Clean Cut: Reducing Surgical Site Infections in Ethiopia September Update

Clean Cut: Reducing Surgical Site Infections in Ethiopia September Update

Recently the Global Surgery Foundation have helped fund the 'Clean Cut: Reducing Surgical Site Infections in Ethiopia' project. Read the Clean Cut Ethiopia: Project update below:

Project overview

The expected outcomes of Clean Cut are to: 

1) improve compliance with critical standards of perioperative infection prevention, and

2) reduce deaths and complications from surgery in a scalable, sustainable fashion

Project progress

Our intention was to launch the Clean Cut programme in a number of hospitals in Ethiopia, expanding beyond the current nine already involved in implementation. The COVID-19 pandemic has had a massive impact on Ethiopia’s health and surgical systems, with the rapid shift in priorities meaning that the launch of this project has been delayed.

Lifebox Ethiopia has drawn on its resources and expertise in the surgical and anaesthesia eco-systems, to support partners, clinicians and the Ethiopian Federal Ministry of Health in their COVID response.

Lifebox Ethiopia has produced a range of tools, training materials and pilot initiatives to support Healthcare Professionals to prevent themselves and their patients from contracting the virus.

This has included:

  • A video, made by the Lifebox Ethiopia team, on ​safe donning, doffing and reprocessing of PPE​, available ​here
  • A ​checklist for use by surgical teams when operating on suspected or confirmed COVID 19 patients​, available ​here​. This is designed to be used in conjunction with the WHO Surgical Safety Checklist. A package of related training materials has been developed and a Training of Trainers session delivered to six Ethiopian clinicians who will cascade the training at their facilities.
  • Lifebox has donated a total of ​500 pulse oximeters to partner hospitals in Ethiopia in support of their COVID-19 response, along with the development and dissemination of a tool to support the use of a pulse oximeter in decision-making during COVID​. The tool and related training videos are available​ here
  • Locally-made PPE - surgical face masks (approved by the Ethiopian Food and Drug Administration) and patient isolation gowns have been purchased and donated to seven hospitals
  • Medical equipment maintenance project - a tripartite agreement has been made between Lifebox, Ethiopia COVID Response Team (ECRT), and Tegbare’id Polytechnic College (TPC) to collect broken and maintainable essential medical devices from different hospitals from all over Ethiopia to be maintained, in support of the COVID response. This is expected to be completed by November 2020.
  • N-95 decontamination project - an agreement was made between Lifebox, Addis Ababa Institute of Technology (AAiT), and St. Peter’s Specialized Hospital to pilot the use of a UVC cabinet for decontamination of N-95 masks, as per the scientific evidence. One cabinet has been built and seven more will be completed in the coming weeks; the FDA approval process has also been started.

Lifebox plans to launch the Clean Cut project at five new sites in October 2020, in collaboration with the Federal Ministry of Health. The project’s content will be adapted to incorporate elements of the materials outlined above, and to be appropriate and relevant to support surgical teams to reduce surgical site infections, improve safety and outcomes during a time of COVID. We have used this pandemic, and the associated travel restrictions, to adapt our strategy to take advantage of the increasing acceptance of distance learning and training by clinicians worldwide, and our on-site programme managers and clinical partners already steeped in the programmatic elements. Our
programme delivery is now oriented towards remote delivery and support, which was always our intention but which we accelerated during lockdown.

The results of Clean Cut in the first pilot hospitals have just been released in the BJS. Implemented in five hospitals, we followed over 2000 patients and demonstrated a 35% relative risk reduction in surgical infections after establishing Clean Cut. This was mostly due to the improving of compliance; we noted an overall improvement in compliance with the six infection prevention standards we focused on from 2.9/6 to 4.6/6 as shown in the radar plot below. Furthermore, in patients with high compliance with these six standards (3 or more compared to 2 or less), the risk of infection was cut nearly in half (46% relative risk reduction).

We anticipate this publication to reignite interest in the work and reinforce the principles we focus on while implementing the work.

Thomas Weiser MD, MPH, FACS, FRCSEd (ad hom), FCS

Lifebox Tikur Ambessa Hospital Ethiopia:

Lifebox Menelik Hospital Ethiopia: 

Lifebox OR Tikur Ambessa Hospital Ethiopia:

Full document hereRead more about the GSF and other projects they fund here

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