Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2019 May 30:8:91.
doi: 10.1186/s13756-019-0541-3. eCollection 2019.

Implementation of a surgical unit-based safety programme in African hospitals: a multicentre qualitative study

Lauren Clack  1 , Ursina Willi  1 , Sean Berenholtz  2 , Alexander M Aiken  3 , Benedetta Allegranzi #  4 , Hugo Sax #  1
Affiliations
Multicenter Study

Implementation of a surgical unit-based safety programme in African hospitals: a multicentre qualitative study

Lauren Clack et al. Antimicrob Resist Infect Control. .

Abstract

Background: A Surgical Unit-based Safety Programme (SUSP) has been shown to improve perioperative prevention practices and to reduce surgical site infections (SSI). It is critical to understand the factors influencing the successful implementation of the SUSP approach in low- and middle-income settings. We undertook a qualitative study to assess viability, and understand facilitators and barriers to implementing the SUSP approach in 5 African hospitals.

Methods: Qualitative study based on interviews with individuals from all hospitals participating in a WHO-coordinated before-after SUSP study. The SUSP intervention consisted of a multimodal strategy including multiple SSI prevention measures combined with an adaptive approach aimed at improving teamwork and safety culture.

Results: Thirteen interviews (5 head surgeons, 3 surgeons, 5 nurses) were conducted with staff from five hospital sites. Identified facilitators included influential individuals (intrinsic motivation of local SUSP teams, boundary spanners, multidisciplinary engagement, active leadership support), peer-to-peer learning (hospital networking and positive deviance, benchmarking), implementation fitness (enabling infrastructures, momentum from previous projects), and timely feedback of infection rates and process indicators. Barriers (organisational 'constipators', workload, mistrust, turnover) and local solutions to these were also identified.

Conclusions: Participating hospitals benefitted from the SUSP programme structures (e.g. surveillance, hospital networks, formation of multidisciplinary teams) and adaptive tools (e.g. learning from defects, executive rounds guide) to change perceptions around patient safety and improve behaviours to prevent SSI. The combination of technical and adaptive elements represents a promising approach to facilitate the introduction of evidence-based best practices and to improve safety culture through local team engagement in resource-limited settings.

Keywords: Implementation science; Infection prevention; Surgical site infection.

PubMed Disclaimer

Conflict of interest statement

Competing interestsThe authors report no competing interests.

References

    1. Burke JP. Infection control - a problem for patient safety. N Engl J Med. 2003;348:651–656. doi: 10.1056/NEJMhpr020557. - DOI - PubMed
    1. Allegranzi B, Bagheri Nejad S, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet. 2011;377:228–241. doi: 10.1016/S0140-6736(10)61458-4. - DOI - PubMed
    1. Report on the burden of endemic health care-associated infection Wordwide. Geneva, Switzerland: World Health Organization 2011.
    1. Suetens C, Hopkins S, Kolman J, et al. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. Sweden: ECDC Stockholm; 2013.
    1. Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care–associated infections. N Engl J Med. 2014;370:1198–1208. doi: 10.1056/NEJMoa1306801. - DOI - PMC - PubMed

Publication types

MeSH terms