ADHERENCE PRACTICE TO THE WORLD HEALTH ORGANIZATION’S SURGICAL SAFETY CHECKLIST IN OPERATING ROOMS IN KISII COUNTY TEACHING AND REFERRAL HOSPITAL, KENYA

Abstract

World Health Organization (WHO) introduced the Surgical Safety Checklist (SSC) in 2008 to assure safety in operating rooms (ORs). Globally, adherence level varies with developing countries posting the lowest levels compared to their developed counterparts. The main objective of the study was to evaluate adherence practices to the WHO SSC in ORs in Kisii County Teaching & Referral Hospital (KTRH). The specific objectives were to assess the level of adherence and to determine staff and institutional related factors that influence adherence to the WHO SSC in ORs in KTRH. The study preferred a mixed method cross-sectional design. WHO SSC adherence level was assessed by conducting a retrospective review of 424 randomly selected surgical files. The OR staff were selected through a census method and 31 responded to the interviews to determine both staff and institutional factors that influenced adherence to the WHO SSC. Qualitative data was analysed using SPSS and both descriptive & inferential statistics were generated. Statistical significance was set at p=<0.05. Qualitative data was analysed using a thematic approach. The study findings indicated that the WHO SSC was available in 100% of the surgical files reviewed. Elective surgeries had better adherence level (78%) compared to emergency cases (22%). There was a varying adherence level as per the type of surgery done orthopaedic (4%), Paediatric (8%), gynaecology (16%), urology (32%) and adult general (40%). A decreasing trend in adherence level on each section of the WHO SSC was noted with the Sign-in posting 5.7%, Time-out (1.8%) and Sign-out posting 0.7%. The average adherence level was 2.7%. Key staff factors that influenced adherence to the WHO SSC included: experience in OR(p=0.014), attitude (p=0.014) and perception (p=0.009). Institutional factors were: lack of essential consumables and drugs (77.4%), lack of refresher trainings (54.5%), understaffing (48.4%) and lack of management support (45.2%). In conclusion, there was a low (2.7%) level of adherence to the WHO SSC in KTRH. The aforementioned staff and institutional influenced the adherence to WHO SSC. This study recommends to the management to institute a structured health system-based quality improvement intervention to improve adherence by addressing the staff and institutional factors to promote surgical safety in the facility.