Impact of Surgical Lighting on Intraoperative Safety in Low-Resource Settings: A Cross-Sectional Survey of Surgical Providers

Abstract

Background:
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.

Methods:
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.

Results:
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.

Conclusions:
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.

Full text

ORIGINAL SCIENTIFIC REPORT
Impact of Surgical Lighting on Intraoperative Safety in Low-
Resource Settings: A Cross-Sectional Survey of Surgical Providers
Jared A. Forrester
1
•Nicholas J. Boyd
2
•J. Edward F. Fitzgerald
3
•
Iain H. Wilson
4
•Abebe Bekele
5
•Thomas G. Weiser
1,6,7
ÓSocie
´te
´Internationale de Chirurgie 2017
Abstract
Background 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.
Methods 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.
Results 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 oper-
ations 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.
Conclusions 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.
Paper will be presented at the 18th COSECSA Scientific Conference
in Maputo, Mozambique, December 4–8.
&Jared A. Forrester
jaredf2@stanford.edu
1
Department of Surgery, Section of Trauma & Critical Care,
Stanford University, 300 Pasteur Drive, S067, Stanford,
CA 94305-5106, USA
2
Great Ormond Street Hospital For Children NHS Trust,
London, UK
3
Kings Centre for Global Health, Kings College London,
London, UK
4
Lifebox Foundation, London, UK
5
Department of Surgery, School of Medicine, Addis Ababa
University, Addis Ababa, Ethiopia
6
Lifebox Foundation, Boston, MA, USA
7
Department of Clinical Surgery, Royal Infirmary of
Edinburgh, University of Edinburgh, Edinburgh, UK
123
World J Surg
DOI 10.1007/s00268-017-4293-z

Introduction
Surgical volume has increased dramatically in the past decade
[1][2], yet there are the estimated 140 million additional
operations required annually to meet the minimum need for
operative care [3]. The Lancet Commission for Global Sur-
gery and the Disease Control Priorities programme evidenced
the need for increasing surgical services and capacity, while
also necessitating assurance for the quality of surgical care
delivered [4,5]. Surgical safety in low- and middle-income
countries (LMICs) is a major, but poorly recognized public
health issue that requires urgent attention.
Along with well-trained healthcare providers, certain fun-
damental equipment and infrastructure requirements are
essential for delivering safe surgical care. High-quality
lighting of the surgical field is one such requirement and is
usually dependent on a reliable electricity supply. The World
Health Organization (WHO) Service Availability and
Readiness Assessment (SARA) classifies essential electrical
equipment into: (1) infrastructure, (2) medical devices, and (3)
support appliances for specific health services [6,7]. Surgical
lighting is part of both the infrastructure and support appli-
ances for health services; therefore, it is a fundamental com-
ponent of safe surgical care.
Electricity outages are common in low-resource settings
and severely impact surgical lighting. In a study of eleven
sub-Saharan African countries, only 28% of health facilities
and 34% of hospitals had reliable access to electricity,
defined as no outages of greater than 2 h in the past week [8].
High-quality theatre lights are nearly universally available in
high-resource settings, yet many surgeons also wear head-
lights specifically designed to improve illumination of the
surgical field. Such headlights are expensive, and their
availability is limited in LMICs. Improving the consistency
of surgical field illumination may have multiple benefits,
such as reducing morbidity and increasing surgical volume
through reduction in delays and cancellations.
Despite known unreliability of electricity in LMICs and the
recognized need for quality lighting to provide surgical care,
there is a paucity of literature on how electricity failures
impact surgical lighting or how operating theatre lighting
affects patient care. This study, through surveying surgical
providers working in LMICs, aimed to assess the current state
of surgical lighting and its perceived impact on surgical care.
Materials and methods
Definitions
For this study, quality of surgical lighting was defined as
the ability to consistently illuminate the surgical field.
LMICs were defined by standard economic criteria [9].
