Abstract:
Background: Millions of patients worldwide suffer disability and death due to complications related to surgery. While WHO surgical safety checklist have been shown to improve teamwork and maternal surgical outcomes, the studies that longitudinally measure the change in maternal surgical outcomes following implementation of WHO SSC in LMICs, including Tanzania are limited and largely ineffective. Very few data are locally available to assess the extent of surgical complications and the use of SSC.
Methodology: A mixed-method study design which involved both quantitative and qualitative data collection. The pre and post data collection on the use of WHO SSC, and maternal and perioperative complications was done before intervention and 18 months after implementation of the intervention (leadership and safe cesarean birth trainings). A total of 1,080 patient files were randomly selected and assessed (466 during pre-implementation and 614 after 18 months of implementation). The study was administered to 218 surgical members (nurse, surgeon, and anesthesiologist) in 40 CEmONC health facilities to assess the perceived elements of WHO SSC that transformed the maternal surgical outcomes.
Results: A total of 1080 files for women who either delivered through C-section or normal; 466 before and 614 after leadership and safe cesarean trainings were reviewed for use of surgical safety checklist and screened for maternal sepsis and surgical site infections. At 18 months, a WHO Surgical safety checklist was used to 94.3% (182 of 193) of women who delivered through C-section as compared with 3.7% (5 of 136) before leadership and safe cesarean trainings (P<0.001). There were less surgical site infections rates after C-section when the WHO SSC was used, 1% during pre-implementation as compared to when it was not, 14% after 18 months of implementation, this translates to 93% reduction of surgical site infection rates.
The proportion of women with postoperative sepsis after C-section reduced from 2.9% (4 of 136) during the pre-implementation to 0% (0 of 193) at the post-implementation (P =0.017). The C-section related Post-operative mortality ratio (POMR) reduced from 161 deaths per 100,000 C-section during pre-implementation to 99 deaths per 100,000 C-sections during post-implementation (P=0.6).
Overall, 95.7% of surgical team members were positive about the critical elements of the WHO surgical safety checklist that transformed the maternal surgical outcomes in Kagera and Mara regions. Approximately 98.2% were positive about staff attitudes, 100% positive about cooperation among disciplines within the operating room, teamwork, and adherence to established safety practices.
Conclusion: This study shows successful introduction and use of WHO Surgical safety checklist and improved maternal surgical outcomes in the lake zone of Tanzania.
