Sterile Reprocessing and Surgical Safety Checklist Training to Improve Perioperative Infection Prevention in Ethiopia

Perioperative infection prevention and control (IPC) standards are known to reduce surgical site infections (SSI), but compliance is challenging. Clean Cut is a multimodal checklist-based quality improvement initiative to improve compliance with IPC standards. This study evaluates the impact of Clean Cut training workshops to improve IPC compliance when delivered as part of a bundled intervention.

From September 2021 to January 2023, nine Ethiopian hospitals received a bundled intervention that included educational workshops on the WHO Surgical Safety Checklist (SSC) and sterile reprocessing practices. Simultaneously, teams undertook a process mapping exercise of IPC standards to identify process gaps. We performed a time-series analysis to assess changes in compliance with the SSC, instrument, and linen reprocessing in the 4 months before and after the intervention. We calculated incidence rate ratios (IRR) of compliance and predicted the change in average weekly compliance.

We observed 5821 operations, 2876 (49.4%) pre-intervention and 2946 (50.6%) post-intervention. Trends in SSC, instrument, and linen reprocessing compliance improved after the intervention. Average weekly SSC compliance improved 9.1% (RR: 1.09; 95% CI: 1.002-1.188; p = 0.044) while compliance with instrument reprocessing improved 12.1% (IRR: 1.12; 95% CI: 1.074-1.173; p < 0.001) and linen reprocessing 8.0% (IRR: 1.08, 95% CI: 1.017-1.147; p = 0.013).

Workshop delivery coupled with process mapping of infection prevention standards was effective in improving compliance with the SSC and sterile reprocessing as part of a bundled intervention to reduce SSI. Observed improvements that temporally follow this work provide evidence of the value of this intervention.