Surgical Safety Checklist Use and Post-Caesarean Sepsis in the Lake Zone of Tanzania: Results from Safe Surgery 2020.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
accepted:
21
09
2021
pubmed:
21
11
2021
medline:
1
2
2022
entrez:
20
11
2021
Statut:
ppublish
Résumé
Maternal sepsis accounts for significant morbidity and mortality in lower income countries, and caesarean delivery, while often necessary, augments the risk of maternal sepsis. The aim of this study was to investigate the effect of Safe Surgery 2020 surgical safety checklist (SSC) implementation on post-caesarean sepsis in Tanzania. We conducted a study in 20 facilities in Tanzania's Lake Zone as part of the Safe Surgery 2020 intervention. We prospectively collected data on SSC adherence and maternal sepsis outcomes from 1341 caesarian deliveries. The primary outcome measure was maternal sepsis rate. The primary predictor was SSC adherence. Multivariable logistic regression was used to estimate independent associations between SSC adherence and maternal sepsis. Higher SSC adherence was associated with lower rates of maternal sepsis (<25% adherence: 5.0%; >75% adherence: 0.7%). Wound class and facility type were significantly associated with development of maternal sepsis (Wound class: Clean-Contaminated 3.7%, Contaminated/Dirty 20%, P = 0.018) (Facility Type: Health Centre 5.9%, District Hospital 4.5%, Regional Referral Hospital 1.7%, P = 0.018). In multivariable analysis, after controlling for wound class and facility type, higher SSC adherence was associated with lower rates of maternal sepsis, with an adjusted odds ratio of 0.17 per percentage point increase in SSC adherence (95% CI: 0.04, 0.79; P = 0.024). Adherence to the SSC may reduce maternal morbidity during caesarean delivery, reinforcing the assumption that surgical quality interventions improve maternal outcomes. Future studies should continue to explore additional synergies between surgical and maternal quality improvement.
Sections du résumé
BACKGROUND
Maternal sepsis accounts for significant morbidity and mortality in lower income countries, and caesarean delivery, while often necessary, augments the risk of maternal sepsis. The aim of this study was to investigate the effect of Safe Surgery 2020 surgical safety checklist (SSC) implementation on post-caesarean sepsis in Tanzania.
METHODS
We conducted a study in 20 facilities in Tanzania's Lake Zone as part of the Safe Surgery 2020 intervention. We prospectively collected data on SSC adherence and maternal sepsis outcomes from 1341 caesarian deliveries. The primary outcome measure was maternal sepsis rate. The primary predictor was SSC adherence. Multivariable logistic regression was used to estimate independent associations between SSC adherence and maternal sepsis.
RESULTS
Higher SSC adherence was associated with lower rates of maternal sepsis (<25% adherence: 5.0%; >75% adherence: 0.7%). Wound class and facility type were significantly associated with development of maternal sepsis (Wound class: Clean-Contaminated 3.7%, Contaminated/Dirty 20%, P = 0.018) (Facility Type: Health Centre 5.9%, District Hospital 4.5%, Regional Referral Hospital 1.7%, P = 0.018). In multivariable analysis, after controlling for wound class and facility type, higher SSC adherence was associated with lower rates of maternal sepsis, with an adjusted odds ratio of 0.17 per percentage point increase in SSC adherence (95% CI: 0.04, 0.79; P = 0.024).
CONCLUSIONS
Adherence to the SSC may reduce maternal morbidity during caesarean delivery, reinforcing the assumption that surgical quality interventions improve maternal outcomes. Future studies should continue to explore additional synergies between surgical and maternal quality improvement.
Identifiants
pubmed: 34799791
doi: 10.1007/s00268-021-06338-3
pii: 10.1007/s00268-021-06338-3
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
303-309Informations de copyright
© 2021. Société Internationale de Chirurgie.
Références
Black R, Laxminarayan R, Temmerman M, et al. Disease control priorities, (volume 2): reproductive, maternal, newborn, and child health. The World Bank 2016
http://www.healthdata.org/gbd . [Accessed July 2020]
Bonet M, Brizuela V, Abalos E et al (2020) Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study. Lancet Glob Health 8(5):e661–e671. https://doi.org/10.1016/S2214-109X(20)30109-1
doi: 10.1016/S2214-109X(20)30109-1
Acosta CD, Harrison DA, Rowan K, et al. 2016. Maternal morbidity and mortality from severe sepsis: a national cohort study. BMJ Open. Doi: https://doi.org/10.1136/bmjopen-2016-012323
Molina G, Weiser TG, Lipsitz SR et al (2015) Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA 314(21):2263–2270. https://doi.org/10.1001/jama.2015.15553
doi: 10.1001/jama.2015.15553
pubmed: 26624825
World Health Organization. WHO statement on caesarean section rates. World Health Organization 2015.
