Lifebox, an international nonprofit organization working to make surgery and anesthesia safer, announced significant results for reducing surgical site infections (SSIs) by nearly half in ill-equipped hospitals and health facilities systems, after it successfully accomplished its pilot projects in five local hospital facilities in Addis Ababa and Oromia regional state.
A study published in the British Journal of Surgery on Wednesday, revealed encouraging results of Clean Cut – a Lifebox program that engages surgical teams to address preventable causes of SSIs.
Entitled “Outcomes Following Implementation of Clean Cut, an Adaptive, Multimodal Surgical Infection Prevention Program for Low Resource Settings: A Prospective Quality Improvement Study,” the study details the impact of Clean Cut in five pilot hospitals in Ethiopia, whereby a combined data and relevant measures and indictors were collected and analyzed within two years, since the pilot project commenced in Ethiopia.
According to the report, in a prospective cohort of over 2,000 surgical patients, the results showed a reduction in the risk of SSIs by 35 percent.
“Most importantly, for scalability across low and middle-income countries, Clean Cut requires no major investments in new infrastructure or resources,” said a statement by Lifebox sent to The Reporter.
“We are very excited and encouraged by our results. Effective implementation of the Surgical Safety Checklist requires coordination and teamwork, and that is what we were able to accomplish through this program,” the statement said, quoting Thomas G Weiser (MeD), Trauma Surgeon and Clinical Lead of the Clean Cut program.
“We improved outcomes and reduced postoperative infections without relying on major capital investments. We know that global surgery gets a fraction of global health funding, and here we have a program that slashes infection rates regardless of a hospital’s budget or location. Clean Cut makes surgery demonstrably safer for patients. If we can effectively disseminate and scale this work, it has ramifications for surgical ecosystems worldwide.”
Head of Lifebox- East African Chapter, Senait Bitew, told The Reporter that the project – Clean Cut – was first introduced in 2016 as a pilot project, primarily commencing its intervention in five surgical hospitals, mainly in Jimma University Specialized Hospital (JUSH), Tikur Anbessa Specialized Hospital (TASH), Menelik II Specialized Hospital (MII) [both affiliated with Addis Ababa University – and St Peter’s Hospital; and Fitche Hospital.
The first three are high-volume tertiary teaching facilities, whereas St Peter’s is a regional referral hospital and Fitche is a district hospital, under the auspices of the Oromia Regional Health Bureau. Together they have a combined catchment population of over 25 million people.
In its latest report, Lifebox labels SSIs as a leading cause of morbidity and mortality in surgical patients particularly in low and middle-income countries where rates of infection can be nearly twice that of high-income countries such as the USA, UK and other advanced nations.
Clean Cut is a checklist-based program that works to reduce SSIs by improving adherence to six essential preoperative infection prevention practices such as appropriate timing of antibiotics, confirmation of instrument sterility and routine swab counting.
Across the five pilot hospitals, there was a 64 percent increase in compliance across these six infection prevention standards (from 2.9 to 4.5 out of six) with the maintenance of sterile field improving by 49 percent and confirmation of instrument sterility increasing by 50 percent.
As a result, the relative risk of infection dropped by 35 percent for all surgical patients. “When comparing surgical patients with low versus high compliance of infection prevention standards, high compliance reduced the risk of infection by 46 percent.”
“This is welcome news for surgical patients in Ethiopia,” said Tihitena Negussie (MD) of Black Lion Hospital.
“Like in many low-income countries, Ethiopian patients suffer disproportionately from surgical infections. Clean Cut is a locally-led and affordable way for surgical teams to make every single patient safer. With the backing of the Federal Ministry of Health, we’re rolling out Clean Cut across Ethiopia, to replicate our successes to date,” She said.
Initially supported by the GE Foundation’s Safe Surgery 2020 initiative, Clean Cut is now being rolled out in a number of new facilities in Ethiopia, in collaboration with MoH. With the results demonstrated by the pilot, Lifebox plans to implement Clean Cut in new settings in the coming months, The Reporter has learnt.