Questionnaire design and distribution
A novel, 18-item questionnaire survey was developed in
English consisting of free text, binomial, and Likert-like
scale responses [Appendix]. The questionnaire was designed
with reference to previously published guidelines on ques-
tionnaire-based research [10,11]. The survey tool was pilot-
tested by surgeon and anaesthesia members of the study team
with experience practicing in LMICs; content validity was
ensured by this iterative process, and the feedback received
was then used to further refine the question items. Individual
question items were compulsory. Identifiable information
collected (e.g. email address) was voluntarily provided. No
incentives were offered for participation.
A link to the online survey (SurveyMonkey.com, LLC,
Palo Alto, California, USA) was distributed to the members of
different surgical societies through the College of Surgeons of
East, Central, and Southern Africa (COSECSA), including the
Surgical Society of Ethiopia, surgical specialty associations,
and local and international surgical mailing lists. Individuals
were also encouraged to share the link with their colleagues in
a ‘‘snowball’’ recruitment strategy. Data collection took place
from 17 December 2016 to 9 May 2017. Due to this snowball
strategy, the survey response rate was not captured. The eth-
ical dimensions of this voluntary evaluation survey were
considered, and no concerns were identified; completion of
the questionnaire was taken as implied consent to participa-
tion in this study; and IRB approval was not pursued.
This study was undertaken by the Lifebox Foundation
(http://www.lifebox.org), a non-profit, charitable organiza-
tion registered in the UK and USA. The Lifebox Founda-
tion works to implement sustainable changes of practice
that will ultimately raise the safety and quality standards of
global surgery and anaesthesia.
Data analysis
Only fully completed questionnaires were included in the
analysis. Mann–Whitney U test was used where appropri-
ate for comparison between groups, and p\0.05 was
considered significant. Microsoft Excel (Microsoft, 2013,
Redmond, Washington, USA) was used to calculate
descriptive statistics. Free-text responses were indepen-
dently categorized by theme into groups for analysis by
four of the authors, with differences resolved by discussion.
Results
Respondent demographics
A total of 100 surveys were fully completed and included
in the analysis. Respondents represented 39 countries, 85%
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123

being permanent practitioners in LMICs. The remainder
were visiting surgeons who practice in LMICs, responding
for the main LMIC hospital where they practice. A wide
variety of surgical disciplines and surgical practice settings
were represented with the majority practicing in
regional/national referral hospitals (67%) (Table 1).
Current status of surgical lighting
40% of respondents reported the quality of the surgical
lighting in their operating theatre as either poor or very
poor, with no significant difference between surgical set-
ting sizes (41.8% in regional/tertiary centres and 42.9% in
smaller referral centres, p=0.87) (Fig. 1). Electrical
power failures were common. Almost half of respondents
(48%) reported main power failure at least once per week,
with nearly one-third of the respondents (32%) reporting
operation delays or cancellations due to poor lighting. Most
respondents reported their hospitals possess a backup
generator (94%), though of those only 48% noted this
backup to be always available. During power outages and
the resultant failure of surgical field illumination, respon-
dents reported a variety of solutions in the operating the-
atre, most commonly relying on the backup generator
(58%) or the using a mobile phone light (29%). Only 9%
reported using a surgical headlight regularly, with unaf-
fordability (65%) and poor in-country suppliers (43%)
being the most common barriers to headlight use (Table 2).
