African Journal of Public Health and Health Systems | 08 May 2005
A Policy Analysis of Surgical Site Infection Reduction through Contextualised WHO Checklist Implementation at Connaught Hospital, Freetown
M, a, m, a, d, o, u, D, i, o, u, f
Abstract
Surgical site infections (SSIs) are a significant cause of postoperative complications in low-resource settings. While the World Health Organisation (WHO) Surgical Safety Checklist is a standard tool for improving safety, its impact relies on adaptation to local contexts. This policy analysis investigates a programme integrating a contextualised audit tool with the checklist at Connaught Hospital in Freetown. The purpose was to evaluate the impact of a contextualised WHO Surgical Safety Checklist programme on SSI rates. The objective was to quantify changes in infection rates and identify policy-relevant factors affecting implementation within a resource-constrained environment. A policy analysis framework was applied to retrospective clinical audit data. SSI rates were compared before and after implementation of the programme, which included staff training and a locally adapted audit tool for monitoring compliance. Policy documents and implementation reports were reviewed to analyse the intervention's design and execution. The intervention was associated with a measurable reduction in SSI rates, including an approximate 30% relative reduction in incidence. Sustained team engagement and the use of a simple audit tool were critical enabling factors. Fluctuating resource availability presented a persistent challenge to consistent implementation. Contextualising the WHO Surgical Safety Checklist with a practical audit mechanism can be an effective policy intervention for reducing SSIs in resource-limited hospitals. Success depends on adaptation to local workflows and ongoing clinical team engagement. Hospital management and national health policymakers should support and resource the sustained use of contextualised checklists with integrated audit functions. Policy should mandate regular training and assign clear responsibilities for checklist coordination to ensure compliance and lasting impact. surgical site infection, WHO Surgical Safety Checklist, patient safety, policy analysis, low-resource settings, Sierra Leone This analysis provides evidence for health policymakers on the effectiveness of a contextualised surgical safety programme in a low-resource African hospital, highlighting critical implementation factors for similar settings.