Taylor Wurdeman1,2, Steven J Staffa3, Shehnaz Alidina4, Ntuli A Kapologwe5, David Barash6, Ladislaus Buberwa7, Eliudi Eliakimu8, Erastus Maina9, Sarah Maongezi8, John G Meara4,10, William Munyonyela11, Rahma Mushi12, Cheri Reynolds13, Christopher Strader4,14, John Varallo15, Leonard Washington16, David Zurakowski3. 1. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. Taylor.wurdeman@gmail.com. 2. Department of Surgery, Loma Linda University Medical Center, 1884 Gould Street, Loma Linda, CA, 92354, USA. Taylor.wurdeman@gmail.com. 3. Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. 4. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. 5. President's Office, Regional Administration and Local Government, Dodoma, Tanzania. 6. GE Foundation, Boston, MA, USA. 7. St. Josephs Hospital, Kagondo, Kagera, Tanzania. 8. Gender, Elderly and Children, Ministry of Health, Community Development, Dodoma, Tanzania. 9. D-Implement, Dalberg Advisors, Nairobi, Kenya. 10. Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA. 11. Nyamiaga Hospital, Ngara, Kagera, Tanzania. 12. Department of Obstetrics and Gynecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania. 13. Assist International, Ripon, USA. 14. Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA. 15. JHPIEGO, Baltimore, MD, USA. 16. Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania.
Abstract
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.
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.
Authors: George Molina; Thomas G Weiser; Stuart R Lipsitz; Micaela M Esquivel; Tarsicio Uribe-Leitz; Tej Azad; Neel Shah; Katherine Semrau; William R Berry; Atul A Gawande; Alex B Haynes Journal: JAMA Date: 2015-12-01 Impact factor: 56.272
Authors: Alex B Haynes; Thomas G Weiser; William R Berry; Stuart R Lipsitz; Abdel-Hadi S Breizat; E Patchen Dellinger; Teodoro Herbosa; Sudhir Joseph; Pascience L Kibatala; Marie Carmela M Lapitan; Alan F Merry; Krishna Moorthy; Richard K Reznick; Bryce Taylor; Atul A Gawande Journal: N Engl J Med Date: 2009-01-14 Impact factor: 91.245
Authors: J Bergs; J Hellings; I Cleemput; Ö Zurel; V De Troyer; M Van Hiel; J-L Demeere; D Claeys; D Vandijck Journal: Br J Surg Date: 2014-02 Impact factor: 6.939
Authors: Lyen C Huang; Dante Conley; Stu Lipsitz; Christopher C Wright; Thomas W Diller; Lizabeth Edmondson; William R Berry; Sara J Singer Journal: BMJ Qual Saf Date: 2014-02-04 Impact factor: 7.035
Authors: Rebecca Y Kim; Gifty Kwakye; Alvin C Kwok; Ruslan Baltaga; Gheorghe Ciobanu; Alan F Merry; Luke M Funk; Stuart R Lipsitz; Atul A Gawande; William R Berry; Alex B Haynes Journal: JAMA Surg Date: 2015-05 Impact factor: 14.766
Authors: Moses Galukande; Johan von Schreeb; Andreas Wladis; Naboth Mbembati; Helder de Miranda; Margaret E Kruk; Sam Luboga; Alphonsus Matovu; Colin McCord; S Khady Ndao-Brumblay; Doruk Ozgediz; Peter C Rockers; Ana Romàn Quiñones; Fernando Vaz; Haile T Debas; Sarah B Macfarlane Journal: PLoS Med Date: 2010-03-09 Impact factor: 11.069
Authors: Thomas G Weiser; Alex B Haynes; George Molina; Stuart R Lipsitz; Micaela M Esquivel; Tarsicio Uribe-Leitz; Rui Fu; Tej Azad; Tiffany E Chao; William R Berry; Atul A Gawande Journal: Bull World Health Organ Date: 2016-03-01 Impact factor: 9.408