AMR) and improve the overall quality of health care delivery. They are also intended to support countries in the development of their own national protocols for IPC and AMR action plans and to support health care facilities as they develop or strengthen their own approaches to IPC. These are the first international evidence-based guidelines on the core components of IPC programmes. These new WHO guidelines are applicable for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.