Sustainable Results for Tackling Surgical Infection



New Research Shows Lasting Impact of Lifebox Clean Cut Program 

FOR IMMEDIATE RELEASE: 

ADDIS ABABA/LONDON/NEW YORK: November 3, 2021 – Safe surgery non-profit Lifebox announced today results on the lasting impact of its surgical infection reduction program, Clean Cut.

Published in The Journal of the American Medical Association (JAMA) Surgery, “Sustainability of a Surgical Quality Improvement Program at Hospitals in Ethiopiadetails the results of a followup audit conducted at seven hospitals in a cohort of 3,385 surgical patients six to eighteen months after completion of the program. The results demonstrate that compared to baseline, hospitals maintained improvements in compliance with all six program infection prevention standards, indicating the lasting behavior changes achieved by Clean Cut. 

“These positive results demonstrate the ability of Clean Cut to achieve lasting improvements in the safety of surgical patients,” said Dr. Nichole Starr, general surgery resident at UCSF and lead author. “This study is further evidence that interventions to increase surgical quality and infection prevention behaviors are essential investments for long-term improvements in patient safety.”

Surgical site infections (SSIs) are the leading hospital acquired infection in low- and middle-income countries – where rates of infection are more than double that found in the United States1. Clean Cut, a quality improvement intervention developed by the global non-profit Lifebox, supports surgical teams in addressing the causes of SSIs by improving adherence to six infection prevention practices, including the appropriate timing of antibiotics and confirmation of instrument sterility.

The sustainability audit also shows compliance continued to improve across four of the practices compared with the post-implementation period: surgical safety checklist use (58.4% vs 50.0%), skin antisepsis (74.8% vs 57.6%), antibiotic prophylaxis (65.7% vs 58.7%), and gauze counting (94.7% vs 93.9%).

Some attrition in compliance occurred with surgical linen integrity and sterility (46.0% vs 39.0%) and instrument sterility (54.7% vs 41.8%), but performance in these two areas remained above baseline (6.2% and 7.7%, respectively).

These welcome results show the lasting impact of Lifebox’s work in Ethiopia without the need for major resource investment,” said Dr. Natnael Gebeyehu Admasu, general surgery resident at Tikur Anbessa Hospital, Addis Ababa. “In partnership with the Federal Ministry of Health of Ethiopia, Clean Cut has impacted more than 80,000 surgical patients to date and we are excited to replicate this success in other locations.”

A previous study – published in the British Journal of Surgery in September 2020 – showed Clean Cut resulted in a 35% reduction in the risk of SSIs in all surgical patients

Lifebox is scaling the Clean Cut program across Ethiopia in partnership with the Federal Ministry of Health, impacting more than 80,000 surgical patients to date, and is replicating the program in Liberia and Madagascar. 


Full article in The Journal of the American Medical Association here.  

More information about the Clean Cut Program here

About Lifebox: Lifebox is a nonprofit organization that improves the safety of surgery and anesthesia in low-and middle-income countries. Chaired by Dr. Atul Gawande, Lifebox works across three core pillars of Safer Surgery – improving anesthesia safety, strengthening surgical teamwork, and reducing surgical infection rates, and . By working alongside local partners, Lifebox provides training and tools needed to save lives through safer surgery. To date Lifebox has worked in over 116 countries and trained more than 11,000 healthcare providers. www.lifebox.org

Contact: For further information or to arrange interviews: Kitty Jenkin, kitty@lifebox.org +447803425743

Further information on Global Surgery:

  • – 5 billion people lack access to safe, affordable, and effective surgery3.
  • – 28-32% of the global burden of disease can be attributed to surgically treatable conditions4.
  • – An estimated 16.9 million lives were lost in 2010 from conditions requiring surgical care5.
  • – The GlobalSurg Collaborative reported that infection rates following gastrointestinal surgery was 23% in low income countries (nearly twice that of high income countries)6.
  • – The African Surgical Outcomes Study found that infections occur in 10% of all patients undergoing surgery, of whom nearly 1 in 10 die7.

1 GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infectious Diseases. 2018;18(5):516-525.

2 Forrester JA, Starr N, Negussie T, Schaps D, Adem M, Alemu S,et al.Clean Cut (adaptive, multimodal surgical infection prevention programme) for low-resource settings: a prospective quality improvement study. Br J Surg. Published online September 21, 2020. https://bjssjournals.onlinelibrary.wiley.com/doi/full/10.1002/bjs.11997

3,4,5 Meara, J et al, Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development, Lancet Commission 2015

6 GlobalSurg Collaborative. Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study. Lancet Infectious Diseases. 2018;18(5):516-525.

7 Biccard BM, Madiba TE, Kluyts HL, et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet. 2018;391(10130):1589- 1598