Evidence map›Paper›PMID 34157086›Full record

ArticleThe British journal of surgery2021

Clean Cut (adaptive, multimodal surgical infection prevention programme) for low-resource settings: a prospective quality improvement study.

J A Forrester, N Starr, T Negussie, D Schaps, M Adem, S Alemu, D Amenu, N Gebeyehu, T Habteyohannes, F Jiru and 7 more

Registry-linked trialOpen access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The British journal of surgery, 2021. 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 21 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 2 pooled it
4.8field-weighted citation impact, top 4% of its field
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 map

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

21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 53 citations in OpenAlex.

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  19. Outcomes of a multicomponent safe surgery intervention in Tanzania's Lake Zone: a prospective, longitudinal study.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2021
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 5 institutions in 3 countries.

J A ForresterDepartment of Surgery, Stanford University, Stanford, USA.
N StarrDepartment of Surgery, University of California San Francisco, San Francisco California USA.ORCID 0000-0003-0714-5512
T NegussieDepartment of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
D SchapsDuke University School of Medicine, Durham North Carolina USA.
M AdemDepartment of Surgery, Menelik II Referral Hospital, Addis Ababa, Ethiopia.
S AlemuDepartments of Surgery, , Jimma, Ethiopia.
D AmenuObstetrics and Gynaecology, School of Medicine, College of Health Sciences, Jimma, Ethiopia.
N GebeyehuQuality Improvement Department, St Peter's Specialized Hospital, Fitche, Ethiopia.
T HabteyohannesDepartment of Surgery, St Peter's Specialized Hospital, Addis Ababa Gulele Subcity, Fitche, Ethiopia.
F JiruDepartment of Health Economics, Management, and Policy, Jimma University Medical Centre, Jimma, Ethiopia.
A TesfayeQuality Improvement Department, St Peter's Specialized Hospital, Fitche, Ethiopia.
E WayessaFitche General Hospital, Fitche, Ethiopia.
R ChenStanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Palo Alto, USA.
A TrickeyStanford-Surgery Policy Improvement Research and Education Center, Department of Surgery, Stanford University, Palo Alto, USA.ORCID 0000-0001-9993-3860
S BitewLifebox Ethiopia, Addis Ababa, Ethiopia.
A BekeleDepartment of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.ORCID 0000-0003-0018-9096
T G WeiserDepartment of Surgery, Stanford University, Stanford, USA.ORCID 0000-0002-3118-3888
Stanford University · USJimma University · ETAddis Ababa University · ETDuke University · USUniversity of California, San Francisco · US

Funding

RESEARCH TRAINING IN GASTROINTESTINAL SURGERYT32DK007573 · NIDDK · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HARRIS, HOBART WHITAKER · 1988 to 2019
$3.0M
NIDDK NIH HHS T32 DK007573
6 · The paper itself

Abstract

backgroundClean Cut is an adaptive, multimodal programme to identify improvement opportunities and safety changes in surgery by enhancing outcomes surveillance, closing gaps in surgical infection prevention standards, and strengthening underlying processes of care. Surgical-site infections (SSIs) are common in low-income countries, so this study assessed a simple intervention to improve perioperative infection prevention practices in one.

methodsClean Cut was implemented in five hospitals in Ethiopia from August 2016 to October 2018. Compliance data were collected from the operating room focused on six key perioperative infection prevention standards. Process-mapping exercises were employed to understand barriers to compliance and identify locally driven improvement opportunities. Thirty-day outcomes were recorded on patients for whom intraoperative compliance information had been collected.

resultsCompliance data were collected from 2213 operations (374 at baseline and 1839 following process improvements) in 2202 patients. Follow-up was completed in 2159 patients (98·0 per cent). At baseline, perioperative teams complied with a mean of only 2·9 of the six critical perioperative infection prevention standards; following process improvement changes, compliance rose to a mean of 4·5 (P < 0·001). The relative risk of surgical infections after Clean Cut implementation was 0·65 (95 per cent c.i. 0·43 to 0·99; P = 0·043). Improved compliance with standards reduced the risk of postoperative infection by 46 per cent (relative risk 0·54, 95 per cent c.i. 0·30 to 0·97, for adherence score 3-6 versus 0-2; P = 0·038).

conclusionThe Clean Cut programme improved infection prevention standards to reduce SSI without infrastructure expenses or resource investments.

Indexed as

Quality ImprovementAdultChecklistDeveloping CountriesEthiopiaFemaleHumansIntraoperative PeriodMaleProspective StudiesRisk FactorsSurgical Procedures, OperativeSurgical Wound InfectionTreatment OutcomeYoung Adult

Identifiers

PMID34157086
PMCPMC10364890
OpenAlexW3087460055

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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.