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Excerpt
Confronted with worldwide evidence of substantial public health harm due to inadequate patient safety, the World Health Assembly (WHA) in 2002 adopted a resolution (WHA55.18) urging countries to strengthen the safety of health care and monitoring systems. The resolution also requested that WHO take a lead in setting global norms and standards and supporting country efforts in preparing patient safety policies and practices. In May 2004, the WHA approved the creation of an international alliance to improve patient safety globally; WHO Patient Safety was launched the following October. For the first time, heads of agencies, policy-makers and patient groups from around the world came together to advance attainment of the goal of “First, do no harm” and to reduce the adverse consequences of unsafe health care. The purpose of WHO Patient Safety is to facilitate patient safety policy and practice. It is concentrating its actions on focused safety campaigns called Global Patient Safety Challenges, coordinating Patients for Patient Safety, developing a standard taxonomy, designing tools for research policy and assessment, identifying solutions for patient safety, and developing reporting and learning initiatives aimed at producing ‘best practice’ guidelines. Together these efforts could save millions of lives by improving basic health care and halting the diversion of resources from other productive uses.
The Global Patient Safety Challenge, brings together the expertise of specialists to improve the safety of care. The area chosen for the first Challenge in 2005–2006, was infection associated with health care. This campaign established simple, clear standards for hand hygiene, an educational campaign and WHO's first Guidelines on Hand Hygiene in Health Care.
The problem area selected for the second Global Patient Safety Challenge, in 2007–2008, was the safety of surgical care. Preparation of these Guidelines for Safe Surgery followed the steps recommended by WHO.
The groundwork for the project began in autumn 2006 and included an international consultation meeting held in January 2007 attended by experts from around the world. Following this meeting, expert working groups were created to systematically review the available scientific evidence, to write the guidelines document and to facilitate discussion among the working group members in order to formulate the recommendations. A steering group consisting of the Programme Lead, project team members and the chairs of the four working groups, signed off on the content and recommendations in the guidelines document. Nearly 100 international experts contributed to the document (see end). The guidelines were pilot tested in each of the six WHO regions—an essential part of the Challenge—to obtain local information on the resources required to comply with the recommendations and information on the feasibility, validity, reliability and cost–effectiveness of the interventions.
Contents
- Section I. Introduction
- Section II. Ten essential objectives for safe surgery: review of the evidence and recommendations
- Objective 1. The team will operate on the correct patient at the correct site
- Objective 2. The team will use methods known to prevent harm from administration of anaesthetics, while protecting the patient from pain
- Objective 3. The team will recognize and effectively prepare for life-threatening loss of airway or respiratory function
- Objective 4. The team will recognize and effectively prepare for risk of high blood loss
- Objective 5. The team will avoid inducing an allergic or adverse drug reaction for which the patient is known to be at significant risk
- Objective 6. The team will consistently use methods known to minimize the risk for surgical site infection
- Pathogenesis and microbiology
- Prevention and surveillance of surgical site infections
- Definitions of surgical site infection
- Methods of scoring infection
- Surveillance of surgical site infections
- Risk factors
- Presurgical skin disinfection
- Special cases for decontamination
- Antibiotic prophylaxis
- Minimizing contamination in the operating room
- Guaranteeing the sterility of surgical instruments: sterility indicators
- Recommendations
- References
- Objective 7. The team will prevent inadvertent retention of instruments and sponges in surgical wounds
- Objective 8. The team will secure and accurately identify all surgical specimens
- Objective 9. The team will effectively communicate and exchange critical information for the safe conduct of the operation
- Objective 10. Hospitals and public health systems will establish routine surveillance of surgical capacity, volume and results
- Feasibility and implications of measurement
- Current measures in surgery
- Surgical surveillance: surgical vital statistics for systems-level evaluation
- Surgical surveillance: basic patient measures for hospitals and practitioners
- The surgical apgar score: a simple outcome score for surgery
- Future directions of surgical surveillance
- Recommendations
- References
- Summary of recommendations
- Section III. The World Health Organization Surgical Safety Checklist
- Section IV. Implementation Manual for WHO Patient Safety Surgical Safety Checklist
- Introduction
- Before induction of anaesthesia
- Has the patient confirmed his/her identity, site, procedure and consent?
- Is the site marked?
- Is the anaesthesia machine and medication check complete?
- Is the pulse oximeter on the patient and functioning?
- Does the patient have a known allergy?
- Does the patient have a difficult airway/aspiration risk?
- Does the patient have a risk of >500 ml blood loss (7 ml/kg in children)?
- Before skin incision
- Confirm all team members have introduced themselves by name and role
- Confirm the patient's name, procedure and where the incision will be made
- Has antibiotic prophylaxis been given in the last 60 minutes?
- Anticipated critical events
- To surgeon: what are the critical or non-routine steps? How long will the case take? What is the anticipated blood loss?
- To anaesthetist: are there any patient-specific concerns?
- To nursing team: has sterility (including indicator results) been confirmed? Are there equipment issues or any concerns?
- Is essential imaging displayed?
- Before patient leaves operating room
- Additional notes – promoting a safety culture
- Appendix A A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population
- Appendix B Authors and contributors
The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
- NLM CatalogRelated NLM Catalog Entries
- WHO Guidelines for Safe Surgery 2009WHO Guidelines for Safe Surgery 2009
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