Knowledge, attitude and practices regarding World Health Organization surgical safety checklist and the challenges in its implementation at a teaching hospital in North India

Priya Sharma, Vartika Tripathi, Uma Gupta


Background: The WHO in 2009 published the surgical safety checklist (SSC) for reducing the surgical complications. For its successful implementation it is imperative to identify the current knowledge, attitude and practices of the involved personnel and explore the anticipated barriers. Objective of this study was to evaluate the knowledge, attitude and practices of the participants about the SSC and determine the possible challenges in its implementation.

Methods: This study is a descriptive, cross-sectional study involving the use of a pre-tested questionnaire carried out in a teaching hospital. All personnel involved in the operation theater who gave their written consent were enrolled.

Results: Awareness regarding the SSC is high and existing practices are favorable towards patient safety amongst Hospital personnel. Attempts should be made to educate all personnel to gain complete knowledge regarding the checklist. The anticipated barriers, of which lack of knowledge was found to be the most prominent, should be dealt with.

Conclusions: A strategy aimed at proper education, stepwise implementation, alleviating the hindrances and regular feedbacks can result in decreasing the surgery related complications and morbidities through implementation of the surgical safety checklist.


Implementation barriers, Patient safety, Surgical complications, Surgical safety checklist

Full Text:



Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139-44.

De Vries EN, Ramrattan MA, Smorenburg SM, Gouma DJ, Boermeester MA. The incidence and nature of in-hospital adverse events: a systematic review. Qual Saf Health Care. 2008;17:216-23.

Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population safe surgery saves lives study group. N Engl J Med. 2009;360(5):491-9.

Fourcade A, Blache JL, Grenier C, Bourgain JL, Minvielle E. Barriers to staff adoption of a surgical safety checklist. BMJ Qual Saf. 2012;21:191-7.

Hurtado JJ, Jiménez X, Peñalonzo MA, Villatoro C, de Izquierdo S, Cifuentes M. Acceptance of the WHO surgical safety checklist among surgical personnel in hospitals in Guatemala City. BMC Health Serv Res. 2012;12(1):169.

Dangyangs SY, Afonne C. Awareness, knowledge and perception of safe surgery checklist and its implementation in jos university teaching hospital, Plateau State, Nigeria South American Journal of Clinical Research Special Edition 2016:1. Available at: _Knowledge_and_Perception_of_Safe_Surgery_Checklist_and_its_Implementation_in_Jos_University_Teaching_Hospital_Plateau_State_Nigeria. Accessed on 08th May 2020.

Mazzocco K, Petitti DB, Fong KT, Bonacum D, Brookey J, Graham S, et al. Surgical team behaviors and patient outcomes. The American Journal of Surgery. 2009 May 1;197(5):678-85.

Lingard L, Regehr G, Orser B, et al. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg. 2008;143:12-8.

Vohraa RS, Cowleyb JB, Bhasinc N, Barakatd HM, Goughe MJ. On behalf of the, Attitudes towards the surgical safety checklist and factors associated with its use: a global survey of frontline medical professionals. Annal Med Surg. 2015;4:119e123.

Cullati S, Licker MJ, Francis P, Degiorgi A, Bezzola P, Courvoisier DS, et al. Implementation of the surgical safety checklist in switzerland and perceptions of its benefits: cross-sectional survey. PLoS ONE. 2014;9(7):e101915.