Perception and Involvement of Operating Room Professionals in the Use of the Surgical Safety Checklist: A Cross-Sectional Study in Cameroon
Abstract
A cross-sectional study examining operating room professionals’ knowledge, perceptions and actual use of the WHO Surgical Safety Checklist in two referral hospitals in Yaoundé, Cameroon.
The WHO Surgical Safety Checklist is a simple, low-cost patient safety tool used in operating rooms worldwide. However, knowing about the checklist and applying it effectively during real surgical practice are different challenges. In Cameroon and other resource-limited settings, a gap can exist between theoretical knowledge and consistent implementation.
Between March and June 2025, a cross-sectional study was conducted in the operating theatres of two referral hospitals in Yaoundé. Forty-one surgical team members completed a structured questionnaire. A trained observer also directly observed 25 surgical procedures to assess how completely the checklist was used in real-time practice.
Eighty-five percent of participants could accurately describe the checklist and all respondents agreed that it improves patient safety. However, 46% considered it burdensome and 73% reported difficulty using it during emergencies. Direct observation showed that approximately 60% of checklists were executed incompletely or only on paper. Adherence was 78% at Sign-In, 52% at Time-Out and 41% at Sign-Out.
Operating room professionals understood the value of the WHO Surgical Safety Checklist, but this awareness did not consistently translate into meaningful practice. The findings support stronger senior clinical leadership, practical team-based training, particularly for emergencies, and better integration of the checklist into routine surgical workflow.
85% Correctly Defined the SSC
Thirty-five of the 41 operating room professionals could correctly define the Surgical Safety Checklist, demonstrating a high level of general awareness.
100% Recognised Its Safety Value
All 41 respondents acknowledged the checklist’s objectives and agreed that it improves patient safety and helps prevent surgical errors.
71% Identified All Three Phases
Twenty-nine participants correctly identified the Sign-In, Time-Out and Sign-Out phases in the correct sequence, revealing a remaining knowledge gap despite high overall awareness.
78% Recognised Communication Benefits
A substantial majority of respondents believed that the Surgical Safety Checklist improves communication within the operating room team.
46% Considered the Checklist Burdensome
Nearly half of participants perceived checklist use as an additional administrative burden, highlighting an important implementation barrier.
73% Reported Difficulty in Emergencies
Thirty participants reported that the checklist was difficult to apply correctly and consistently during emergency procedures, where time pressure is particularly significant.
Approximately 60% Were Poorly Executed
Direct observation of 25 surgical procedures showed that roughly 60% of checklists were incomplete, lacked meaningful team engagement or were reduced to superficial completion.
78% Correct Execution
The Sign-In phase performed before anaesthesia induction showed the highest observed compliance of the three WHO checklist phases.
Compliance Fell to 52%
Correct execution declined substantially during Time-Out, the critical pre-incision pause requiring collective participation by the operating room team.
Only 41% Correct Execution
Sign-Out demonstrated the lowest compliance, showing a progressive decline in checklist execution from the beginning to the end of the surgical procedure.
Positive Attitudes Did Not Ensure Practice
The contrast between universal endorsement of the checklist and incomplete observed execution illustrates an important gap between knowledge, perception and real-world practice.
Leadership, Training & Feedback Are Needed
The study supports visible senior leadership, team-based and simulation training, regular non-punitive feedback and integration of the checklist into routine operating room procedures.
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Original Research
A descriptive cross-sectional study examining knowledge, perceptions and real-world use of the WHO Surgical Safety Checklist among operating room professionals in Cameroon.
Two Referral Hospitals in Yaoundé
The study was conducted between March and June 2025 in the operating rooms of the Military Hospital of Region 1 and Bethesda Hospital, representing public and private surgical settings.
41 Operating Room Professionals
Participants included professionals actively working in the operating rooms, including surgeons, nurse anaesthetists, operating room nurses and assistant operating room staff.
25 Surgical Procedures
A trained investigator directly observed 25 elective and emergency surgical procedures using a structured observation grid to assess actual checklist execution.
Questionnaire + Observation
The study combined a structured self-administered questionnaire with non-participant observation, allowing self-reported knowledge and perceptions to be compared with actual operating room practice.
Descriptive Analysis
Questionnaire and observational data were analysed using Sphinx Plus V5 and Microsoft Excel 2016. Categorical data were reported using frequencies and percentages.
Institutional Ethical Approval
Ethical approval was obtained from the institutional review boards of both participating hospitals. Participation was voluntary, informed consent was obtained, and study data were anonymised and securely stored.
From Awareness to Reliable Practice
The findings support team-based and simulation training, visible leadership from senior clinicians, regular non-punitive performance feedback and integration of the SSC into standard operating procedures.
Equal Contributions
All authors contributed equally to the conception and design of the study, data collection, analysis and interpretation of results, and drafting and final approval of the manuscript.
Conflict of Interest & Funding
Conflict of Interest:
The authors declare no conflict of interest.
Funding:
This research received no specific grant from any public,
commercial, or not-for-profit funding agency.
Language Editing & Grammar Only
Artificial intelligence tools were used solely for language editing and grammatical support during manuscript preparation. No AI tools were used for data generation, data analysis, interpretation of results or substantive content creation. The authors take full responsibility for the manuscript’s content.
Available on Reasonable Request
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Editorial Timeline
CC BY 4.0
This article is published under the Creative Commons
Attribution 4.0 International licence.
DOI: 10.64573/torgj2601002
Volume 2 · Issue 2 · Special Issue · 2026
The Operating Room Global Journal (TORGJ).
ISSN 3105-3262.
Original Research.
DOI: 10.64573/torgj2601002.
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