Table 1 Respondent demographics and practice settings
Demographic Regional/National centres (n=67) Smaller referral centres (n=28) Others (n=5) Total (n=100)
N%N%N%N
Hospital setting
Regional/national referral hospital 67 100 0 0.0 0 0 67
First referral hospital 0 0 9 32.1 0 0 9
District hospital 0 0 8 28.6 0 0 8
Private hospital 0 0 6 21.4 0 0 6
Other 0 0 0 0.0 5 100 5
Rural health clinic/health centre 0 0 3 10.7 0 0 3
Private clinic/health centre 0 0 2 7.1 0 0 2
Surgeon practice location
Permanent 59 88 22 78.6 4 80 85
Visiting 6 9 5 17.9 0 0 11
Other 2 3 1 3.6 1 20 4
Surgical specialty
General 39 58.2 18 64.3 3 60 60
Other 7 10.4 3 10.7 0 0 10
OB/GYN 7 10.4 2 7.1 0 0 9
Orthopaedic 4 6.0 3 10.7 0 0 7
Paediatric surgery 6 9.0 0 0.0 0 0 6
Plastic surgery 2 3.0 0 0.0 1 20 3
Cardiothoracic surgery 1 1.5 1 3.6 1 20 3
Neurosurgery 1 1.5 0 0.0 0 0 1
ENT 0 0.0 1 3.6 0 0 1
Legend. OB/GYN =obstetrician and gynaecologist; ENT =otolaryngologist. Smaller referral centres include first referral hospitals, district
hospitals, private hospitals, rural health clinic/health centres, private clinic/health centres. Note: For categories of ‘‘hospital setting’’ and
‘‘surgeon practice location’’, respondents instructed that if working at many hospitals, it is the hospital where they work the most. If the
respondent is a visiting surgeon, it is the main hospital where the respondent is visiting
Fig. 1 Quality* of surgical lighting
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Table 2 State of surgical lighting in LMICs
Question Regional/National
centres (n =67)
Smaller referral centres
(n =28)
Others
(n =5)
Total (n =100)
N% NN N%N
How often do you experience main electricity power failures while operating?
Many times per day 6 9.0 5 17.9 1 20 12
Most days 15 22.4 2 7.1 0 0 17
Weekly 11 16.4 7 25.0 1 20 19
Monthly 4 6.0 1 3.6 1 20 6
Less often than monthly 17 25.4 5 17.9 0 0 22
Never 13 19.4 7 25.0 1 20 21
Other 1 1.5 1 3.6 1 20 3
Does your facility have a backup generator?
Yes—always available 29 43.3 15 53.6 4 80 48
Yes—sometimes available 28 41.8 8 28.6 0 0 36
Yes—very unreliable 6 9.0 4 14.3 0 0 10
No 1 1.5 0 0.0 0 0 1
Do not know 2 3.0 0 0.0 0 0 2
Other 1 1.5 1 3.6 1 20 3
What do you do in your operating theatre when there is a main power failure?*
Rely on backup generator 41 61.2 15 53.6 2 40 58
Use mobile phone light 22 32.8 6 21.4 1 20 29
Use torch/other battery-operated light 16 23.9 8 28.6 1 20 25
Use headlight 13 19.4 9 32.1 3 60 25
Stop operating 16 23.9 4 14.3 0 0 20
Not applicable (No power cuts) 9 13.4 6 21.4 1 20 16
Other 2 3.0 2 7.1 0 0 4
Do you ever delay or cancel operations due to poor lighting?
Yes 26 38.8 4 14.3 2 40 32
No 41 61.2 24 85.7 3 60 68
Do you use a surgical headlight for operating?
Yes, always 4 6.0 5 17.9 0 0 9
Yes, occasionally 26 38.8 13 46.4 3 60 42
No 37 55.2 10 35.7 2 40 49
What do you see as the main barrier(s) for having a surgical headlight?*
The cost makes it unaffordable 44 65.7 19 67.9 2 40 65
Poor suppliers in my country 29 43.3 12 42.9 2 40 43
Only poor-quality/unsuitable headlights available to me 13 19.4 6 21.4 1 20 20
Not applicable/there are no barriers/I already own one 10 14.9 4 14.3 0 0 13
Never thought of this as a solution to poor lighting 10 14.9 2 7.1 0 0 12
Uncomfortable to use in my environment 8 11.9 4 14.3 1 20 13
Other 6 9.0 2 7.1 0 0 8
I do not want one 3 4.5 1 3.6 1 20 5
Legend. * =Multiple response question. Smaller referral centres include first referral hospitals, district hospitals, private hospitals, rural health
clinic/health centres, private clinic/health centres
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Impact on patient safety
The majority of respondents (80%) reported the quality of
surgical lighting in their operating theatre presented a
patient safety risk. Eighteen per cent of respondents
reported direct experience of adverse intraoperative events
due to poor surgical lighting (Fig. 2) with two-thirds of
these substantiated in qualitative comments. Of these
responses, qualitative analysis revealed major themes with
issues including unintended blood loss (5), inadvertent
intestinal spillage/injury (4), and inadvertent nerve damage
(1). A representative sample of qualitative comments
received is provided in the text box [Box 1].
