Surgical site infections remain one of the most pressing challenges in healthcare worldwide, but in resource-limited settings like Nepal, the stakes are particularly high. It’s for this reason that RCSEd’s Global Surgery Foundation (Now known as Global CARE) awarded £11,900 to Bikash Kumar Shah and Dr. Dinesh Pd. Koirala for their one-year project, completed in mid-2025, to train surgical teams across Nepal in evidence-based infection prevention techniques and reduce the burden of preventable post-operative complications.
A Project Born from Necessity
The Surgery Shield Project emerged from a stark reality: surgical site infection rates in Nepal range from 2.6% to nearly 17% depending on the facility and procedure type, which is significantly higher than rates observed in developed countries. These infections don't just represent statistics; they translate to extended hospital stays, increased healthcare costs, and most importantly, preventable suffering for patients.
Led by Bikash Kumar Shah and Dr. Dinesh Pd. Koirala, the project set out to address fundamental gaps in infection control knowledge and practice. Many healthcare facilities in Nepal face constraints such as inadequate infection control supplies, limited access to advanced surgical equipment, and crucially, a lack of up-to-date training on prevention techniques.
Training That Reaches Beyond Surgeons
What makes the Surgery Shield Project particularly impactful is its inclusive approach. Rather than focusing solely on surgeons, the training reached across the entire surgical ecosystem: 533 healthcare professionals in total, including staff nurses, medical interns, surgical residents, anesthetists, and operating theatre staff. This holistic strategy recognises that infection prevention requires every team member to be knowledgeable and vigilant.
The training was delivered across three key sites: Kathmandu Institute of Child Health in Damak, Tribhuvan University Teaching Hospital in Kathmandu, and Janaki Medical College in Janakpur. Each one-day intensive session combined educational lectures with hands-on simulation exercises, covering everything from the epidemiology of surgical site infections to practical aseptic techniques.
Measurable Impact
The numbers tell a compelling story. Pre-training assessments revealed baseline knowledge scores averaging 55%. Following the training, participants achieved an average score of 85%, which is a 30% improvement that was statistically significant. But beyond the test scores, the real impact lies in changed practices and increased confidence among healthcare workers.
Nurses at Tribhuvan University Teaching Hospital reported increased confidence in adhering to aseptic protocols. Surgeons at Janaki Medical College adopted standardised wound care techniques. These behavioral changes translate directly into reduced infection risks for patients undergoing surgical procedures.
The project also made significant strides in gender equity, with 65% of participants being female healthcare professionals, a demographic often underrepresented in surgical education in Nepal. By empowering female nurses and interns who form a substantial portion of the healthcare workforce, the project strengthened the entire surgical care system.
A Ripple Effect Across Nepal's Healthcare System
The benefits extend far beyond the 533 individuals trained. Each participant returns to their facility equipped to share knowledge with colleagues and implement improved protocols. The project distributed comprehensive educational materials and guidelines that serve as ongoing references for best practices.
By reducing surgical site infections, the project alleviates pressure on Nepal's healthcare system. Lower infection rates mean fewer prolonged hospitalizations, reduced need for expensive antibiotic treatments, and fewer revision surgeries, which are all critical in resource-constrained settings.
Building for the Future
Perhaps most importantly, the Surgery Shield Project has established a scalable model for surgical safety training that can be replicated across other healthcare facilities in Nepal and similar resource-limited settings throughout South Asia. The project team is preparing research manuscripts to share their findings with the global health community, contributing valuable evidence to the underrepresented body of knowledge on infection control in low- and middle-income countries.
The training emphasised low-cost, practical interventions, optimising existing sterilisation protocols, improving environmental hygiene, and maintaining sterile fields, making the lessons immediately applicable without requiring expensive technologies.
