{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T05:07:32Z","timestamp":1791090452654,"version":"4.1.0"},"reference-count":67,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/501100007446","name":"King Khalid University","doi-asserted-by":"publisher","award":["RGP2\/348\/46"],"award-info":[{"award-number":["RGP2\/348\/46"]}],"id":[{"id":"10.13039\/501100007446","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2026,4,3]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2019 safety attitudes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 \u2018always\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjqs-2025-019076","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T09:53:55Z","timestamp":1776851635000},"page":"527-540","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Surgical safety checklist awareness and safety attitudes in the Eastern Mediterranean region: a cross-sectional study"],"prefix":"10.1136","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2155-8500","authenticated-orcid":false,"given":"Assem","family":"Gebreal","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatma Badr","family":"El Dine","sequence":"additional","affiliation":[{"name":"Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Alexandria University, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albaraa","family":"Abdulsalam","sequence":"additional","affiliation":[{"name":"University of Aleppo, Aleppo, Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1495-6620","authenticated-orcid":false,"given":"Doaa Hamdy","family":"Aly","sequence":"additional","affiliation":[{"name":"Egypt Ministry of Health & Population, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9197-6396","authenticated-orcid":false,"given":"Shaimaa","family":"Abdelaziz Abdelmoneim","sequence":"additional","affiliation":[{"name":"Alexandria Health Affairs Directorate, Ministry of Health and Population, Alexandria, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walid M","family":"Abd El Maksoud","sequence":"additional","affiliation":[{"name":"Department of General Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siwar Belhaj","family":"Salem","sequence":"additional","affiliation":[{"name":"University of Monastir, Monastir, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaa Nadir Mohamed","family":"Abdelrahim","sequence":"additional","affiliation":[{"name":"University Hospital Sharjah, Sharjah, UAE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saja A","family":"Albanaa","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Baghdad, Baghdad, Iraq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0207-7584","authenticated-orcid":false,"given":"Saja","family":"Alasaad","sequence":"additional","affiliation":[{"name":"Syrian Private University, Damascus, Syrian Arab Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv Yussuf","family":"Ali","sequence":"additional","affiliation":[{"name":"University of Nairobi Faculty of Veterinary Medicine, Kangemi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramez M","family":"Odat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noha","family":"Taymour","sequence":"additional","affiliation":[{"name":"Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tabraiz Amin","family":"Malik","sequence":"additional","affiliation":[{"name":"C.M.H. 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