Adherence to Safe Surgery Practices in Government Hospitals in Sekondi-Takoradi Metropolis

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Date

2019-07

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University of Ghana

Abstract

Background Surgery is vital, resolving much of the global burden of disease. In spite of improvements in surgical care there are still risks of harm to patients due to non-adherence to surgical safety standards. In Ghana, data on surgery related adverse events are scanty. Few studies done in Ghana estimates surgery related adverse events at 19% and prevalence of surgical site infections (SSIs) ranges from 9.6% to 40%. Successive peer review assessments in the Western region over the past five years have also revealed a significant proportion of surgical site infections, poor infection prevention and control practices in the surgical theatres and non - usage of surgical safety checklist for patients mostly in these four hospitals in Sekondi- Takoradi Metropolis. To address this, Ghana adopted the WHO surgical safety guidelines in 2010. This study was to assess adherence of four government hospitals to safe surgery practices and associated factors in the Sekondi-Takoradi Metropolis (STM). Methods This was a cross sectional study with mixed method. Structured questionnaires were used to assess knowledge of theatre staff on safe surgery practices. Theatre assessment for availability of logistics and a retrospective record review of adult patients (≥13 years) who had surgeries involving incisions under spinal and/or general anaesthesia from January-December, 2018 were done to assess the use of WHO SSC and presence of SSIs using checklists. Six key staff were also interviewed. Quantitative data were analyzed using Excel 15.0 and STATA 15.0 and univariate, bivariate and multivariate analysis done and results presented as frequencies, proportions, p-values and odd ratios using tables and figures. Qualitative data were analysed by transcribing responses of participants word for word and thematic analysis used to analyze their core statements. Knowledge level of respondents was categorised as poor, average and good. Adherence was assessed by rate of use and completion rate of the WHO surgical safety checklist and results scored as adherence or non-adherence. Results Overall, none of the hospitals was found to adhere to safe surgery practices. Overall checklist use and completion rate were 50.1% and 21.0% respectively. Mean knowledge score was 61.8± 14.4. Majority (62.3%) of respondents had average knowledge. Five out of six key staff interviewed were aware of the WHO SSG. After controlling for other variables, marital status, knowledge of WHO SSG, perception of surgical checklist is a waste of time and internal training sections on Infection Prevention and Control (IPC) were significantly associated with knowledge level of respondents (p-value <0.05). The total proportion of SSIs was 49.1% (46/381). There was a 25% increase odds of developing SSI after surgery for each day increase of the stay of patients after surgery (AOR: 1.25, 95% CI: [110, 1.43], p-value = 0.001). Conclusion None of the hospitals was found to adhere to safe surgery practices. Factors found to affect adherence were little knowledge about the guidelines, motivation for staff, workload and lack of monitoring systems in place to check the proper use of the checklist. Majority of the respondents had moderate knowledge level on safe surgery practices and proportion of surgical site infections were high. Implementation of the WHO safe surgery guidelines was not successful in STM resulting in non-adherence to safe surgery practices. This poses great risk to the safety of surgical patients as evidenced by the proportion of surgical site infections

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MPhil. Applied Epidemiology and Disease Control

Keywords

Surgery, Surgical Care, Surgical Safety Standards, Sekondi- Takoradi Metropolis

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