Discussion
Despite the known deficiencies of infrastructure in low-
resource settings, this is the first study to investigate the
extent and impact of surgical lighting on surgical capacity
and patient safety and the effect of electrical power outages
on surgical lighting. Surgical practitioners working in low-
resource settings overwhelmingly report that poor-quality
surgical field lighting is a major patient safety issue and
decreases surgical capacity through delayed and cancelled
operations.
Electricity is an essential component of basic hospital
infrastructure [12]. In a study of sub-Saharan African
facilities, less than 65% of all hospitals, and even fewer
clinics, fulfil this basic infrastructural requirement [13]. In
another study, all surveyed hospitals in Uganda reported
frequent power outages [14]. At one centre in Uganda, 13%
of operating days had at least one main operating theatre
power outage, with a mean duration of 6 h and 40 min
[15]. Operating theatre lighting is fundamentally reliant on
a dependable electricity infrastructure [16].
In this survey, 40% of surgeons working in LMICs
reported their operating theatre lighting as poor at best, with
no statistical difference between the different levels of health
facility. For our study, we defined quality of operating the-
atre lighting as the ability to consistently illuminate the
surgical field, which incorporates both power (a represen-
tation of the lighting intensity) and time (consistency of
availability). Poor-quality operating theatre lighting, either
from low intensity or inconsistency, can lead to delays and
cancellations, as reported by a third of the respondents.
The impact of unreliable electricity on patient safety is
recognized, but poorly reported with only a few case
reports highlighting this critical patient safety issue
[17,18]. A global literature review identified only two
papers out of over 1500 linking electricity reliability and
health outcomes [19]. Likewise, a WHO global literature
review identified only a dozen of over 400 titles reporting
the impact of electricity access on health outcomes, with no
studies linking electricity access to health outcomes as a
primary study objective [12].
Fig. 2 Does the quality* of surgical lighting impact the safety for
your patient?
Box 1 Representative qualitative comments from respondents regarding the harm to patients due to poor surgical lighting
Unintended blood loss
‘‘During a caesarean section, there was excessive haemorrhage following a power cut as the surgeon could not control the bleeder [bleeding
blood vessel] with the torches used. The patient needed a [blood product] transfusion which otherwise was totally unnecessary’’
‘‘We were trying to control bleeding in a case of a trauma due to road traffic accident. [The] patient did not pass, but we could have done
better if there was adequate lighting’’
‘‘The patient had severe haemorrhage, and it was not possible to cauterize due to lack of electricity’’
‘‘Blood loss from inability to see bleeders [blood vessels]’’
Inadvertent intestinal spillage/injury
‘‘The patient had an iatrogenic bowel perforation that was missed’’
‘‘During a Hartman procedure [sigmoidectomy and colostomy], we [were] stuck in total shade, the backup generator was out of gasoline,
and I had a little spillage of the colon [colonic contents] into the abdominal cavity’’
‘‘Injury to the bowel’’
Inadvertent nerve damage
‘‘While I was ligating a patent ductus arteriosus (PDA), I damaged the recurrent laryngeal nerve of a young girl because of poor visibility
due to lack of good illumination’’
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Poor-quality surgical lighting is seen as a patient safety
risk, as reported by 80% of respondents. Nearly one-fifth
reported direct knowledge of an adverse patient outcome
due to poor surgical lighting. Surgeons most commonly
reported uncontrolled haemorrhage or inadvertent bowel
injury, both indicative of lighting failures at crucial times
during surgery. Also of importance, power outages, and
subsequent surgical lighting issues, can affect surgeon
safety. Almost 70% of surgical residents at a large referral
centre in Ethiopia reported a needle-stick injury in the
operating theatre during their training. The lack of appro-
priate operating equipment was cited as the most frequent
cause for injury [20]. Given the low rate of surgeon hep-
atitis B vaccination [21] and the higher prevalence of
human immunodeficiency virus (HIV) and hepatitis B in
patients in LMICs, power cuts impacting surgical lighting
present a substantial occupational work hazard.
