Manuscript Title:

IMPACT OF IMPLEMENTING THE CHECKLIST PROCEDURE ON THE INCIDENCE OF SURGICAL SITE INFECTIONS IN CESAREAN SECTION WOMEN

Author:

G.BRAHIMI, H. OULD BABA ALI, S. AIT SEDDIK, S. AMRIT

DOI Number:

DOI:10.5281/zenodo.11058765

Published : 2024-04-23

About the author(s)

1. G.BRAHIMI - Department of Epidemiology and Preventive Medicine, BeniMessous University Hospital Centre.
2. H. OULD BABA ALI - Department of Epidemiology and Preventive Medicine, BeniMessous University Hospital Centre.
3. S. AIT SEDDIK - Department of Epidemiology and Preventive Medicine, BeniMessous University Hospital Centre.
4. S. AMRIT - Department of Epidemiology and Preventive Medicine, BeniMessous University Hospital Centre.

Full Text : PDF

Abstract

Introduction: Surgical site infections (SSI) constitute a significant source of morbidity and mortality for cesarean parturients, with considerable impact on the healthcare system. Although the occurrence of SSIs depends on several factors, including those related to the patient, pregnancy complications, surgical procedure, and healthcare environment, these infections are largely preventable. The occurrence of SSIs may raise questions about the quality and safety of surgical interventions. Prevention of SSIs depends on a set of best practices to be applied before, during, and after surgical intervention. The aim of our study is to assess the impact of implementing the Pre- and Per-operative Safety Checklist on the incidence of SSIs in cesarean women. Materials and Methods: This was a before-after evaluation study conducted in 2014 and 2015. Recruitment of parturients took place between February and April of each year, with the implementation of the checklist for SSI prevention after the first year of surveillance. Data collection was done in real-time (daily) with follow-up until Day 30. Data were entered and analyzed using Epi Info6 version 6.04 (CDC, Atlanta, USA), and multivariate analysis was performed using Epi Info 7 version 3.5.4. Results: A total of 611 cesarean sections were included, 311 in the pre-checklist study and 300 in the post-checklist study. The checklist was observed for 60% of procedures, i.e., 179 cesareans were performed with checklist application. A total of 66 cases of SSIs were recorded during the study period, of which 59 (89.4%) were superficial infections, 6 (9%) were deep SSIs, and 1 case was an organ or cavity infection (endometritis). The impact of prevention on reducing the incidence rate of SSIs was demonstrated in our study by applying a small number of effective measures to prevent infections, as listed on a Checklist for Patient Safety. A significant decrease in the incidence rate between the two study periods was achieved, dropping from 16.7% to 4.7% (an 86% reduction), and the risk of SSIs in cesarean parturients was reduced to 0.063 (OR = 0.063, 95% CI: [0.02-0.2], p <0.00001), meaning it is 15.9 times lower after implementing all prevention measures. The utility of such a tool reminding the application of best practices was thus demonstrated, with convincing results, which would also lead to healthcare cost savings. The Checklist should now be an integral part of daily work for teams, ensuring safer surgery.


Keywords

Surgical Site Infections - Caesarean Section - Impact Study - Patient Safety - Check-List, Risk Factors.