Barriers and Facilitators of Implementing WHO Safe Surgery Checklist: A Cross-Sectional Study in Public Hospitals of Iran

Background: The implementation of WHO safe surgery checklist (SSC) was proposed by the Ministry of Health and Medical Education in the operation rooms of Iranian hospitals in 2011, but was canceled after several years due to some challenges in implementation. Objectives: This study aimed to investigate the barriers and facilitators of the effective implementation of the SSC. Methods: This cross-sectional study was performed in public hospitals of Tabriz city in 2019. The study population consisted of operation room working for staff, and the purposive sampling was used. The research tool was a researcher-made questionnaire designed through literature review and included three parts of demographic variables, barriers, and facilitating factors. Data were analyzed with SPSS-22. Results: The mean of barriers to implementation of the SSC was 3.03 out of 5. The most important barrier to implementing the checklist was the weakness in team working (3.18), while checklist barriers were the least important (2.98). The mean score of facilitating factors was 3.46. Among the facilitators, the highest score was for team working facilitators with a score of 3.47 and the lowest score was for the facilitators associated with the checklist with a score of 3.37. Conclusions: This is one of the first studies that explored the barriers to and facilitators of SSC implementation in Iranian hospitals. We identified weak team working as the most important barrier to implementing the checklist. These results help policymakers and hospital managers to implement the checklist more effectively.

Reducing surgical site infections and mortality among obstetric surgical patients in Tanzania: a pre-evaluation and postevaluation of a multicomponent safe surgery intervention

IntroductionDespite ongoing maternal health interventions, maternal deaths in Tanzania remain high. One of the main causes of maternal mortality includes postoperative infections. Surgical site infection (SSI) rates are higher in low/middle-income countries (LMICs), such as Tanzania, compared with high-income countries. We evaluated the impact of a multicomponent safe surgery intervention in Tanzania, hypothesising it would (1) increase adherence to safety practices, such as the WHO Surgical Safety Checklist (SSC), (2) reduce SSI rates following caesarean section (CS) and (3) reduce CS-related perioperative mortality rates (POMRs).MethodsWe conducted a pre-cross-sectional/post-cross-sectional study design to evaluate WHO SSC utilisation, SSI rates and CS-related POMR before and 18 months after implementation. Our interventions included training of inter-professional surgical teams, promoting use of the WHO SSC and introducing an infection prevention (IP) bundle for all CS patients. We assessed use of WHO SSC and SSI rates through random sampling of 279 individual CS patient files. We reviewed registers and ward round reports to obtain the number of CS performed and CS-related deaths. We compared proportions of individuals with a characteristic of interest during pre-implementation and post implementation using the two-proportion z-test at p≤0.05 using STATA V.15.ResultsThe SSC utilisation rate for CS increased from 3.7% (5 out of 136) to 95.1% (136 out of 143) with p<0.001. Likewise, the proportion of women with SSI after CS reduced from 14% during baseline to 1% (p=0.002). The change in SSI rate after the implementation of the safe surgery interventions is statistically significant (p<0.001). The CS-related POMR decreased by 38.5% (p=0.6) after the implementation of safe surgery interventions.ConclusionOur findings show that our intervention led to improved utilisation of the WHO SSC, reduced SSIs and a drop in CS-related POMR. We recommend replication of the interventions in other LMICs.

Safe Surgery During the COVID-19 Pandemic

Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. Recent Findings Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Summary Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.

A Clinical Study on Laparoscopic Cholecystectomy in a Tertiary Care Teaching Hospital

Background: Laparoscopic cholecystectomy is gaining popularity for the surgical treatment of gallbladder diseases. The technique has advantages of safe surgery, minimal complications, lower duration of hospital stay, and early return to normal activities. We in the current study tried to evaluate the outcomes of laparoscopic cholecystectomies done in our tertiary care teaching hospital. Methods: Based on the inclusion and exclusion criteria n=40 cases were identified and treated with laparoscopic cholecystectomy. A complete history which included the pasthistory, family history, socioeconomic status, nature of symptoms, diet history was obtained. All the patients underwent a complete clinical examination. The investigations carried out were complete blood picture, bleeding time, clotting time, ECG, LFT, KFT, FBS, blood groups, chest x-ray, and Ultrasound scan of the abdomen. All cases were operated as per the standard procedures. Results: The most common sign recorded in the cases was pain in right hypochondrium. Out of n=40 cases, 95% were present with pain 5% was without pain. Clinical jaundice was found in 10% of cases and tenderness was found on examination in 95% of cases. USG showed the presence of multiple stones was in 76% of cases, thickening of the gall bladder was in 80% cases and presence of mass was detected in 8% of cases. The follow-up period was 3 months in which no complications were reported. Conclusion: The study found that most of the cases of cholelithiasis now occurring across the spectrum of different ages. The diagnosis has now become easy with the presence of ultrasonography which has sensitivity and specificity. The motto of safe surgery, low morbidity, and early back to work is best done with laparoscopic cholecystectomy.