Implementing the WHO Safe Childbirth Checklist: lessons from a global collaboration.

The WHO Safe Childbirth Checklist (SCC) was developed to ensure the delivery of essential maternal and perinatal care practices around the time of childbirth. A research collaboration was subsequently established to explore factors that influence use of the Checklist in a range of settings around the world. This analysis article presents an overview of the WHO SCC Collaboration and the lessons garnered from implementing the Checklist across a diverse range of settings. Project leads from each collaboration site were asked to distribute two surveys. The first was given to end users, and the second to implementation teams to describe their respective experiences using the Checklist. A total of 134 end users and 38 implementation teams responded to the surveys, from 19 countries across all levels of income. End users were willing to adopt the SCC and found it easy to use. Training and the provision of supervision while using the Checklist, alongside leadership engagement and local ownership, were important factors which helped facilitate initial implementation and successful uptake of the Checklist. Teams identified several challenges, but more importantly successfully implemented the WHO SCC. A critical step in all settings was the adaptation of the Checklist to reflect local context and national protocols and standards. These findings were invaluable in developing the final version of the WHO SCC and its associated implementation guide. Our experience will provide useful insights for any institution wishing to implement the Checklist.

Assessment of severity of haemolytic disease of newborn by monocyte monolayer assay.

The present study was undertaken to estimate the predictive value of antibody titration, antibody quantitation and monocyte monolayer assay (MMA) in assessment of severity of haemolytic disease of the newborn (HDN). Serum samples from 45 alloimmunized mothers, with anti-D(23), anti-c(10), anti-K(6), anti-E(5) and anti-e(1) were taken for the study. The results obtained were compared and the efficiency of each technique in predicting the severity of HDN was assessed. Antibody quantitation and MMA (phagocytic index) correlated well with severity of HDN in mothers with anti-D antibodies. Antibody quantitation (anti-D) had a positive predictive value of 54.5 per cent and negative predictive value of 85.7 per cent while MMA had a positive predictive value of 75 per cent and a negative predictive value of 100 per cent. These findings suggest MMA to be a good negative predictor of HDN but not a good positive predictor of haemolytic disease of the newborn.

Analysis of quality assurance programmes for HIV screening in blood transfusion centres in Delhi.

The safety of blood transfusion has attained tremendous importance because of the problems posed by acquired immunodeficiency syndrome (AIDS) and other transfusion-transmissible diseases. While performing screening tests for human immunodeficiency virus (HIV) antibodies in donated blood is indispensable, it is also essential to introduce an effective quality assurance programme covering inspection of specimens, review of record-keeping, maintenance of equipment, and verification of results. We carried out an analysis of such quality assurance programmes during routine annual inspection of 11 blood transfusion centres in Delhi, India. The following parameters were studied: standardization of sample collection and handling; adherence to the recommended technical procedure; use of standard operating procedure; proper use of test reagents; laboratory record-keeping; proper handling of HIV-positive blood units; recording and communication of results; observation of safety guidelines; equipment quality control; and training of staff. A pretested closed-type questionnaire with a weighted scoring system was used for evaluation. Performance for each parameter was graded as follows: 76-100%, excellent; 51-75%, good; 26-50%, fair; and < 25%, poor. Centres were categorized according to the total score obtained for all parameters. Overall performance > 50% was considered satisfactory. Of the 11 centres, none was excellent overall, five were considered satisfactory, and six were unsatisfactory.

PIP: During routine annual inspection of 11 blood transfusion centers in Delhi, the authors analyzed program quality assurance with regard to the standardization of sample collection and handling, adherence to the recommended technical procedure, use of standard operating procedure, proper use of test reagents, laboratory record-keeping, proper handling of HIV-positive blood units, the recording and communication of results, observation of safety guidelines, equipment quality control, and staff training. A pre-tested closed-type questionnaire with a weighted scoring system was used for evaluation. No center recorded an excellent score, 5 were considered satisfactory, and 6 were unsatisfactory. Significant lapses were found in a majority of the transfusion centers, with serious breaches in a few centers on standard operating procedure, the proper use of reagents, and observation of safety guidelines.

Evaluation of awareness and utilization of an autologous blood transfusion programme.

Autologous blood transfusion (ABT) has an important role in transfusion practice in the developing world due to increasing incidence of HIV and hepatitis C virus infection. Our study was done to evaluate the level of awareness and utilization of an autologous blood transfusion programme in a teaching hospital in Delhi. We assessed the level of awareness of preoperative ABT amongst treating physicians from different specialties in a teaching hospital through an anonymous questionnaire. The utilization of this methodology in transfusion practice was estimated from records of the Blood Transfusion Service. Of the 150 doctors contacted 96 (64%) responded. Although 67.7% of them were aware of the technique and its advantages, only 21.8% used it for the patients under their care. In the preceding 24 months 133 (1.1%) of 12,090 blood collections in the transfusion service were from autologous donor-patients. Only one unit of blood was collected from each patient, although 41.8% of them received > or = 2 units of blood. Of the 11,123 patients transfused, 55 (0.49%) received the ABT. Thus only 55 (41.3%) of 133 total ABT collections were utilized. The study highlights that there is a general lack of awareness about ABT amongst physicians. This transfusion practice is rarely and inadequately used. The study was repeated the following year after an intensive intervention strategy was adopted. The results show a trend towards improvement in the practice of ABT. This study emphasizes the need for proper organization, planning and communication between clinicians and blood transfusion personnel for effective implementation of an ABT programme, especially in countries with a high incidence of transfusion-transmitted infections and acute shortages of blood for transfusion.