Evidence map›Paper›PMID 31419972›Full record

ArticleBMC health services research2019

Qualitative outcomes of Clean Cut: implementation lessons from reducing surgical infections in Ethiopia.

Aviva S Mattingly, Nichole Starr, Senait Bitew, Jared A Forrester, Tihitena Negussie, Sylvia Bereknyei Merrell, Thomas G Weiser

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC health services research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04812522 (CheckList Expansion for Antisepsis and iNfection Control in Cesarean Section - CLEAN-CS), which is not on this map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04812522 nacompletednot on this mapstarted 2021, after this paper: background citation

CheckList Expansion for Antisepsis and iNfection Control in Cesarean Section - CLEAN-CS: A Cluster-Randomized, Stepped Wedge Interventional Trial to Reduce Postoperative Infections Following Cesarean Delivery

TypeinterventionalSponsorThe Lifebox FoundationRan2021 to 2023Enrolled10,506ConditionsCesarean Section ComplicationsArmsClean Cut program
3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Review
  4. Article
  5. Article
  6. Article
  7. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Aviva S MattinglyStanford University School of Medicine, Palo Alto, CA, USA.
Nichole StarrDepartment of Surgery, University of California San Francisco, San Francisco, CA, USA.
Senait BitewLifebox Foundation, London, UK and Brooklyn, NY, USA.
Jared A ForresterDepartment of Surgery, Division of General Surgery, Section of Trauma & Critical Care, Stanford University School of Medicine, Palo Alto, CA, USA.
Tihitena NegussieDepartment of Pediatric Surgery, Addis Ababa University, Addis Ababa, Ethiopia.
Sylvia Bereknyei MerrellDepartment of Surgery, Stanford-Surgery Policy Improvement Research & Education Center (S-SPIRE), Palo Alto, CA, USA.
Thomas G WeiserLifebox Foundation, London, UK and Brooklyn, NY, USA. tweiser@stanford.edu.ORCID http://orcid.org/0000-0002-3118-3888

Funding

School of Medicine, Stanford University n/a
6 · The paper itself

Abstract

backgroundClean Cut is a six month, multi-modal, adaptive intervention aimed at reducing surgical infections through improving six critical perioperative processes: 1) handwashing/skin preparation, 2) surgical gown/drape integrity, 3) antibiotic administration, 4) instrument sterility, 5) gauze counts, and 6) WHO Surgical Safety Checklist use. The aim of this study was to elucidate themes across Clean Cut implementation sites in Ethiopia to improve implementation at future hospitals.

methodsWe conducted semi-structured interviews of 20 clinicians involved in Clean Cut at four hospitals. Participation was limited to Clean Cut team members and included surgeons, anesthetists, operating room (OR) nurses, ward nurses, OR managers, quality improvement personnel, and hospital administrators. Audio recordings were transcribed and coded using qualitative software. A codebook was inductively and iteratively derived between two researchers, tested for inter-rater reliability, and applied to all transcripts. We conducted thematic analysis to derive our final qualitative results.

resultsThe interviews revealed barriers and facilitators to the implementation of Clean Cut, as well as strategies for future implementation sites. Key barriers included material resource limitations, feelings of job burden, existing gaps in infection prevention education, and communication errors during data collection. Common facilitators included strong hospital leadership support, commitment to improved patient outcomes, and organized Clean Cut training sessions. Future strategies include resource assessments, creating a sense of responsibility among staff, targeted training sessions, and incorporating new standards into daily routine.

conclusionsThe findings of this study highlight the importance of engaging hospital leadership, providers and staff in quality improvement programs, and understanding their work contexts. The identified barriers and facilitators will inform future initiatives in the field of perioperative infection prevention.

Indexed as

Guideline AdherenceChecklistEthiopiaEvaluation Studies as TopicFemaleHumansMalePractice Guidelines as TopicQuality ImprovementSurgical Wound InfectionEthiopiaQuality improvementResource limitedSurgical infection

Identifiers

PMID31419972
PMCPMC6698005

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.