VERY IMPORTANT SOCIETY- KNOWLEDGE OMS- PROGRAM SURGERY SAFE

General review of the work: Anderson Silva Messiah Fagundes (MS / SAS) Edmundo Machado Ferraz (Brazilian College of Surgeons) Heiko Thereza Santana (UIPEA / ANVISA) Renato S. Grimbaum (Hospital of the Portuguese Charity - CCIH) Rogério da Silva Lima (PAHO / WHO in Brazil)

 It is an honor to start this article because one of the employees, chosen by WHO, was my professor of surgery, Prof. Dr Edmundo Machado Ferraz, and with emphasis, because the importance of the subject, which should have been implanted worldwide, but what we see is only the large and accredited hospitals follow nomas of the "Safe Surgery".
Objective (Obj) 1: The team will operate the right patient and the right surgical site; Obj 2: The team will use methods known to prevent damage to the administration of anesthetics, while protecting the patient from pain; Obj 3: The team will recognize and effectively prepare for airway loss or respiratory function threatening the life; Obj 4: The team will recognize and effectively prepared for the risk of major blood loss; Obj 5: The team will avoid inducing adverse reaction to drugs or allergic reaction known risk to the patient; Obj 6: The team will use systematically, known methods to minimize the risk of surgical site infection; Obj 7: The team will prevent inadvertent retention swabs or instruments in surgical wounds; Goal 8: The team will maintain secure and accurately identify all surgical specimens; Goal 9: The team will communicate effectively and exchange critical information for the safe conduct of the operation; Obj 10: Hospitals and public health systems will establish routine surveillance of capacity, volume and surgical outcomes

The First Global Challenge focused on infections related to health care, involving: 1) hand hygiene; 2) medical and surgical safe procedures; 3) safety of blood and blood products; 4) safe administration of injectable and biopharmaceuticals; and 5) water safety, sanitation and waste management.

Thus, this new Global Challenge aims to increase the quality standards targeted at health care anywhere in the world and includes: 1) prevention of surgical site infections; 2) safe anesthesia; SECOND GLOBAL CHALLENGE FOR PATIENT SAFETY: SAVE LIVES 3) safe surgical teams; and 4) indicators of surgical care.
WHO was asked to take the lead in establishing global norms and standards and to give support to the efforts of countries in the preparation of public policy and patient safety practices. In May 2004, the World Health Assembly 57th approved the creation of an international alliance to improve patient safety globally and the World Alliance for Patient Safety was launched in October 2004.

The Global Challenge for Patient Safety, a central element of the Covenant, unites the expertise of specialists to improve the safety of care. The area chosen for the first Challenge in 2005-2006 was infection related to health care. This campaign established simple and clear standards for hand hygiene, an educational campaign and the first manual for hand hygiene.

The problem area chosen for the second Global Challenge for Patient Safety in 2007-2008: .1 - Manual Development for Safe Surgery OMS2.

There are at least four underlying challenges to improve surgical safety. First, it has not yet been recognized as a significant public health concern. Because of the frequency of the high cost of surgical care, it is assumed to be of limited relevance in poor countries and middle income; However, in 2002, the report "The Global Burden of Disease" WHO showed that a significant proportion of disability arising from disease worldwide due to conditions that are treatable by cirúrgica.Segundo intervention in the developing world, contributing to difficulties: the poor state of infrastructure and equipment; the supply and quality of drugs that do not inspire confidence; the flaws in the administration of the organizations and in infection control; the skills and the training of personnel and inadequate underfunding severo.O third underlying problem to ensure surgical safety is that the security practices do not seem to be used reliably in any country. Lack of resources is a problem in low-income settings, but is not necessarily the most important. The surgical site infection, for example, remains one of the most common causes of serious surgical complications, although evidence indicates that proven measures - such as antibiotic prophylaxis immediately before incision and confirmation of the effectiveness of sterilization of instruments - are followed inconsistently. This is not due to the cost, but the shortcomings in the systematization. Antimicrobials, for example, are provided in the preoperative in both rich and poor countries, but both are often administered too early, too late or in the wrong way. The complications of anesthetics also continue to be a substantial cause of death in the world during surgery, although the safety and monitoring standards have reduced the numbers of death and disability in industrialized countries unnecessary. The fourth underlying problem to improve surgical safety is its complexity. Even the simplest procedures involve tens of critical steps, each with opportunities for failure and the potential to cause injuries to patients - correct patient identification and location; providing efficient product sterilization for health; the follow-up of the multiple steps involved in the safe administration of anesthesia and the surgery. The most critical feature of surgical teams is the very team itself - surgeons, anesthesiologists, nurses and others. A team that works effectively together to use their knowledge and skills for the benefit of the surgical patient, can prevent a significant proportion of the complications that threaten life. However, surgical teams have received little guidance or structure to promote effective teamwork and thereby minimize the risks to the promotion of a safe surgery. The goal of the program "Safe Surgery Saves Lives" is to solve these problems. The Challenge "The Safe Surgery Saves Lives": identifying solutions.
The Challenge: Identifying solutions. The goal: to improve the safety of surgical care in the world, through the definition of a core set of safety standards that can be applied in all countries and settings. International expert working groups have been established to review the literature and medical experiments worldwide, and to reach a consensus on security practices in four areas: teamwork, anesthesiology, prevention of surgical site infection and measurements of health services. Employees with experience in surgery, anesthesiology, nursing, infectious diseases, epidemiology, biomedical engineering, health systems, quality improvement and other related fields, as well as patients and patient safety groups were recruited from each WHO region; they themselves requested the participation of doctors and other stakeholders worldwide.

