Improving Patient Safety Culture Perceptions in Resource-Limited Operating Rooms: A Nurse-Led Multifaceted Implementation of the WHO Surgical Safety Checklist.

backgroundStrengthening patient safety culture (PSC) is essential for enhancing clinical practice, teamwork, and nursing leadership in surgical settings. However, evidence on interventions that promote PSC in operating rooms (ORs) in low- and middle-income countries remains limited.

objectiveTo evaluate the association between a multifaceted intervention and PSC perceptions among OR professionals in a resource-limited setting.

methodsA quasiexperimental, nonrandomized before-and-after study with a concurrent control group was conducted over 21 months across 12 ORs in two tertiary hospitals in Tunisia. One hospital served as the intervention site and the other as the control site. All eligible healthcare professionals (n = 347; surgeons, anesthesiologists, nurses, OR specialized nurses, and assistant caregivers) were invited to participate. The intervention focused on implementing the Surgical Safety Checklist (SSC) and included team-based training, practice runs, awareness campaigns, local nurse champions, continuous mentorship, and audit and feedback processes. Data were collected at three time points (baseline, postintervention, and follow-up) using the French version of the Hospital Survey on PSC. All data were anonymized to ensure confidentiality.

resultsThe intervention was associated with significant and sustained improvements in four key dimensions of PSC: "Organizational learning-continuous improvement" increased from 37.7% to 50.6%, "Teamwork within units" from 47.6% to 59.1%, "Communication openness" from 27.2% to 46.2%, and "Teamwork across units" from 29.2% to 37.5%. The overall perceived level of safety increased from 70.7% at baseline to 82.4% postintervention and was sustained at follow-up.

conclusionsA multifaceted intervention focusing on SSC implementation and incorporating team-based training, continuous feedback, and supported practice was associated with improved PSC perceptions in a resource-limited setting. Such approaches may support the sustainable integration of safety protocols into routine surgical practice. IMPLICATIONS FOR NURSING MANAGEMENT: Findings highlight the critical role of nurse champions and the active engagement of OR managers in leading safety initiatives. Structured implementation support, including mentorship, continuous training, and audit and feedback, may facilitate adherence to the SSC. For perioperative nursing leaders in resource-limited settings, strong leadership engagement and organizational support are essential to sustain long-term implementation of safe surgical practices.