Impact of Surgical Lighting on Intraoperative Safety in Low-Resource Settings: A Cross-Sectional Survey of Surgical Providers
- 1.3k Downloads
Safe surgery requires high-quality, reliable lighting of the surgical field. Little is reported on the quality or potential safety impact of surgical lighting in low-resource settings, where power failures are common and equipment and resources are limited.
Members of the Lifebox Foundation created a novel, non-mandatory, 18-item survey tool using an iterative process. This was distributed to surgical providers practicing in low-resource settings through surgical societies and mailing lists.
We received 100 complete responses, representing a range of surgical centres from 39 countries. Poor-quality surgical field lighting was reported by 40% of respondents, with 32% reporting delayed or cancelled operations due to poor lighting and 48% reporting electrical power failures at least once per week. Eighty per cent reported the quality of their surgical lighting presents a patient safety risk with 18% having direct experience of poor-quality lighting leading to negative patient outcomes. When power outages occur, 58% of surgeons rely on a backup generator and 29% operate by mobile phone light. Only 9% of respondents regularly use a surgical headlight, with the most common barriers reported as unaffordability and poor in-country suppliers.
In our survey of surgeons working in low-resource settings, a majority report poor surgical lighting as a major risk to patient safety and nearly one-third report delayed or cancelled operations due to poor lighting. Developing and distributing robust, affordable, high-quality surgical headlights could provide an ideal solution to this significant surgical safety issue.
The authors would like to thank the survey respondents; Luca Koritsanzky, Sibonile Mathe, and Sarah Kessler for their coordination of efforts within the Lifebox Foundation; and Rosemary Mugwe, Chief Executive Officer of COSECSA, for help in the questionnaire distribution.
Compliance with ethical standards
Conflict of interest
All authors have been involved in Lifebox activities. JAF is a current Lifebox fellow; NJB and JEFF were former fellows; JEFF is currently an honorary clinical fellow; IHW and TGW are trustees of Lifebox UK and US, respectively; AB is the Ethiopia Lead for Clean Cut, a Lifebox programme to improve surgical safety. There was no funding for this project.
- 6.World Health Organization (2015) Service availability and readiness assessment (SARA) an annual monitoring system for service delivery implementation guide. World Health Organization, Geneva 2015. PrintGoogle Scholar
- 7.World Health Organization (2015) Service availability and readiness assessment (SARA) an annual monitoring system for service delivery reference manual. World Health Organization, Geneva 2015. PrintGoogle Scholar
- 9.The World Bank Group (2015) Low & middle income. Available at: http://data.worldbank.org/income-level/low-and-middle-income. Accessed 16 Apr 2017
- 12.WHO, World Bank (2014) Access to modern energy services for health facilities in resource-constrained settings. World Health Organization, Geneva 2014. PrintGoogle Scholar
- 15.Freedman RL, Freedman BPT, Ttendo S, et al. (2017) Resilience of electrical infrastructure and its impact on safe surgery in a Ugandan referral hospital—a Lifebox Fellowship project. Poster session presented at AAGBI Winter Scientific Meeting 2017 Audit and Quality Improvement, London, UKGoogle Scholar
- 16.World Health Organization (2009) WHO guidelines for safe surgery 2009. World Health Organization, Geneva 2009. PrintGoogle Scholar
- 17.Kabasongora M (2014) Hospital suspends vital operations due to power breaks. Available at https://ugandaradionetwork.com/story/mbarara-hospital-suspends-vital-operations-due-to-power-breaks. Accessed 22 March 2017
- 18.Nahamya J (2015) 7 Babies die at Mbarara hospital over load shedding. Available at http://www.chimpreports.com/7-babies-die-at-mbarara-hospital-over-load-shedding/. Accessed 22 March 2017
- 19.Studies LC (2013) Low carbon studies powering the health sector—Annex A—Literature Review. UKAID, London 2013. PrintGoogle Scholar
- 20.Bekele A, Shiferaw S, Gulilat D (2013) Levels and trends of occupational hazards among surgical residents at Tikur Anbessa Hospital, Addis Ababa Ethiopia. East Cent Afr J Surg 18:61–66Google Scholar
- 27.We Care Solar. Available at https://wecaresolar.org/. Accessed 4 June 2017