Medical Professionals Endorse WHO Checklist For Safer Surgery

A new safety checklist for surgical procedures developed by the World Health Organization (WHO) won the endorsements of nearly 250 health organizations from over 40 countries at a launching event yesterday at the Pan American Health Organization (PAHO) in Washington, D.C.
The endorsements include “70 professional associations, ministries of health and hospitals from 29 countries in the Americas,” said PAHO Director Mirta Roses. “Our participation in ‘Safe Surgery Saves Lives’ is an important step to bring forward the patient safety agenda in the Americas.”
The new Surgical Safety Checklist, from WHO’s World Alliance for Patient Safety, offers simple step-by-step guidelines that surgical teams should follow before and after any operation to ensure patient safety. The guidelines range from making sure the right patient is being operated on at the right body site to estimating the amount of blood loss that can be expected. WHO estimates that adherence to the checklist could prevent some 3.5 million deaths and major disabilities annually.
“There are 7 million deaths and disabilities due to complications of surgery every year around the world,” said WHO Director-General Margaret Chan in a special message for the event. “Half of these could be avoided by following basic standards of care.”
About 234 million major surgical procedures are performed worldwide each year, or 1 for every 25 human beings, according to a WHO-sponsored study published this week in the medical journal The Lancet. This is more than twice the number of childbirths, and “there are 10 to 100 times more complications due to surgery than to childbirth,” said Dr. Atul Gawande, coauthor of the study and team leader for the development of the WHO Surgical Safety Checklist. Gawande’s study estimates that 1 million people die during or immediately after surgery each year, and that half of these deaths could be prevented through safer practices.
Gawande said his team borrowed the checklist concept from the aviation industry, which has used pre-flight checklists effectively to reduce accidents resulting from human error. He said the team’s short-term goal is to have the checklist used in 2,500 hospitals by the end of next year.
The Surgical Safety Checklist divides surgery into three phases: “Sign in,” before anesthesia is administered; “Time Out,” before skin incision; and “Sign Out,” before the patient leaves the operating room. WHO recommends that a single “checklist coordinator” take responsibility for confirming that each member of the surgical team has completed his or her required tasks before the operation can begin. Among the issues covered in the checklist are:
(Before the operation)
* The patient’s identity and the exact surgical site
* The procedure to be performed
* Known patient allergies
* Antibiotics have been administered within 60 minutes of the operation
(After the operation)
* All instruments, sponges and needles are accounted for
* Labeling of specimens
* Plans for postoperative care
WHO has begun testing the checklist’s effectiveness through pilot projects in eight countries: Canada, India, Jordan, New Zealand, Philippines, Tanzania, the United Kingdom, and the United States. Based on preliminary data from 1,000 operations, “We have already seen significant reductions in deaths and disabilities,” said Gawande.

Adults Not Getting Recommended Vaccinations

Have you received all of your recommended vaccinations? If you are older than 18, chances are you have not gotten your recommended vaccination for tetanus, diphtheria, and whooping cough (Td/Tdap), nor the human papillomavirus vaccine (HPV). If you are older than 65, you may be among the one-third of your peers who did not get vaccinated against pneumonia.
It seems that adults are much better at making sure their children get their recommended vaccinations than they are at lining up for their own. According to a new report issued by the Trust for America’s Health, the Infectious Diseases Society of America, and the Robert Wood Johnson Foundation, 33.1 percent of adults ages 65 and older did not get vaccinated against pneumonia in 2008, even though the Centers for Disease Control and Prevention (CDC) recommends that all seniors receive the vaccination. The area with the worst pneumonia vaccination record was Washington, D.C., with 45.6 percent of seniors not immunized. Oregon seniors had the best record, with 26.8 percent avoiding the vaccine.
The new report, entitled Adult Immunization: Shots to Save Lives, notes that an estimated 40,000 to 50,000 adults in the United States die each year from illnesses that could have been prevented if they had gotten their routine and recommended vaccinations. Compared with the pneumonia vaccine figures, the report shows that 90 percent of eligible adult women have not had their HPV vaccine, and 97.9 percent of eligible adults had shunned their tetanus, diphtheria, and whooping cough vaccine in the previous two years. Adults also avoided their seasonal flu vaccine in 2008, with 63.9 percent not being vaccinated.
The report addressed the reasons why so many adults fail to get their recommended vaccinations. Some of them include: failure of insurance to cover the cost of vaccines, most adults do not work in places that require vaccinations, many adults do not believe vaccines are safe or effective, and many adults who do not have health insurance cannot afford vaccines.
To overcome these obstacles, the authors of the report recommend that health insurance, including Medicare, cover the cost of vaccines; that doctors offer vaccines during regular exams and screenings; that the public be educated about the safety and effectiveness of vaccines; and that vaccines be covered for adults who do not have health insurance.
The public can access the report on adult vaccinations on the Trust for America’s Health website. A complete schedule of recommended vaccinations for adults can be seen on the CDC website.