Weiser TG, Haynes AB, Molina G et al (2016) Size and distribution of the global volume of surgery in 2012. Bull World Health Organ 94(3):201. https://doi.org/10.2471/BLT.15.159293
doi: 10.2471/BLT.15.159293
pubmed: 26966331
pmcid: 4773932
Galukande M, von Schreeb J, Wladis A et al (2010) Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries. PLoS Med 7(3):e1000243. https://doi.org/10.1371/journal.pmed.1000243
doi: 10.1371/journal.pmed.1000243
pubmed: 20231871
pmcid: 2834708
Haynes AB, Weiser TG, Berry WR et al (2009) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360(5):491–499. https://doi.org/10.1056/NEJMsa0810119
doi: 10.1056/NEJMsa0810119
pubmed: 19144931
Bergs J, Hellings J, Cleemput I et al (2014) Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications. Br J Surg 101(3):150–158. https://doi.org/10.1002/bjs.9381
doi: 10.1002/bjs.9381
pubmed: 24469615
Kim RY, Kwakye G, Kwok AC et al (2015) Sustainability and long-term effectiveness of the WHO surgical safety checklist combined with pulse oximetry in a resource-limited setting: two-year update from Moldova. JAMA Surg 150(5):473–479. https://doi.org/10.1001/jamasurg.2014.3848
doi: 10.1001/jamasurg.2014.3848
pubmed: 25806951
Leth RA, Møller JK, Thomsen RW et al (2009) Risk of selected postpartum infections after cesarean section compared with vaginal birth: a five-year cohort study of 32,468 women. Acta Obstet Gynecol Scand 88(9):976–983. https://doi.org/10.1080/00016340903147405
doi: 10.1080/00016340903147405
pubmed: 19642043
Naidoo M, Moodley J, Gathiram P et al (2017) 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. S Afr Med J 107(3):248–257. https://doi.org/10.7196/SAMJ.2017.v107i3.11320
doi: 10.7196/SAMJ.2017.v107i3.11320
pubmed: 28281432
Alidina S, Kuchukhidze S, Menon G et al (2019) Effectiveness of a multicomponent safe surgery intervention on improving surgical quality in Tanzania’s Lake Zone: protocol for a quasi-experimental study. BMJ Open 9(10):e031800. https://doi.org/10.1136/bmjopen-2019-031800
doi: 10.1136/bmjopen-2019-031800
pubmed: 31594896
pmcid: 6797473
Huang LC, Conley D, Lipsitz S et al (2014) The surgical safety checklist and teamwork coaching tools: a study of inter-rater reliability. BMJ Qual Saf 23(8):639–650. https://doi.org/10.1136/bmjqs-2013-002446
doi: 10.1136/bmjqs-2013-002446
pubmed: 24497526
Dellinger R, Levy M, Rhodes A et al (2013) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 39(2):165–228. https://doi.org/10.1097/CCM.0b013e31827e83af
doi: 10.1097/CCM.0b013e31827e83af
pubmed: 23361625
pmcid: 7095153
Mioton LM, Jordan SW, Hanwright PJ et al (2013) The relationship between preoperative wound classification and postoperative infection: a multi-institutional analysis of 15,289 patients. Arch Plast Surg 40(5):522. https://doi.org/10.5999/aps.2013.40.5.522
doi: 10.5999/aps.2013.40.5.522
pubmed: 24086804
pmcid: 3785584
Conroy K, Koenig AF, Yu YH et al (2012) Infectious morbidity after cesarean delivery: 10 strategies to reduce risk. Rev Obstet Gynecol 5(2):69
pubmed: 22866185
pmcid: 3410505
De Simone B, Sartelli M, Coccolini F et al (2020) Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines. World J Emerg Surg 15(1):10. https://doi.org/10.1186/s13017-020-0288-4
doi: 10.1186/s13017-020-0288-4
pubmed: 32041636
pmcid: 7158095
Van Klei WA, Hoff RG, Van Aarnhem EE et al (2012) Effects of the introduction of the WHO “Surgical Safety Checklist” on in-hospital mortality: a cohort study. Ann Surg 255(1):44–49. https://doi.org/10.1097/SLA.0b013e31823779ae
doi: 10.1097/SLA.0b013e31823779ae
pubmed: 22123159
Boeckmann LM, Rodrigues MC. Adaptation and validation of a surgical safety checklist in the cesarean delivery. Texto & Contexto-Enfermagem 2018;27(3).
Shikha SS, Latif T, Moshin M et al (2018) Evaluation of surgical site infection among post cesarean patients in mymensingh medical college hospital. Mymensingh Med J 27(3):480–486
pubmed: 30141435