Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments.

Autor:	Starr N; Department of Surgery, University of California, San Francisco.; Lifebox Foundation, New York, New York., Gebeyehu N; Lifebox Foundation, New York, New York.; Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia., Nofal MR; Lifebox Foundation, New York, New York.; Department of Surgery, Boston Medical Center, Boston, Massachusetts.; Department of Surgery, Stanford University, Palo Alto, California., Forrester JA; Hoag Family Cancer Institute, Newport Beach, California., Tesfaye A; Lifebox Foundation, New York, New York.; Department of Surgery, St Peter's Specialized Hospital, Addis Ababa, Ethiopia., Mammo TN; Lifebox Foundation, New York, New York.; Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia., Weiser TG; Lifebox Foundation, New York, New York.; Department of Surgery, Stanford University, Palo Alto, California., Amdie DA; Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia., Abreha M; Lifebox Foundation, New York, New York., Alemu M; Department of Surgery, Zewditu Memorial Hospital, Addis Ababa, Ethiopia., Ally S; Lifebox Foundation, New York, New York., Abdukadir AA; Haramaya University Hiwot Fana Comprehensive Specialized Hospital, Harar, Ethiopia., Assefa G; Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia., Bedore Y; Department of Surgery, Hawassa University Hospital, Hawassa, Ethiopia., Bekele A; Department of Surgery, University of Global Health Equity, Kigali, Rwanda., Berhanu M; Jhpiego/Ethiopia, Addis Ababa, Ethiopia., Alemu SB; Lifebox Foundation, New York, New York., Chimdesa Z; Department of Surgery, Zewditu Memorial Hospital, Addis Ababa, Ethiopia., Derbew M; Lifebox Foundation, New York, New York.; Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia., Fast C; Sterile Processing Education Charitable Trust, Calgary, Alberta, Canada., Fernandez K; Lifebox Foundation, New York, New York., Kahsay S; International Samaritan, Addis Ababa, Ethiopia., Kassahun A; Department of Surgery, University of Gondar, Gondar, Ethiopia., Kebede H; Lifebox Foundation, New York, New York., Kitesa G; Department of Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia., Koritsanszky L; Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts., Lima B; Lifebox Foundation, New York, New York., Mellese B; Department of Surgery, Hawassa University Hospital, Hawassa, Ethiopia., Mengistu M; Department of Surgery, University of Global Health Equity, Kigali, Rwanda., Negash S; Lifebox Foundation, New York, New York.; Department of Surgery, Menelik II Hospital, Addis Ababa, Ethiopia., Tara M; Lifebox Foundation, New York, New York., Taye S; Lifebox Foundation, New York, New York., Torgeson K; Lifebox Foundation, New York, New York., Tsehaye M; Department of Orthopedics, St Paul Millennium Medical College, Addis Ababa, Ethiopia., Tiruneh A; Department of Surgery, Zewditu Memorial Hospital, Addis Ababa, Ethiopia., Stave K; World Federation of Societies of Anaesthesiologists, London, UK.
Jazyk:	angličtina
Zdroj:	JAMA surgery [JAMA Surg] 2024 Feb 01; Vol. 159 (2), pp. 161-169.
DOI:	10.1001/jamasurg.2023.6033
Abstrakt:	Importance: Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intense external programmatic and resource support. Objective: To examine the improvement in adherence to infection prevention and control standards and rates of postoperative infections in hospitals in the Clean Cut program after implementation strategies were updated and program execution was refined. Design, Setting, and Participants: This cohort study evaluated and refined the Clean Cut implementation strategy to enhance scalability based on a qualitative study of its pilot phase, including formalizing programmatic and educational materials, building an automated data entry and analysis platform, and reorganizing hospital-based team composition. Clean Cut was introduced from January 1, 2019, to February 28, 2022, in 7 Ethiopian hospitals that had not previously participated in the program. Prospective data initiated on arrival in the operating room were collected, and patients were followed up through hospital discharge and with 30-day follow-up telephone calls. Exposure: Implementation of the refined Clean Cut program. Main Outcomes and Measures: The primary outcome was surgical site infection (SSI); secondary outcomes were adherence to 6 infection prevention standards, mortality, hospital length of stay, and other infectious complications. Results: A total of 3364 patients (mean [SD] age, 26.5 [38.0] years; 2196 [65.3%] female) from 7 Ethiopian hospitals were studied (1575 at baseline and 1789 after intervention). After controlling for confounders, the relative risk of SSIs was reduced by 34.0% after program implementation (relative risk, 0.66; 95% CI, 0.54-0.81; P < .001). Appropriate Surgical Safety Checklist use increased from 16.3% to 43.0% (P < .001), surgeon hand and patient skin antisepsis improved from 46.0% to 66.0% (P < .001), and timely antibiotic administration improved from 17.8% to 39.0% (P < .001). Surgical instrument (38.7% vs 10.2%), linen sterility (35.5% vs 12.8%), and gauze counting (89.2% vs 82.5%; P < .001 for all comparisons) also improved significantly. Conclusions and Relevance: A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs. The demonstration of scalability reinforces the value of this SSI prevention program.
Databáze:	MEDLINE
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