BMJ quality & safety · 2026
Surgical safety checklist awareness and safety attitudes in the Eastern Mediterranean region: a cross-sectional study.
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Gebreal Assem, El Dine Fatma Badr, Abdulsalam Albaraa, Aly Doaa Hamdy, Abdelaziz Abdelmoneim Shaimaa, Abd El Maksoud Walid M, Salem Siwar Belhaj, Abdelrahim Alaa Nadir Mohamed, Albanaa Saja A, Alasaad Saja, Ali Rajiv Yussuf, Odat Ramez M, Taymour Noha, Malik Tabraiz Amin, Mohammed Abdelrahman Zaki Ali, Fayed Notaila Mohammed, Al-Ansi Khlood Saleh Mohammed, Attar Majda, Ahmed Ibrahim Mutwakil Gamal, Ghazy Ramy Mohamed
Аннотация
BACKGROUND: The World Health Organization Surgical Safety Checklist (WHO-SSC) is a global tool designed to enhance teamwork and safety in operating rooms (ORs). Its use remains under-reported in the Eastern Mediterranean Region (EMR). This study aimed to assess WHO-SSC awareness, adoption, satisfaction with its implementation, barriers and its impact on healthcare professionals' safety attitudes.
METHODS: Using a validated questionnaire, a cross-sectional survey was conducted from 11 March to 18 June 2024, in hospitals across 12 countries in the EMR through face-to-face and online distribution. Healthcare professionals' safety attitude was assessed using the modified operating-room version of the Safety Attitudes Questionnaire. A multiple logistic regression model was used for data analysis, reporting aOR with 95% CIs.
RESULTS: The study involved 3861 respondents, comprising 1348 surgeons, 1277 OR nurses and 1236 anaesthesiologists. Overall, 52.5% of respondents reported awareness of the WHO-SSC. Among those aware, adoption was highest in private and teaching hospitals and lowest in charity hospitals, with 56.2% expressing satisfaction with its implementation. Reported 'always' adherence to the checklist was 32% in elective surgeries, compared with 19% in emergency surgeries. The main barriers included a lack of training, time constraints, limited awareness and poor team communication. Overall, 61.4% of participants demonstrated a positive safety attitude. Positive attitudes were associated with older age, being from a low-income and middle-income country, and WHO-SSC awareness.
CONCLUSION: This study emphasises inadequate awareness and adoption of the WHO-SSC in the EMR. Strengthening training, institutional support and context-specific implementation strategies is essential to enhance surgical safety culture in the region.
METHODS: Using a validated questionnaire, a cross-sectional survey was conducted from 11 March to 18 June 2024, in hospitals across 12 countries in the EMR through face-to-face and online distribution. Healthcare professionals' safety attitude was assessed using the modified operating-room version of the Safety Attitudes Questionnaire. A multiple logistic regression model was used for data analysis, reporting aOR with 95% CIs.
RESULTS: The study involved 3861 respondents, comprising 1348 surgeons, 1277 OR nurses and 1236 anaesthesiologists. Overall, 52.5% of respondents reported awareness of the WHO-SSC. Among those aware, adoption was highest in private and teaching hospitals and lowest in charity hospitals, with 56.2% expressing satisfaction with its implementation. Reported 'always' adherence to the checklist was 32% in elective surgeries, compared with 19% in emergency surgeries. The main barriers included a lack of training, time constraints, limited awareness and poor team communication. Overall, 61.4% of participants demonstrated a positive safety attitude. Positive attitudes were associated with older age, being from a low-income and middle-income country, and WHO-SSC awareness.
CONCLUSION: This study emphasises inadequate awareness and adoption of the WHO-SSC in the EMR. Strengthening training, institutional support and context-specific implementation strategies is essential to enhance surgical safety culture in the region.