The World Health Organization (WHO) created the WHO Surgical Safety Checklist to prevent adverse events in operating rooms. The aim of this study was to analyze WHO checklist implementation in three operating rooms of public hospitals in the Brazilian Federal District. A prospective cross-sectional study was performed with pre- (Period I) and post (Period II)-checklist intervention evaluations. A total of 1141 patients and 1052 patients were studied in Periods I and II for a total of 2193 patients. Period I took place from December 2012 to March 2013, and Period II took place from April 2013 to August 2014. Regarding the pre-operatory items, most surgeries were classified as clean-contaminated in both phases, and team attire improved from 19.2% to 71.0% in Period II. Regarding checklist adherence in Period II, "Patient identification" significantly improved in the stage "Before induction of anesthesia". "Allergy verification", "Airway obstruction verification", and "Risk of blood loss assessment" had low adherence in all three hospitals. The items in the stage "Before surgical incision" showed greater than 90.0% adherence with the exception of "Anticipated critical events: Anesthesia team review" (86.7%) and "Essential imaging display" (80.0%). Low adherence was noted in "Instrument counts" and "Equipment problems" in the stage "Before patient leaves operating room". Complications and deaths were low in both periods. Despite the variability in checklist item compliance in the surveyed hospitals, WHO checklist implementation as an intervention tool showed good adherence to the majority of the items on the list. Nevertheless, motivation to use the instrument by the surgical team with the intent of improving surgical patient safety continues to be crucial.

BackgroundAccording to the World Health Organization, the WHO surgical safety checklist can prevent complications, improve communication and contribute to postsurgical safety culture; hence, there is a need to investigate the attitudes and opinions of surgical teams regarding safety utilizing the WHO instrument. The aim of this study was to assess the attitudes and opinions towards surgical safety among operating room professionals in three public hospitals in the Brazilian Federal District.MethodsA cross-sectional study was conducted with the use of a checklist based on the safety attitudes questionnaire-operating room, sent out during the pre- and post-intervention surveys of the WHO surgical safety checklist (period I and period II) between 2012 and 2014.ResultsAbout 470 professionals, mostly nurse technicians, responded to the questionnaire in both periods. Regarding the perception of safety and agreement about the collaboration of the operating team, a significant statistical improvement of the nursing staff and anesthesiologists was observed in the operating room after the checklist was implemented. After utilizing the checklist before each surgical procedure, concerns about patient safety and compliance with standards as well as rules and hand-washing practices in the operating room statistically improved after the post-intervention, especially by the nursing staff. The checklist was considered easy and quick to use by most respondents. They also believed that the checklist inclusion improved communication, reflecting significant differences. At least 90.0 % of respondents from each team agreed that the checklist helps prevent errors in the operating room.ConclusionsThe study results showed progress in relation to the attitudes and opinions regarding surgical safety from operating teams in relation to the checklist response in the surveyed units. However, difficulties in its implementation are experienced, especially in relation to checklist use acceptance by the surgeons. New studies are needed to verify the sustainability of the surgical teams’ changes in attitudes in the hospitals studied.

Diversas medidas de prevenção dos riscos relacionados à assistência e à melhoria da saúde são desenvolvidas em favor da segurança do paciente. A segurança do paciente é entendida como a redução, a um mínimo aceitável, do risco de dano desnecessário associado à atenção à saúde. Danos desnecessários são conhecidos como Eventos Adversos (EAs). A preocupação com a segurança cirúrgica constitui um desafio mundial de saúde pública. No Brasil, a Agência Nacional de Vigilância Sanitária (ANVISA) e o Ministério da Saúde delinearam ações, política e regulamentação sanitária para prevenir EAs, incluindo aqueles decorrentes de procedimentos cirúrgicos. Em 2013 foi instituído o Programa Nacional de Segurança do Paciente (PNSP), e a ANVISA regulamentou as ações de segurança do paciente. Apesar dos avanços da política nacional de segurança do paciente, recentemente instituída no país, ainda são necessárias medidas visando a busca da qualidade e da segurança nos cuidados cirúrgicos. A instituição e a sustentação de cultura de segurança pode asseverar a cirurgia segura nos serviços de saúde. O objetivo deste artigo é discutir os principais componentes envolvidos na qualidade do cuidado e da segurança do paciente, como prioridades nos serviços de saúde e nas estratégias nacionais empregadas para a promoção da assistência cirúrgica segura.

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This report describes a survey of microbiology laboratories (n = 467) serving Brazilian hospitals with ≥10 intensive care beds and/or involved in the government health care adverse event reporting system. Coordinators were interviewed and laboratories classified as follows: Level 0 (no minimal functioning conditions-85.4% of laboratories); Level 1 (minimal functioning conditions but inadequate execution of basic routine-6.7%); Level 2 (minimal functioning conditions and adequate execution of basic routine but no adequate procedures for quality control-5.8%); Level 3 (minimal functioning conditions, adequate execution of basic routine, and adequate procedures for quality control, but no direct communication with the infection control department-0.9%); Level 4 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, and direct communication with infection control, but no available advanced resources-none); and Level 5 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, direct communication with infection control, and available advanced resources-0.9%). Twelve laboratories did not perform Ziehl-Neelsen staining; 271 did not have safety cabinets; and >30% without safety cabinets had automated systems. Low quality was associated with serving hospitals not participating in government adverse-event program; private hospitals; nonteaching hospitals; and those outside state capitals. Results may reflect what occurs in many other countries where defining priorities is important due to limited resources.