Improving Compliance With the World Health Organization Surgical Safety Checklist Through a Clinical Audit at Prince Osman Digna Hospital, Sudan

Background and aim The World Health Organization (WHO) Surgical Safety Checklist (SSC) is widely used to support safe perioperative practice; however, achieving consistent and complete use in routine clinical settings remains challenging, particularly in resource-limited environments. Quality improvement audits provide a structured approach for evaluating current practice, identifying gaps, and supporting improvements in perioperative processes and team communication. This study aimed to assess baseline compliance with the WHO SSC and evaluate the impact of targeted interventions on checklist adherence at Prince Osman Digna Hospital, Sudan. Methods A closed-loop clinical audit was conducted between March and August 2025. The first cycle involved a retrospective review of all surgical cases (n = 101) performed over a two-week period, representing total coverage of eligible procedures. This was followed by a two-month intervention comprising staff education, standardized checklist documentation, and regular feedback. A second prospective audit cycle assessed all consecutive surgical cases (n = 203) performed over a three-month period, again using total coverage sampling. Compliance with SSC components across the Sign In, Time Out, and Sign Out phases was compared between cycles. Results Baseline compliance varied widely, with particularly low adherence in communication-dependent checklist items. In the first cycle, team introductions were documented in 22 (21.8%) cases, discussion of anticipated critical steps in 18 (17.8%), and completion of surgical counts in 41 (40.6%). Following the intervention, substantial improvements were observed across most parameters, including team introductions (86 (42.4%) vs. 22 (21.8%), p < 0.001), discussion of anticipated critical steps (66 (32.5%) vs. 18 (17.8%), p = 0.006), surgical counts (132 (65.0%) vs. 41 (40.6%), p < 0.001), specimen labeling (96 (47.3%) vs. 28 (27.7%), p = 0.001), and nursing sterility confirmation (184 (90.6%) vs. 25 (24.8%), p < 0.001). Several domains demonstrated large absolute improvements, while a few items, such as surgical site marking (161 (79.3%) vs. 83 (82.2%), p = 0.554), showed minimal change. Conclusions Targeted, low-cost audit interventions significantly improved adherence to the WHO SSC and strengthened perioperative communication. This project demonstrates that audit-driven strategies can effectively enhance surgical safety practices in resource-limited settings and provides a scalable model for ongoing quality improvement.