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The COVID-19 pandemic has strained surgical systems worldwide and placed healthcare providers at risk in their workplace. To protect surgical care providers caring for patients with COVID-19, in May 2020 we developed a COVID-19 Surgical Patient Checklist (C19 SPC), including online training materials, to accompany the World Health Organization Surgical Safety Checklist. In October 2020, an online survey was conducted via partner and social media networks to understand perioperative clinicians' intraoperative practice and perceptions of safety while caring for COVID-19 positive patients and gain feedback on the utility of C19 SPC. Descriptive statistics were used to characterise responses by World Bank income classification. Qualitative analysis was performed to describe respondents' perceptions of C19 SPC and recommended modifications. Respondents included 539 perioperative clinicians from 63 countries. One-third of respondents reported feeling unsafe in their workplace due to COVID-19 with significantly higher proportions in low (39.8%) and lower-middle (33.9%) than higher income countries (15.6%). The most cited concern was the risk of COVID-19 transmission to self, colleagues and family. A large proportion of respondents (65.3%) reported that they had not used C19 SPC, yet 83.8% of these respondents felt it would be useful. Of those who reported that they had used C19 SPC, 62.0% stated feeling safer in the workplace because of its use. Based on survey results, modifications were incorporated into a subsequent version. Our survey findings suggest that perioperative clinicians report feeling unsafe at work during the COVID-19 pandemic. In addition, adjunct tools such as the C19 SPC can help to improve perceived safety.

BACKGROUND: The WHO Surgical Safety Checklist improves surgical outcomes, but evidence and theoretical frameworks for successful implementation in low-income countries remain lacking. Based on previous research in Madagascar, a nationwide checklist implementation in Benin was designed and evaluated longitudinally. METHODS: This study had a longitudinal embedded mixed-methods design. The well validated Consolidated Framework for Implementation Research (CFIR) was used to structure the approach and evaluate the implementation. Thirty-six hospitals received 3-day multidisciplinary training and 4-month follow-up. Seventeen hospitals were sampled purposively for evaluation at 12-18 months. The primary outcome was sustainability of checklist use at 12-18 months measured by questionnaire. Secondary outcomes were CFIR-derived implementation outcomes, measured using the WHO Behaviourally Anchored Rating Scale (WHOBARS), safety questionnaires and focus groups. RESULTS: At 12-18 months, 86·0 per cent of participants (86 of 100) reported checklist use compared with 31·1 per cent (169 of 543) before training and 88·8 per cent (158 of 178) at 4 months. There was high-fidelity use (median WHOBARS score 5·0 of 7; use of basic safety processes ranged from 85·0 to 99·0 per cent), and high penetration shown by a significant improvement in hospital safety culture (adapted Human Factors Attitude Questionnaire scores of 76·7, 81·1 and 82·2 per cent before, and at 4 and 12-18 months after training respectively; P < 0·001). Acceptability, adoption, appropriateness and feasibility scored 9·6-9·8 of 10. This approach incorporated 31 of 36 CFIR implementation constructs successfully. CONCLUSION: This study shows successfully sustained nationwide checklist implementation using a validated implementation framework.

Agbélima est un produit dérivé des racines tubérisées du manioc (Manihot esculenta Crantz, Euphorbiaceae) moulues, pressées puis fermentées. Il sert à préparer une pâte communément appelée agbéli. Les analyses microbiologiques réalisées sur le agbélima frais ont abouti durant les 72 H à la caractérisation des flores fermentaires. Les leuconostocs présents en nombre élevé au début de la fermentation du produit, subissent une réduction après 24 H et au fur et à mesure que la fermentation se poursuive à cause de l’acidité élevée. Par contre, les lactobacillus (Lactobacillus brevis, Lactobacillus pentosus, Lactobacillus plantarum), suivis des lactocoques et des levures sont les responsables majeures de cette fermentation, car leur nombre augmente avec la réduction du pH. Aussi après 48H, les lactobacillus sont également légèrement inhibéset suppléés par les lactocoques qui ont montré une croissance progressive tout au long des 72 H de fermentation. C’est donc une association de bactéries lactiques et de levures, qui réalise la fermentation et développe le goût, l’arôme et l’odeur caractéristiques du produit. L’augmentation en nombre des souches fermentaires durant les 72 H pourrait être expliquée, par l’action du couple réduction pH/utilisation des sucres libérés lors de l’hydrolyse de la fraction d’amidon présent.Mots clés : Manioc, agbélima, microflores fermentaires, acidité.The agbélima is a by-product of cassava tuberous (Manihot esculenta Crantz, Euphorbiaceae) roots ground, pressed and fermented. It is used to prepare a paste commonly known as agbeli. Microbiological analyzes performed on fresh agbélima resulted in the characterization of fermentative flora during 72 H. Leuconostocs present in high numbers at the beginning of the fermentation product, underwent reduction after 24 H and the decrease continued gradually as the fermentation proceeded due to the high acidity. On the other hand, the lactobacillus (Lactobacillus brevis, Lactobacillus pentosus, Lactoba