Safe surgery: Tool and Resources
The WHO Surgical Safety Checklist was developed after extensive consultation aiming to decrease errors and adverse events, and increase teamwork and communication in surgery. The 19-item checklist has gone on to show significant reduction in both morbidity and mortality and is now used by a majority of surgical providers around the world.
Other translations
Checklist Adaptation Guide
Speakers' kit
Starter Kit
This starter kit will help administrators, clinicians, nurses, and other patient safety personnel walk through the process of implementing the WHO Surgical Safety Checklist in a facility.
Other materials

1 May 2008
The second global patient safety challenge : safe surgery saves lives

Infographic
Safe Surgery Saves Lives poster
WHO Surgical Safety Checklist Implementation
As with any new tool, one of the biggest challenges of the WHO Surgical Safety Checklist is to ensure its successful implementation. WHO thus launched an implementation manual alongside the Checklist to aid its introduction.

2 April 2009
Implementation manual WHO surgical safety checklist 2009
Safe surgery saves lives

3 April 2009
WHO Guidelines for safe surgery: safe surgery saves lives
Modifying the Checklist for implementation
To ensure successful implementation, it is important to make sure that the Checklist is suitable for your setting. Adaptation after local consultation is encouraged.
Reproduction of the WHO Surgical Safety Checklist
The WHO Surgical Safety Checklist can be reproduced in its entirety without any modifications or adaptations to layout or wording. This includes the WHO emblem as it appears as an integral part of this tool.
If the Checklist is modified in any way, the WHO logo should not be used. Instead, in order to acknowledge the original WHO source, the Checklist should bear the following text:
“Based on the WHO Surgical Safety Checklist,© World Health Organization 2009. All rights reserved.”
- Copyright and translation
- Request for permission to reprint and reproduce the Checklist
How do I know whether the Checklist we already use meets the goals of the WHO Surgical Safety Checklist?
Conduct a small test. Print out the WHO Checklist, use it for a case, and note the following:
- Does the entire team stop all other activity for a few moments at three critical points, i.e., pre-anesthesia, pre-incision and before the patient leaves the OR? The goal is for the entire team to participate in each pause. (The surgeon may not have to be present for the pre-anesthesia check.)
- Does the entire team verbally confirm each item on the WHO Checklist? The goal is for the entire team to participate. At a minimum, every item on the WHO Checklist should be confirmed. Other items may also be addressed.
- Are the items verified without reliance on memory? The goal is to use a tool for reference to ensure every item is covered, e.g., a form, poster, or computer screen.
If you can answer “yes” to all of these questions, then the spirit of the WHO Checklist is being met. Consider running through this exercise with several more cases to see if this occurs with every patient every time. If not, redesign your processes to ensure it does.
Improving teamwork and communication is one of the main goals of using a checklist. Many hospitals are already doing most of the items on the list but not reviewing them as a team. If there is no designated point when these items are reviewed, it is common to find that they are verified most of the time, but not every time, i.e., not consistently. The results of the WHO pilot study appear to confirm the conclusions of a number of earlier studies that indicate that preoperative team introductions and briefings and postoperative debriefings contribute to improved processes and outcomes.
Frequently asked questions (FAQs)
Patient safety: Safe surgery saves lives Patient safety: Safe surgery saves lives
Global support for Safe Surgery Saves Lives
A range of professional societies and organizations from countries worldwide have expressed their support for the creation of a WHO Surgical Safety Checklist and the Safe Surgery initiative. During the active phase of the campaign, the following endorsed the Checklist:
Alphabetical list of supporting organizations
- Academia Mexicana de Cirugia
- Accreditation Canada
- Action Against Medical Accidents (AvMA)
