Implementation of the World Health Organization Surgical Safety Checklist, Including Introduction of Pulse Oximetry, in a Resource-Limited Setting

Kwok, Alvin C.; Funk, Luke M.; Baltaga, Ruslan; Lipsitz, Stuart R.; Merry, Alan; Dziekan, Gerald; Ciobanu, G.; Berry, William R.; Gawande, Atul A.

doi:10.1097/sla.0b013e3182777fa4

Cited by 119 publications

(125 citation statements)

References 18 publications

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“…[16] To date only Haynes et al [4] have shown significant reductions in mortality, other studies having failed to do so. [2,[5][6][7][8] The overall complication rates in our study were lower than those reported by others. [4,5,7] This may be because previous studies were done in tertiary, central or specialised teaching hospitals on highrisk patients, and we specifically excluded such hospitals.…”

Section: Other Findingscontrasting

confidence: 54%

“…[3] Haynes et al [4] showed reductions in the death rate of between 1.5% and 0.8% in their study in eight different hospitals globally. In addition, while many investigators have demonstrated statistically significant reductions in postoperative complications after implementation of the SSCL, [4][5][6][7] others have not found the same benefits. [2,8] Very few studies from low-and middle-income countries (LMICs) have measured the impact of the SSCL on maternal mortality, despite surgical mortality being reported to be five to ten times higher than in high-income countries (HICs), and the rate of deaths due to general anaesthesia being as high as 1 per 150 cases in some parts of sub-Saharan Africa.…”

Section: Researchmentioning

confidence: 99%

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The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

et al. 2017

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Corresponding author: M Naidoo (naidoom@ukzn.ac.za)Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery. Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres. Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery. Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 -0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 -0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 -1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 -0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL. Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation.

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Section: Other Findingscontrasting

confidence: 54%

Section: Researchmentioning

confidence: 99%

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

et al. 2017

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“…Following Haynes's study, (9) others were published (19)(20)(21) showing improvements in the care outcomes, culminating in a meta-analysis that demonstrated a 43% reduction in the risk of surgical infection (RR 0.57, CI 0.41-0.79 ) with the use of the checklist. (10) A systematic review (13) published in 2016, involving 25 studies, demonstrated reduction of complications, mainly in developing countries.…”

Section: Discussionmentioning

confidence: 99%

Comparação das taxas de infecção cirúrgica após implantação do checklist de segurança

et al. 2018

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Objective: To compare surgical site infection rates in clean surgery before and after implementation of the checklist proposed by the World Health Organization. Methods: Observational, descriptive, retrospective correlational study performed in a general hospital. Sample consisting of 15,319 records of clean surgeries monitored by the hospital Infection Prevention and Control Service, in the trauma, orthopedics, cardiovascular, plastic, general, and urology specialties. Before implementing the checklist, 5,481 records were evaluated; 9,838 records were reviewed after. Analysis was performed with SPSS 22.0 software and application of the Pearson's chi-square test, considering p <0.05. Results:The overall infection rate in clean surgery was 4.17% in the pre-implementation period of the checklist and 1.10% post-implementation (p<0.05), with statistically signifi cant reductions in spine, aneurysm and bypass, abdominoplasty, mammoplasty, herniorrhaphy and prostatectomy surgeries. Conclusion: A signifi cant reduction was identifi ed in the rate of surgical site infection in clean surgeries when comparing the pre-and postimplementation periods of the checklist proposed by the World Health Organization. ResumoObjetivo: Comparar taxas de infecção de sítio cirúrgico em cirurgia limpa antes e após implantação do checklist proposto pela Organização Mundial de Saúde. Métodos: Estudo observacional, descritivo, retrospectivo do tipo correlacional, realizado em um hospital geral. Amostra constituída por 15.319 registros de cirurgias limpas das especialidades traumato-ortopedia, cardiovascular, plástica, geral e urologia monitoradas pelo Serviço de Controle de Infecção Hospitalar. Antes da implantação do checklist foram avaliados 5.481 registros e após 9.838. Análise realizada com Software SPSS 22.0 e aplicação do teste qui-quadrado de Pearson, considerando-se signifi cativo p<0,05. Resultados: A taxa geral de infecção em cirurgia limpa foi 4.17% no período pré-implantação do checklist e 1.10% pós (p<0.05), com redução estatisticamente signifi cativa nas cirurgias de coluna, aneurisma e by-pass, abdominoplastia, mamoplastia, herniorrafi a e prostatectomia. Conclusão: Observou-se redução signifi cativa da taxa de infecção de sítio cirúrgico nas cirurgias limpas quando comparados os períodos pré e pós-implantação do checklist proposto pela Organização Mundial de Saúde. ResumenObjetivo: Comparar tasas de infección de sitio quirúrgico en cirugía limpia antes y después de implantación del checklist propuesto por Organización Mundial de la Salud. Métodos: Estudio observacional, descriptivo, retrospectivo, tipo correlacional, realizado en hospital general. Muestra de 15.319 registros de cirugías limpias de traumatología-ortopedia, cardiovascular, plástica, general y urología, monitoreadas por Servicio de Control de Infección Hospitalaria. Antes de implantarse el checklist fueron evaluados 5.481 registros, y 9.838 después. Análisis realizado aplicando Software SPSS 22.0 y test de Chi-cuadrado, considerándose signifi catividad d...

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“…1 Dr Gawande conducted a multinational study to determine how effective a 19-item Surgical Safety Checklist could be in improving outcomes. 2 Although each site had to make accommodations for their local conditions, every site that implemented the checklist saw decreased complications and mortality. Dr Gawande's other studies have focused on checklists that can be used in the operating room, childbirth, and for hospital-acquired infections.…”

Section: To Check or Not To Check: The Role Of Checklists In Childrenmentioning

confidence: 99%

To check or not to check: The role of checklists in children’s palliative care

Knapp

2014

Palliat Med

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Implementation of the World Health Organization Surgical Safety Checklist, Including Introduction of Pulse Oximetry, in a Resource-Limited Setting

Abstract: Successful hospital-wide Surgery Safety Checklist implementation can be achieved in a resource-limited setting and can significantly reduce surgical hazards and complications.

Cited by 119 publications

References 18 publications

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

Comparação das taxas de infecção cirúrgica após implantação do checklist de segurança

To check or not to check: The role of checklists in children’s palliative care

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