. 2014 May 6;9(5):e79524. doi: 10.1371/journal.pone.0079524

Table 4. Item-Level Quality of VMMC Surgical Care from Initial Year (2011) to Expansion Year (2012).

Indicator: Percent (%) of surgical observations with Total Score ( = 1 point) by Item^A
	Kenya			South Africa			Tanzania			Zimbabwe
	2011 (T₀)	2012 (T₁)	Δ = T₁- T₀	2011 (T₀)	2012 (T₁)	Δ = T₁- T₀	2011 (T₀)	2012 (T₁)	Δ = T₁- T₀	2011 (T₀)	2012 (T₁)	Δ = T₁- T₀
Number of surgical observations	154	218	-	116	361	-	133	251	-	140	240	-
Pre-Operative Assessment (1 item)
Performs preoperative assessment including targeted history and physical exam	79.5	70.6	-	51.7	12.2	−39.5 ^*	20.3	26.3	-	97.1	100	+2.9 ^*
Safe Operative Procedures (8 items)
Uses sterile instruments and consumables	100	98.2	-	96.7	97.8	-	98.5	99.2	-	99.3	100	-
Uses sterile gloves	99.3	99.5	-	95.0	84.8	−10.2 ^*	100	99.6	-	99.3	99.5	-
Hand washes or disinfects between clients	90.1	90.4	-	90.0	58.2	−31.8 ^*	93.2	96.4	-	87.1	100	+12.9 ^*
Maintains adequate sterile surgical field	100	95.4	−4.6 ^*	85.0	76.7	-	57.1	79.3	+22.2 ^*	80.7	100	+19.3 ^*
Ensures protective eyewear worn by all surgical staff	5.3	6.4	-	10.8	5.3	-	25.6	55.4	+29.8 ^*	0.7	2.5	-
Safely stores and disposes of medical waste	98.0	100	-	91.7	72.0	−19.7 ^*	100	99.2	-	98.6	99.0	-
Correctly and hygienically processes instrument(s)	98.0	96.3	-	96.7	95.6	-	92.5	87.7	-	97.1	100	+2.9 ^*
Disinfects surgical beds between patients	98.7	97.3	-	92.5	59.8	−32.7 ^*	66.9	64.5	-	84.3	96.6	+12.3 ^*
Step-wise Operative Techniques (13 items)
Cleans surgical area with Chlorhexidine-based solution or Povidine Iodine	100	98.6	-	99.2	89.2	−10.0 ^*	98.5	99.2	-	68.6	100	+31.4 ^*
Identifies skin to be excised	100	95.9	−4.1 ^*	97.5	70.1	−27.4 ^*	93.2	84.1	−9.1 ^*	91.4	100	+8.6 ^*
Ensures no other penile parts are at risk of injury	100	100	-	96.7	96.7	-	99.3	98.4	-	95.7	99.5	+3.8 ^*
Safely administers local anesthesia	98.0	89.9	−8.1 ^*	89.2	70.4	−18.8 ^*	97.0	90.0	−7.0 ^*	89.3	100	+10.7 ^*
Cautiously/gently removes foreskin	100	99.1	-	95.8	94.5	-	100	95.2	−4.8 ^*	94.3	100	+5.7 ^*
Uses electrocautery and/or ligating sutures	100	100	-	97.5	95.3	−2.2 ^*	95.5	92.8	-	92.1	99.5	+7.4 ^*
Correctly ties of surgical knot(s)	56.3	67.0	-	73.3	61.8	−11.5 ^*	72.9	47.4	−25.5 ^*	83.6	99.5	+15.9 ^*
Aligns frenulum and secures mattress suture	100	98.6	-	98.3	87.5	−10.8 ^*	100	99.2	-	90.0	100	+10.0 ^*
Correctly aligns other quadrant sutures	99.3	99.5	-	94.2	96.4	-	100	99.2	-	92.1	100	+7.9 ^*
Avoids placing deep sutures around the frenulum	100	100	-	98.3	96.7	-	100	99.2	-	93.6	94.6	-
Places interrupted sutures evenly	98.7	90.8	−7.9 ^*	85.8	96.4	+10.6 ^*	98.5	98.0	-	89.3	99.5	+10.2 ^*
Ensures no significant bleeding present	100	100	-	97.5	94.2	-	100	99.2	-	85.0	99.5	+14.5 ^*
Places secure dressing	98.7	98.7	-	98.3	96.4	-	98.5	99.6	-	88.6	100	+11.4 ^*
Post-Operative Assessment (7 items)
Waits to determine abnormality or allergic reaction	56.3	56.0	-	40.8	7.5	−33.3 ^*	64.7	73.7	-	22.1	99.5	+77.4 ^*
Reviews patient vital signs	44.4	33.9	−10.5 ^*	66.7	58.2	-	48.9	42.6	-	0	9.8	+9.8 ^*
Provides wound care and pain management advice	63.6	63.8	-	79.2	45.2	−34.0 ^*	63.9	68.5	-	68.6	100	+31.4 ^*
Encourages at least one patient follow-up visit	63.6	59.6	-	87.5	63.2	−24.3 ^*	91.7	89.6	-	98.6	100	-
Provides emergency contact details to patient	96.0	91.3	-	66.7	35.2	−31.5 ^*	82.0	68.5	−13.5 ^*	98.6	99.5	-
Provides post-operative patient counseling	57.6	41.3	−16.3 ^*	10.0	4.4	-	63.2	22.7	−40.5 ^*	98.6	100	-
Reminds of 6-week post-operative abstinence	56.3	31.2	−25.1 ^*	52.5	28.3	−24.2 ^*	31.6	17.1	−14.5 ^*	100	100	-

^[A]

Includes only percent of surgical observations with total score ( = 1 point). Items receiving a partial score ( = 0.5 point) during observation were not counted as correctly done.

Differences from T₀ to T₁ reported at p<0.05 statistical significance.