A cross-sectional survey investigating self-reported usage of the World Health Organization Surgical Safety Checklist among surgical team members at a tertiary hospital in Lilongwe, Malawi

Background: The World Health Organization (WHO) Surgical Safety Checklist (SSC) is a tool to assist surgical teams to optimize the safety of surgery. Its implementation has been shown to significantly reduce postoperative morbidity and mortality. Before the conceptualization of this study, we were not aware of any published data regarding SSC utilization in Malawi. Methods: This was a cross-sectional study assessing knowledge and utilization of the SCC at Kamuzu Central Hospital—a tertiary health facility in Lilongwe, Malawi. Results: Out of 44 respondents, 40 (90.9%) were familiar with the checklist, but only 9 (20.5%) reported using the checklist with every procedure. The most commonly reported reasons for not using the SSC were laziness (n=15, 34.1%) and intentional ignoring of the checklist (n=15, 34.1%). Participants explained that some surgical team members thought that the WHO SSC was a waste of time, some did not understand its importance, and that some contextual and cultural considerations inhibit its use. Of those ever trained on SSC usage, 66% desired refresher training. Of those who had not been trained on SSC usage, 85% desired such training. Conclusions: Study participants reported underutilization of the WHO SCC. Although a majority of the theatre staff were familiar with the checklist, only about one-fifth them reported using it for every surgical procedure. This study identified reported reasons for the underutilization of the WHO SSC, and these data could help inform strategies to overcome these barriers. Potential strategies include mandatory SSC training and implementation.