Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings

Forrester, Jared A.; Koritsanszky, Luca; Amenu, Demisew; Haynes, Alex B.; Berry, William R.; Alemu, Seifu; Jiru, Fekadu; Weiser, Thomas

doi:10.1016/j.jamcollsurg.2018.03.020

Cited by 36 publications

(68 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This included evidence-based best practice recommendations [35][36][37], interviews [65][66][67][68][69][70], and more detailed approaches such as observations, operational data collection, time-andmotion studies, and video footage. [64,[71][72][73][74] Phase 3 81% of studies included perspectives from diverse stakeholders. In less than half of the studies (45%) the maps were generated by multiple stakeholder groups; in the remaining studies maps were generated by researchers.…”

Section: Phasementioning

confidence: 99%

Process Mapping in Healthcare: A Systematic Review

Antonacci

Lennox

Barlow

et al. 2020

Preprint

View full text Add to dashboard Cite

Introduction Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare.Methods We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC–Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analyzed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach.Results The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward.PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N=105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterizing healthcare improvement interventions.Conclusion The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM.Prospero ID : CRD42017082140.

show abstract

Section: Phasementioning

confidence: 99%

Process Mapping in Healthcare: A Systematic Review

Antonacci

Lennox

Barlow

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…There are few studies on SHP in LMICs. Two notable papers report on successful use of high-quality SHP as part of a multimodal strategy to improve patient safety, with SSI as the primary outcome [20,43]. Allegranzi et al used a multi-modal strategy (SUSP) on SSI prevention to reduce SSIs in five centers in four African countries.…”

Section: Sustainable Local Abhr Production: a Brief Case Studymentioning

confidence: 99%

“…The SHP was one of the six process measures used [20]. Forrester et al introduced the ''Clean Cut,'' a multi-modal infection control strategy to improve patient safety and patient outcomes after surgery, with the following process measures: Handwashing/skin preparation; surgical gown/drape integrity; antibiotic administration; instrument sterility; gauze counts; and WHO Surgical Safety Checklist use [43,44]. The authors also mapped out the process measures to identify challenges and obstacles to patient safety and used the results to guide organizational changes to align tasks with specific process goals.…”

Section: Sustainable Local Abhr Production: a Brief Case Studymentioning

confidence: 99%

“…The authors also mapped out the process measures to identify challenges and obstacles to patient safety and used the results to guide organizational changes to align tasks with specific process goals. For their project, because of an inconsistent water supply, the authors defined SHP as surgical hand antisepsis with ABHR [43].…”

Section: Sustainable Local Abhr Production: a Brief Case Studymentioning

confidence: 99%

See 1 more Smart Citation

Effective Hand Preparation for Surgical Procedures in Low- and Middle-Income Countries

Nthumba

2020

Surgical Infections

View full text Add to dashboard Cite

Background: The burden of healthcare-associated infections (HAIs) is greatest in low-and middle-income countries (LMICs); surgical site infections (SSIs) are the most common HAI in LMICs. Hand hygiene is the single most effective strategy for reducing HAIs and the transmission of antimicrobial drug-resistant pathogens. Similarly, effective surgical hand preparation is a critical step in the prevention of SSIs in the surgical patient. Methods: Surgical hand preparation (SHP) is a seemingly simple activity that is easily overlooked. Performed properly, however, along with other measures, it has the potential to reduce SSIs in LMICs. The article reviews the current state of surgical hand preparation in LMICs. Results: Alcohol-based handrubs (ABHRs) have received wide acceptance by healthcare workers for both hand hygiene and SHP; when mixed with emollients, ABHRs retain efficacy against microorganisms and gain skin tolerability and user acceptability. Healthcare institutions in many LMICs face difficulties obtaining the products needed to ensure effective SHP using ABHRs. Conclusion: The ABHRs are the most efficacious surgical hand preparation products available today. They are cost-effective and can safely be prepared locally in hospitals, even in LMICs. The challenge of access to ABHRs should be addressed by national and local governments, through advocacy by healthcare workers coupled with continued lobbying and campaigns by the World Health Organization. Effective surgical hand preparation, like hand hygiene, saves lives.

show abstract

“…Improvements were obtained by working with teams at each hospital to evaluate the existing processes, identify specific standards they hoped to improve and barriers to their compliance, and making system changes along with educating providers on how to improve such practices. In a separate programme called Clean Cut, which was organized by Lifebox (https://www.lifebox.org) and developed by the authors, five hospitals in Ethiopia have undertaken a process of team building, compliance assessment, process mapping to evaluate existing practices, and action planning based on opportunities for improvement identified through the work. In three hospitals that have completed the work, compliance with six critical perioperative infection standards – appropriate skin and hand antisepsis, maintenance of the sterile field, appropriate selection and timing of antibiotics, confirmation of instrument sterility, routine surgical swab counting and use of a perioperative checklist to improve communication during surgery – improved from a mean of 2·8 of the six items completed to 4·6 (preliminary unpublished data from the authors).…”

mentioning

confidence: 99%