Infection Control Strategies for Preventing Methicillin-Resistant Staphylococcus aureus-Related Surgical Site Infections in Pakistan: A Mixed-Methods Analysis

Abstract

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) significantly contributes to surgical site infections (SSIs) in Pakistan, with high prevalence rates among S. aureus isolates, leading to increased morbidity and healthcare costs. OBJECTIVE: This study assessed the effectiveness of infection control strategies in reducing MRSA-related SSIs in Pakistani healthcare facilities, identified implementation barriers, and proposed context-specific recommendations. METHODS: A mixed-methods study, conducted from January to March 2025, surveyed 100 healthcare professionals (32% surgeons, 28% nurses, and 18% infection control specialists) across public, private, and rural hospitals in all Pakistani provinces. Quantitative data from a structured questionnaire were analyzed using chi-square tests and logistic regression, while qualitative responses were thematically analyzed using Braun and Clarke's framework. RESULTS: Quantitatively, only 8% of facilities screened all surgical patients for MRSA, with 46% performing no screening, and 38% achieved 51-70% hand hygiene compliance, correlating with higher MRSA-SSI rates (odds ratio = 3.42, p < 0.001). Qualitatively, key themes included resource scarcity (e.g., "We often share a single dispenser"), staff resistance, and systemic inefficiencies. CONCLUSION: Strengthening hand hygiene, selective MRSA screening, and surgical bundles, alongside improved training and resource allocation, can reduce MRSA-SSIs in Pakistan. Tailoring global guidelines to local constraints is essential for effective implementation. These findings guide strategies to enhance surgical safety in resource-limited settings.