الفهرس 
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Abstract
Surgical care is an integral part of health care throughout the world, with an estimated 234 million operations performed annually. (1) Surgery is performed in every community wealthy and poor, rural and urban, and in all regions. Although surgical care can prevent loss of life or limb, it is also associated with a considerable risk of complications and death.
The Institute of Medicine (IOM) has defined patient safety as ‘‘freedom from accidental injury due to medical care’’. The National Patient Safety Foundation has also defined the goal of patient safety as: “the avoidance, prevention, and amelioration of adverse outcomes or injuries stemming from the process of care.”(10) Safety does not reside in a person, device or department, but emerges from interactions of components of a system.
The risk of complications is not well reported in many parts of the world, but studies in industrialized countries have shown a perioperative rate of death from inpatient surgery of 0.4 to 0.8% , and a rate of major complications of 3 to 17%.(3, 4) These rates are likely to be much higher in developing countries.(5, 6)
In 2007, WHO Patient Safety launched the Second Global Patient Safety Challenge, Safe Surgery Saves Lives. This project’s goal was to improve the safety of patients undergoing surgical procedures around the world. The first step was to gather an international group of experts to develop a solution to the problem of unsafe surgery. Anaesthetists, operating theatre, nurses, surgeons, safety experts, patients and other professionals came together and came up with the WHO Surgery Safety Checklist. (103)
All of the items included on the Checklist are supported by evidence that, if used reliably, can reduce complications from surgery.(104)
Use of the WHO Surgery Checklist reduced the rate of deaths and surgical complications by more than one-third across all eight pilot hospitals. The rate of major inpatient complications dropped from 11% to 7%, (105) and the inpatient death rate following major operations fell from 1.5% to 0.8%.(106)
Aim of the work
The aim of this work is to assess the degree of compliance of health care providers in governmental hospitals in Alexandria, Egypt with the perioperative patient safety guidelines.
Subjects and methods
This study was a cross sectional study. The study was conducted in different surgical departments of randomly selected hospitals representing different administrative types of governmental hospitals in Alexandria. (Main University Hospital and Health Insurance Hospitals).Randomization was done by blind paper picking method.
Different health care providers including anaesthetists, nurses and surgeons were directly observed when they did surgeries in operating rooms of governmental hospitals in Alexandria ,WHO safe surgery checklist will be used to check if health care providers were compliant to its items or not .
Intraoperative observation began when the patient entered the operating theatre and ended when they left it. The Checklist divides the operation into three phases, each correspondingto a specific time period in the normal flow of a procedure:
• The periodbefore induction of anaesthesia (Sign In) phase.
• The period after induction andbefore surgical incision (Time Out) phase.
• The period during the operation and immediatelyafter wound closure but before removing the patient from the operatingroom (Sign Out) phase.
Each phase contains a very important step, in our study we observed 400 surgical operations in different departments and concerned if these steps are applicable or not in the selected hospitals.
The study was exploratory and therefore largely descriptive statistically. Quantitative data will be summarized by mean and standard deviation. Qualitative data were summarized by using frequency and percent.
The following scores were calculated:
o Score for compliance in phase I
o Score for compliance in phase II
o Score for compliance in phase III
o Over all total score for compliance in all items of perioperative patient safety guidelines.
Chi-square test, t test and ANOVA test were used to compare the compliance of health care providers with perioperative patient safety guidelines in governmental hospitals in Alexandria, Egypt.
The most important findings in our study were
Health care providers in operation rooms of governmental hospitals in Alexandria showed compliance of the WHO safe surgery checklist items as the following :
The mean compliance of the Total score “sum” is (49 .85 %) while the stage of the highest mean compliance was stage I “sign in” with a mean (66.78%) and the stage with the lowest mean compliance was stage II “time out ” with a mean (40.79%) while Stage III “sign out” showed mean compliance (42%) .
Also this study revealed low compliance to some items of the checklist as follows:
• At the “sign in” stage health care providers revealed low compliance to the following items: check of anesthesia machine and medications was (63.8%), followed by confirmed identity (60.5%). Lastly, the lowest compliance was to surgical site marking (11.50%).
• At the “time out” Stage, compliance with the pre-incision segment of WHO SSC was low in many elements: team introduce themselves (0%), assessment of blood glucose level (15.8%), display of essential imaging (18.5%) and patient warming (21%)
• At the “sign out” stage , the lowest compliance was observed in the following items: concerns for recovery management (28%) , confirmed labelled specimens (22.3%) and finally identifying equipment problems (15.9%).
Comparison betweenCompliance of health care providers in Health Insurance & Main University Hospitals revealed that:
• The mean compliance to “sign in” stage in Main University Hospital is better than that in Health Insurance Hospital (69.14 ± 27.85Vs63.75 ± 19.82 ). This difference was statistically significant, (t= -2.26, p=.024).
• The mean compliance to “time out” Stage in Health Insurance Hospital is significally better than that in Main University Hospital (42.42 ± 11.15 Vs39.66 ± 12.77). (t = 2.12, p=.004).
• The mean compliance to “sign out” stage in Health Insurance Hospital is not statistically significant lower than Main University Hospital (42.74 ± 16.79Vs41.42 ± 23.19). (t=.660, p=.509).
• There was no significant difference in total compliance of the health care providers in two hospitals to perioperative patient safety guidelines in its all stages, as mean of compliance in main university hospital (50.07 % ± 14.76) & in health insurance hospital (49.57 % ± 10.71),(t= -.388, p=.698) .
Assessment of the compliance of different health care providers to the guidelines revealed that there was significant difference between them as anesthetists showed the highest compliance to the checklist items related to their work with a mean compliance (77.5%) while surgeons showed the lowest mean compliance (42.3%). Nurses showed a mean compliance (47.3%).