Main Menu Browse by Day or Program Author Keywords

504 World Health Organization (WHO) Surgical Safety Checklist implementation helps decrease surgical site infection rates

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Silvia NS Fonseca, MD , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Sonia R. M. Kunzle , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Ivana C Lucca , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Diana Santi , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Marco A Festuccia , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Livian R M Ramos , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Mayra G A Candido , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Magda H Souza , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Francine T Alecrin , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Juliana P Machado , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Rodrigo Costa , Hospital São Francisco, Ribeirão Preto, Estado de São, Brazil
Background:  

The WHO Surgical Safety Checklist (SSCL) has improved compliance with standards and decreased complications from surgery. It consists on a series of checks done before surgery that include verifying patient´s identification, correct side/site of surgery, sterilization of surgical material, antibiotic prophylaxis timing among other verifications.  We decided to implement it in our general tertiary hospital in order to decrease surgical complications, including surgical site infections (SSI).

Objective: To describe the WHO SSCL implementation and the impact on SSI rates.

Methods:

Hospital São Francisco is a 150-bed general tertiary hospital that monthly performs over 1,500 surgeries from all specialties, from one-day surgery to cardiac surgeries, renal transplantation and prosthesis surgeries. In September 2009, we created a work team to implemented WHO SSCL; implementation  started  on October 4th, 2009, one surgical team at a time. All surgical personal was trained and on-going training for all new surgical personal was implemented. From March 2010 and on, WHO SSCL became mandatory for all surgeries. We measured compliance by daily looking at all the SSCL forms and comparing them with the # of surgeries done; the team met twice a month to discuss findings of SSCL. SSI rates were determined by the infection control team by active in-patient surveillance using the CDC definitions. Post-discharge surveillance (PDS) was also done in surgeries over 2 hours duration (audited surgeries,45% of total surgeries), by phoning a sample of patients 2-3 weeks after hospital discharge; PDS rates were calculated by dividing the total # of  contacted patients by the total # of audited surgeries. We compared SSI rates in 2 Periods: January –September 2009 and January-September 2010 using the chi-square method, a p value <0. 05 was considered significant.

Results:  

During the first months of implementation, SSCL adhesion went up from 1,3% (October 2009) to 7%, 20%, 62% and 73% (February 2010). From March 2010 and on, adhesion went up from 95% up to 98% (September 2010). The major problems detected by the SSCL and corrected during the study were related to sterilization indicators. The total SSI rate significantly dropped from 2.8% (2009) to 0.99% in 2010 (171/ 6,197 vs 69/ 6,913 respectively; orthopedic SSI rate dropped from 2.1% to 0.82% (37/ 1,725 vs 18/ 2,196), p<0.01. Cardiac SSI rates also dropped significantly (11.2% in 2009 to 5.3% in 2010).PDS rates went up significantly from 50% (3,106/6,197) in 2009 to 59% (4,059/ 6,913) in 2010 (p<0.01). SSI rates on 2007 and 2008 were also significantly higher: 2. 8 % (2007) and 2.4% (2008) compared to  0.99% (2010).

Conclusions: WHO SSCL implementation was associated with a significant drop of our SSI rates probably because of sterilization improvement.