Reliance on a backup generator is the most common
solution when surgical lighting is affected by electricity
failures, supporting the previous literature [12,14,22,23].
Despite the overwhelming dependence on backup genera-
tors, over half of respondents reported they are not con-
sistently available. In a previous survey of six sub-Saharan
African countries, less than 29% were functional with fuel
available on the day of the survey [12]. Even when gen-
erators are available, there are financial and time con-
straints. Issues with equipment repair, limitations in fuel
supply, and the high cost of fuel can all impact the relia-
bility of generators [12]. Additionally, there can be delays
between the electricity failure and backup generator func-
tioning, averaging 30 min at one large Ugandan referral
hospital [15].
It is important to note that surgical lighting is more
complex than simply ensuring reliable electricity supply.
Surgical operating theatre lights in low-resource settings
are often of poor quality and may not be present or work at
all. Additionally, many battery-powered portable lights are
of poor design and of little help, even if available. Surgical
infrastructure, including ceiling lights, suction machines,
diathermy, and anaesthesia machines, might be redesigned
in such a way to improve durability and functioning with
the inconsistent electricity supply of LMICs. In lieu of this,
we argue that countries should have a standard when
procuring medical equipment.
Non-generator solutions for illuminating the surgical
field when electricity failures impact surgical lighting
include headlights, cell phone lights, flashlights, and nat-
ural lighting through windows [24]. In our study, surgical
providers were most likely to use mobile phone lights,
followed by using another battery-powered light or a
headlight. Many visiting surgeons working in LMICs bring
battery-powered headlights with which to operate. These
surgical headlights are common practice in high-resource
settings, but affordability, poor in-country suppliers, and
inappropriate design limit their use in low-resource set-
tings. Providers have reported altering or fashioning
camping headlights in order to better illuminate the sur-
gical field [25,26]; however, they are fraught with prob-
lems of poor design, light quality, and battery life. Other
solutions include solar power: We Care Solar is an example
of a non-profit specifically working to improve lighting for
health facilities where power infrastructure is lacking [27].
Surgery requires reliable and high-quality lighting.
Unreliable electricity supplies are common in LMICs with
resultant negative consequences on surgical lighting.
Importantly, poor surgical lighting negatively impacts
patient and surgeon safety. Improving surgical lighting
through more consistent electricity supply is important for
surgical care, yet remains a challenging and complex
infrastructural component to achieve. Dependable surgical
lighting options are critical in order to deliver safe surgical
care. Avenues for further investigation include lighting
options independent of an existing power grid and purpose-
built for functioning in these low-resource settings.
Limitations
There are limitations to the study. First, as with all research
of this nature, the results may reflect an element of
responder bias. Though given the paucity of previous
research on this aspect of essential surgical infrastructure,
these results provide an important baseline and thematic
analysis to guide future work. Second, electrical power
supply for operating theatre lighting is only one aspect of a
much wider set of complex issues that need to be addressed
in order to build surgical capacity in these settings. How-
ever, surgical field lighting has a potentially simple solu-
tion that can be addressed without an infrastructural
overhaul of electricity supply. Third, although the number
of responses received is relatively low, the wide distribu-
tion of the survey responses with representation of all
hospital settings across a range of LMICs helps mitigate
against undue focus on any one subgroup.
