Dear Dr. Mensah,

Thank you for submitting your manuscript to PLOS One. Firstly, we would like to apologize for the delay in processing your manuscript. It has been exceptionally difficult to secure reviewers to evaluate your study. We have now received one completed review, which is available below. The reviewer has raised significant scientific concerns about the study that need to be addressed in a revision.

Please note that we have only been able to secure a single reviewer to assess your manuscript. We are issuing a decision on your manuscript at this point to prevent further delays in the evaluation of your manuscript. Please be aware that the editor who handles your revised manuscript might find it necessary to invite additional reviewers to assess this work once the revised manuscript is submitted. However, we will aim to proceed on the basis of this single review if possible. 

Please submit your revised manuscript by Dec 08 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Miquel Vall-llosera Camps

Senior Staff Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: No

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

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Reviewer #1: 1. The research design aligns with the study aim of understanding intraoperative surgical site infection (SSI) prevention practices among nurses in a tertiary hospital. The use of semi-structured interviews and thematic analysis is suitable for the exploratory nature of the work.

The data collection procedures are adequately described, and the inclusion of direct participant quotations supports the authenticity of the findings. However, the analytic process lacks sufficient transparency. There is minimal description of the coding framework, how the codes were developed, refined and integrated into the themes. Although NVivo software is mentioned, its role in data management or theme generation is not clearly explained.

The findings and conclusions are largely consistent, with the data supporting the main claims about infection prevention practices, supervision, and resource challenges. However there is overgeneralization —for example, “multidisciplinary collaboration significantly reduces SSIs” that extends beyond what qualitative data can demonstrate.

There should be explicit documentation of ethics approval (e.g., institutional review board reference number).

Overall, the manuscript requires greater methodological transparency and moderation of inferential claims to fully substantiate its conclusions.

2. The manuscript provides only a superficial description of the analytic process: It lists Braun & Clarke’s phases but does not show how themes were derived from codes. There are no sample codes, codebooks, or excerpts to illustrate analytic progression. The process of reflexivity and peer debriefing is mentioned but not demonstrated with examples. while the method is suitable, the reporting of its application lacks depth and transparency.

3. No details on inter-coder reliability or peer validation (e.g., whether another researcher cross-checked coding).

No clear evidence of data triangulation or how saturation was confirmed. There is Over-reliance on researcher interpretation without documented audit examples.

4. The manuscript lacks frequency indicators for reporting prevalence without quantifying. There is no comparative analysis (e.g., by role, experience, or theatre vs ward) explored, which could have added analytic richness.

5. The manuscript does not include a Data Availability Statement, nor does it indicate where the underlying qualitative data (e.g., anonymized transcripts, coding framework) are deposited.

6. The manuscript is presented in an intelligible and well-structured manner overall. The English is clear though minor grammatical and stylistic issues should be addressed g. Some sentences are overly long or repetitive,

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what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures 

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation. 

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Sepsis under pressure, intraoperative surgical site infection prevention practices among nurses in emergency surgical settings: A qualitative study

PONE-D-25-42877R1

Dear Dr. Mensah,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Nan Jiang

Academic Editor

PLOS One

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

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Reviewer #1: All the comments previously raised have been addressed by the authors with improvements in the methodology thereby strengthening the manuscript

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what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy

Reviewer #1: No

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