ADHERENCE TO SAFE SURGERY PRACTICES IN GOVERNMENT HOSPITALS IN SEKONDI-TAKORADI METROPOLIS

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