Conclusion
In LMICs, the majority of respondents report poor surgical
lighting as a major risk to patient safety and nearly one-
third report delayed or cancelled operations due to poor
lighting. Improving electricity supply is a complex issue to
address, and while most surgeons rely on a backup gen-
erator, they are often unreliable. A purpose-built lighting
element independent of an existing power grid would be a
viable option for operating in these settings. The
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development of robust, affordable, high-quality surgical
headlight could provide an ideal solution to the substantial
surgical safety issue.
Acknowledgments 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.
Appendix: Lifebox surgical lighting survey
1. Which of these best describes your hospital?
If you work in many hospitals, please complete for the hospital where you work the
most. If you are a visiting surgeon, please complete for the main hospital you visit.
Rural health clinic / health centre
District hospital
First referral hospital
Regional / national referral hospital
Private clinic / health centre
Private hospital
Other (please specify)
Please answer all the following questions based on this hospital
2. Overall, how would you rate the quality of the lighting in your operating theatre?
By quality, we mean the ability to consistently illuminate the surgical field
Very poor
Poor
Good
Excellent
3. How often do you experience main electricity power failures while operating?
Many times each day
Most days
Weekly
Monthly
Less often than monthly
Never
Other (please specify)
4. Does your facility have a backup generator?
Yes - always available
Yes - sometimes available
Yes - very unreliable
No
Do not know
Other (please specify)
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5. What do you do in your operating theatre when there is a main power failure?
(check all that apply)
Use mobile phone light
Use a torch / other battery operated light
Use a headlight
Stop operating
Rely on the backup generator
Not applicable (No powercuts)
Other (please specify)
6. Do you ever delay or cancel operations due to poor lighting?
No
Yes
If yes, how often do you have to do this?
7. Do you use a surgical headlight for operating?
Yes, always
Yes, occasionally
No
If No, please explain why
8. What 5 features would be most important to you for a surgical headlight?
Please select 5 options from the 10 available
Rechargeable battery
Ability to adjust diameter of light focus
Ability to change brightness of the light
Compatibility with eyeglasses and surgical loupes
Separate belt/pocket battery pack
Lightweight on head
Easy to carry around
Durable
Pure white light
Comfortable fit
Other (please specify)
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9. How much would you spend on a high quality headlight with the above features, in USD
($)?
10. What do you see as the main barrier(s) for having a surgical headlight?
(check all that apply)
The cost of specific surgical headlights make it unaffordable for me
Never thought of this as a solution for poor lighting
Poor suppliers in my country
Only poor quality/unsuitable headlights available to me
Uncomfortable to use in my environment
I do not want one
Not applicable (there are no barriers / I already have one)
Other (please specify)
11. In general, does the quality of surgical lighting impact the safety for your patients?
By quality, we mean the ability to consistently illuminate the surgical field
The quality of lighting in my theatre(s) is a significant risk to the safety of my patients
The quality of lighting in my theatre(s) is a small risk to the safety of my patients
The quality of lighting in my theatre(s) is not a risk to the safety of my patients
12. Do you know of a patient who has come to harm because of poor lighting? (eg. during a
power failure)
This can be a patient of yours or a case you heard about
No
Yes
Do not know
If possible, can you describe what happened
13. What country do you work in?
Please complete for the hospital you referred to in question 1
14. Are you permanently based here or a visiting surgeon?
Permanent (or long term resident in this country)
Visiting surgeon
Other (please specify)
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15. What surgical specialty do you practice?
Please choose one that BEST describes your practice
16. What is your email address? (optional)
17. Would you like to be included on the Lifebox mailing list to receive updates on this and
other projects?
Yes
No
18. Any other comments you would like to add?
Respondents agree to anonymous use of responses in scoping provision of a Lifebox headlight
device for surgeons, and to presentation and/or publication of the results where appropriate. No
individual will be identified as part of this survey.
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26. Meier D (2010) Opportunities and improvisations: a pediatric
surgeon’s suggestions for successful short-term surgical volunteer
work in resource-poor areas. World J Surg 34(5):941–946.
doi:10.1007/s00268-010-0454-z
27. We Care Solar. Available at https://wecaresolar.org/. Accessed 4
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