Surgical site infection prevention among surgical healthcare workers in Syria: a nationwide cross-sectional study

Background Surgical site infections (SSIs), infections at or near surgical incisions, represent 20–30% of nosocomial infections globally, with higher prevalence in low- and middle-income countries such as Syria. This study assessed SSI prevalence in two Syrian hospitals alongside a nationwide evaluation of surgical healthcare workers’ knowledge, practices, compliance, and barriers to WHO/CDC SSI prevention guidelines. Methods A cross-sectional survey was conducted among 375 healthcare workers in surgical settings across Syria. A structured questionnaire collected data on demographics, educational background, work experience, self-reported practices, knowledge of WHO guidelines, and perceived barriers to implementation. Composite knowledge and practice scores were calculated. Data were analyzed using descriptive statistics, Pearson correlation, and ANOVA. Results Adherence to basic preventive practices was high, including hand preparation (89.33%) and intraoperative sterilization (91.47%). However, gaps persisted in avoiding preoperative shaving, appropriate antibiotic prophylaxis timing and duration, and postoperative antibiotic discontinuation. Major barriers included lack of role models (68%), inadequate training (63%), and staff shortages. Pearson analysis revealed positive correlations between compliance and practice scores ( r = 0.5203, p < 0.001) and compliance and knowledge scores ( r = 0.3372, p < 0.001). Crucially, the weakest correlation was found between knowledge and practice scores ( r = 0.2662, p < 0.001), highlighting a prominent know-do gap. Hospital-reported SSI prevalence was 9.5% in one hospital and 1.47% in the other. Conclusion This study identified suboptimal knowledge and inconsistent implementation of high-impact SSI prevention practices among Syrian surgical healthcare workers despite strong adherence to basic aseptic measures. Targeted training, improved surveillance systems, and institutional support are needed to strengthen guideline adherence and reduce preventable SSIs.