Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments
Main finding · SSIResult — go to the resultRelative risk 0.66 95% CI 0.54–0.81Authors' conclusion
A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs.
Study context
- Population
- Surgical patients in 7 Ethiopian hospitals not previously in the Clean Cut program, 2019–2022
- Participants
- 3,364 patients · 7 hospitals
- Exposure
- After vs before implementation of the refined Clean Cut program
- Baselinen = 1,575reference
- After interventionn = 1,789
- Outcome
- Surgical site infection (SSI)
Methodological detailsbefore-after quality improvement program, multicentre (7 hospitals), Clean Cut introduced January 1, 2019, to February 28, 2022
- Before-after quality improvement program
- Multicentre (7 hospitals)
- Clean Cut introduced January 1, 2019, to February 28, 2022
Main finding
SSI
Relative risk
0.66
95% CI 0.54–0.81
P < 0.001
After intervention vs Baseline
RR 0.66 (95% CI 0.54–0.81); P < 0.001
As reported in the abstract
Observational data: associations, not effects.
Secondary outcomes
Adherence to infection prevention standards
- Appropriate Surgical Safety Checklist use, baseline vs after
- 16.3% to 43.0% (P < .001)
- Surgeon hand and patient skin antisepsis, baseline vs after
- 46.0% to 66.0% (P < .001)
- Timely antibiotic administration, baseline vs after
- 17.8% to 39.0% (P < .001)
- Surgical instrument sterility
- 38.7% vs 10.2% (P < .001)
- Linen sterility
- 35.5% vs 12.8% (P < .001)
- Gauze counting
- 89.2% vs 82.5% (P < .001)
- All reported as significant improvements
Original publication
Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments. JAMA Surg. Published 1 February 2024. doi:10.
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