Abstract:
Background: The World Health Organization Surgical Safety Checklist is an evidence based
instrument designed to decrease surgical errors and enhance patient outcomes. Despite its proven
value, its use remains inconsistent in many settings, including low resource hospitals. Limited
evidence exists on the knowledge, attitude, and utilization of the checklist among surgical teams
in public hospitals of Harar, Eastern Ethiopia.
Objective: To assess the knowledge, attitude, and utilization of the WHO Surgical Safety
Checklist and identify associated factors among surgical health professionals working in public
hospitals of Harar, Eastern Ethiopia.
Methods: An instutution based cross sectional study was conducted among 170 surgical health
professionals selected using simple random sampling. Knowledge, attitude, and practice levels
were described using frequency and percentage. Multivariable logistic regression was used to
identify independent predictors of consistent checklist utilization. Adjusted odds ratios with 95
percent confidence intervals were reported, and statistical significance was declared at p < 0.05.
Results: Most participants demonstrated strong knowledge 78% (CI:0.71-0.83) of the checklist’s
key components, and the majority held a positive attitude 65% (CI:0.57-0.72) toward its
usefulness and relevance to patient safety. However, utilization was lower 47% (CI:0.4-0.55),
particularly for steps such as team introductions and postoperative planning. Nurses were more
likely to use the checklist consistently than physicians (AOR 4.38, 95% CI 1.90 to 10.09). Staff
working in OBGYN or orthopedic units had lower odds of consistent use compared with those in
general surgery (AOR 0.48, 95% CI 0.24 to 0.96).
Conclusion: Although surgical staff demonstrated high knowledge and favorable attitudes
toward the WHO Surgical Safety Checklist, actual adherence to checklist steps was inconsistent.
Profession and working unit were key determinants of checklist utilization. Targeted
interventions focusing on training, surgical team engagement, and unit specific implementation
strategies may improve consistent use of the checklist.
