Observational study of three different methods of implementing the WHO surgical safety checklist in Guinea

Abstract

Objective: The World Health Organisation Surgical Safety Checklist improves surgical outcomes in resource poor settings but the best method of implementing the checklist is unknown. We aimed to evaluate three different methods of training in Guinea and evaluated the outcome at 3-6 months.Methods: A total of 13 individuals (4 surgeons, 7 anaesthetists and 2 nurses) from 6 different hospitals underwent 3 methods of training (hospital team training, hospital individual training and classroom only training). None had previous knowledge the checklist. Effectiveness of training was evaluated by hospital visits and structured interview at 3-6 months. Corroborating evidence was obtained from interviews with the Hospital Directors and other staff. Findings:Team training was the most successful. All the hospitals who received team training reported improvements in teamwork, anaesthesia, and infection control. No hospital managed to implement the checklist in its entirety. Anaesthetists who received individual training were unable to implement any changes in their own hospitals. Conclusion:Team training is more effective than individual training in ensuring more of the key steps of the checklist are followed. Our results question the effectiveness of running a one day classroom training for implementation of the WHO checklist for single groups of professionals such as anaesthetists in the absence of support from other members of the operating team.

Implementation strategies for infection prevention and control promotion for nurses in Sub-Saharan Africa: a systematic review

“…PENETRATION: 68,635 women received pre-test counseling; 63,094 (91.9%) of women were screened for HIV; Of those screened for HIV, 5550 (8.7%) were HIV positive; Of those who were HIV positive, 5433 (97%) were provided Nevarapine1. PENETRATION: 690 nurses, nurse aids, and trained birth attendants were trained to provide PMTCT in 115 facilities in 6 out of ten provinces in Cameroon44White et al [89]IPC Practices during surgeries (disinfection of equipment, decontamination of equipment, disinfection of environment)1. EDUCATE: (3 different training methods were used to promote the use of the WHO Surgical checklist—nurses were only trained in one method (the team method: an intra-professional training modality)2.…”

Overcoming challenges in implementing the WHO Surgical Safety Checklist: lessons learnt from using a checklist training course to facilitate rapid scale up in Madagascar

“…14 Since 2013, we have been creating and adapting a short-format checklist training course designed to address and overcome challenges to implementation. Our experience in Guinea in 2013 demonstrated better results with multidisciplinary training in a hospital setting rather than teaching individual anaesthetists or surgeons in a classroom and expecting them to return to their local setting and implement change 15 ; a pilot course in the Republic of Congo showed that a short 4-day course led to improved indices of surgical safety sustained at 18 months. 16 We also sought more involvement from local leadership (hospital directors and surgeons) and from the Ministry of Health aiming to use both a ‘bottom-up’ and a ‘top-down’ approach to checklist implementation.…”

Evaluation of a countrywide implementation of the world health organisation surgical safety checklist in Madagascar

“…Mercy Ships operates the world’s largest non-governmental hospital ship, the Africa Mercy , which usually stays in a given country for ten months, providing free surgeries and training. Mercy Ships has trained single hospitals in checklist implementation in Guinea and Republic of Congo and has reported sustained results at 18 months [ 20 , 21 ]. Based on these experiences and those in two pilot hospitals in Madagascar, we developed a three-day checklist implementation course suitable for countrywide scale-up.…”