Surgical safety checklist awareness and safety attitudes in the Eastern Mediterranean region: a cross-sectional study

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.

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.

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.

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.