Risk processing during anesthesia: No progress in the care of surgical patients had such a profound impact as the advancement of safe practices in anesthesiology. The anesthesia can cause harm to patients due to several factors. Respiratory suppression by an anesthetic leads to hypoxia, while maneuvering for control of the airways can lead to injuries. Aspiration is a significant risk to all patients undergoing sedation or anesthesia. Hypo- and hypertension, depression or heart elevation and reactions and drug interactions are also potential threats to life. The anesthesia was long considered more dangerous than the surgery itself, but a systematic approach to identify and address gaps in anesthetic care resulted in a substantial and continuing reduction of risk in industrialized countries during the past two decades.

A "surgical pause": In surgery, there are few examples of systematic improvements in security; However, over the past five years in the United States and other industrialized countries, "surgical pause" was introduced as a standard component of health care. This is a brief pause of less than a minute in the operating room immediately before incision, during which all members of the surgical team - surgeons, anesthesiologists, nurses and anyone else involved - verbally confirm the identification of the patient, surgical site and the procedure to be performed. It is a means to ensure communication between team members and avoid mistakes like the "local-wrong" or "wrong patient".

The "Safe Surgery" aims to improve surgical safety and reduce the number of deaths and surgical complications in four ways: 1. providing medical, hospital administrators and public health officials information about the function and surgical safety standards in public health 2. defining a minimum set of uniform measures or "surgical indicators" for national and international surveillance of health care; 3. identifying a simple set of security standards that can be used in all countries and settings and be compiled into a "surgical safety checklist" for use in operating rooms; and 4. testing the checklist and surveillance tools in pilot sites in all WHO regions and then distributing the checklist for hospitals around the world. The Manual for WHO Safe Surgery is important to this effort. All of the Safe Surgery program working groups considered a range of potential protocols evaluated the evidence for its findings, estimate their impact and devised measures to assess their effects on the performance and safety. The program also idealized a veificação list that can be used by physicians interested in promoting the quality of surgical services.

 The established framework for safe intraoperative care in hospitals involves a routine in the sequence of events - preoperative patient evaluation, surgical intervention and preparation for appropriate postoperative care - each with specific risks that can be mitigated
 In the preoperative phase obtaining informed consent, confirming the patient's identity, the surgical site and the procedure to be performed, verifying the integrity of the anesthetic equipment and the availability of emergency medicines and adequate preparation for intraoperative events all steps are susceptible to intervention.
  During operation, the proper and judicious use of antibiotics, availability of tests for essential image, appropriate patient monitoring, efficient teamwork, surgical opinions and competent anesthetics, meticulous surgical technique and good communication among surgeons, anesthesiology and nurses They are all necessary to ensure a good result. After the operation, a clear care planning, an understanding of intraoperative events and a commitment to high-quality monitoring can improve surgical system, thus promoting patient safety and better results. It also recognizes the need for trained personnel and resources for operation, such as proper lighting and sterilization equipment.
Finally, safe surgery requires continuous quality assurance and monitoring. - The nature of the challenge: Teamwork, safe anesthetics and prevention of surgical site infection are key to improving the safety of surgery and to save lives.

Basic problems of infrastructure should be considered and problems related to the ability to monitor and assess any changes should be instituted abordados.São them, surgical resources, environment, trained staff, clean water, constant light source, constant suction, supplemental oxygen, surgical equipment operating and sterilized instruments, prevention of surgical site infection, hand washing of standardized form, appropriate and judicious use of antimicrobial, antiseptic skin preparation.

Atraumatic wound care, cleaning, disinfection and sterilization of instruments, safe anesthesia, presence of a skilled professional in anesthesiology, security check of the machines and drugs for anesthesia, pulse oximetry, heart rate monitoring, blood pressure monitoring, monitoring temperature. Efficient surgical teams, improved communication with the patient, correct site and procedure. Informed consent. Availability of all team members, as well as adequate preparation of staff and planning of the procedure. Confirmation of the patient allergies; measurement of surgical care and quality assurance; review in double monitoring of results

The Challenge was also guided by three principles. THE FIRST is simplicity. An exhaustive list of standards and guidelines could create a burden that would improve patient safety, but their understanding would be difficult to implement, to transmit and probably face significant resistance. The appeal of simplicity in this setting can not be overstated. THE SECOND principle is the wide applicability. The focus in a social environment possessing features may change the types of issues considered for discussion (eg standards with minimal equipment in poor settings resources), but the goal of the challenge is to reach all environments and settings, from the richest to the poorest resources, so that all Member States can be involved. In addition, regular failures occur in all scenarios and environments and is amenable to common solutions. THE THIRD is the possibility of measurement. If the three principles of simplicity, wide applicability and measurability are followed, the successful implementation target will be possible.
Therefore, patients, healthcare professionals and media - SURGERY SAVES LIVES insured

A HUG