- Adelaide and Meath Hospital, Dublin Incorporating the National Children's Hospital Department of Surgery
- Advanced System Safety Management (ASSM)
- Agencia de Calidad Sanitaria de Andalucía
- Agencia Nacional de Vigilancia Sanitaria
- Agencia Valenciana De Salud
- Agency for Healthcare Quality and Accreditation, Federation of Bosnia and Herzegovina
- All India Institute of Medical Sciences Cardiothoracic Centre
- American Academy of Orthopaedic Surgeons/ American Association of Orthopaedic Surgeons
- Associacion de Coloproctologia del Sur
- American Academy of Otolaryngology-Head & Neck surgery
- American Association of Neurological Surgeons (AANS)
- American Association of Nurse Anesthetists
- American College of Surgeons
- American Orthopaedic Association
- American Society of Anaesthesiologists
- An Bord Altranais
- Anesthesia Patient Safety Foundation
- Asia & Oceania Federation of Obstetrics & Gynaecology
- Asociacion Argentina de Ciruganos
- Asociacion Colombiana de Cirugia
- Asociacion Colombiana de Neurocirurgia
- Asociacion Costarricense de Cirugia
- Asociación de Cirujanos Pediatras de Costa Rica
- Asociación de Médicos Anestesiólogos de Costa Rica
- Asociacion Ecuatoriana De Escuelas Y Facultades De Enfermeria
- Asociacion Española de Cirujanos
- Asociación Española de perfusionistas
- Asociacion Guatemalteca de Neurocirurgia
- Asociacion Guatemalteca de Anestesiologia Reanimacion y Tratamiento del Dolor (AGARTD)
- Asociacion Guatemalteca de Cardiologia
- Asociacion Guatemalteca de Ciencias Neurologicas
- Asociacion Guatemalteca de Cirurgia Neurologica
- Asociacion Guatemalteca de Endoscopia Motilidad e Intervencion Gastrointestinal
- Asociacion Guatemalteca de Enfermeras
- Asociacion Guatemalteca de Medicina y Cirugia Amrulatoia
- Asociacion Guatemalteca de Neurologia
- Asociacion Guatemalteca de Patologia
- Asociacion Medica de Oncologos de Guatemala
- Asociacion Nicaraguense de Anestesiologia y Reanimacion (ANARE)
- Asociacion Quirurgica de Honduras
- Associacao dos Enfermeiros de Sala de Operacoes Portuhueses (AESOP)
- Association for Perioperative Practice
- Association of Anaesthesiologists, Suriname
- Association of Anaesthetists of Great Britain and Ireland
- Association of Nurses of Nicaragua (Asociacion de Enfermeras/os Nicaraguenses)
- Association of Orthopaedic and Trauma Surgeons of Malta
- Association of periOperative Registered Nurses
- Association of Surgeons of Malta
- Association of Surgeons of South Africa
- Australian & New Zealand College of Anaesthetists
- Australian College of Operating Room Nurses (ACORN)
- Australian Society of Anaesthetists
- Aut Even Hospital
- Azerbaijan Medical Association
- Beacon Hospital
- Belize Healthcare Partners Limited
- Belize Medical Associates
- Blackrock Clinic
- Bon Secours Health System
- Bon Secours Hospital Cork
- Bon Secours Hospital Galway
- Bon Secours Hospital Glasnevin
- Bon Secours Hospital Tralee
- British Anaesthetic and Recovery Nurses Association
- British Medical Association
- British Orthopaedic Association
- Caja de Seguro Social
- California Hospital Association
- California Hospital Patient Safety Organization
- Cambridge Health Alliance
- Canadian Anesthesiologists' Society
- Canadian Association of General Surgeons
- Canadian Medical Association
- Canadian Patient Safety Institute
- Children's Hospital Boston
- Children's University Hospital
- Clane General Hospital
- Clean Hands-Safer Care
- Clinica Hospital San Fernando Panama
- Clinical Indemnity Scheme
- CLUB del BLOQ QUIRURGIC (CBQ) de Catalunya (España)
- Colegio Brasileiro de Cirugioes
- Colegio de Ciencias de la Salud de la Universidad San Francisco de Quito
- Colegio de Enfermeras de Costa Rica
- Colegio de Medicos y Cirujanos de Costa Rica
- Colegio de Profesionales de Enfermería de Honduras
- Colegio Domenicano de Cirujanos, Inc
- Colegio Médico de Peru
- Colegio Nacional de Enfermeras
- College of Anaesthesiologists of Sri Lanka
- College of Anaesthetics
- College of Operating Department Practitioners, UK
- College of Surgeons of East Central and Southern Africa
- College of Surgeons, Academy of Medicine of Malaysia
- Comision nacional de arbitraje médico
- Connolly Hospital
- Conselho Federal de Medicina, Brazil
- Consumers Advancing Patient Safety (CAPS)
- Consumers Union
- Cork University Hospital
- Council on Surgical and Perioperative Safety
- Danish Society of Anaesthesiology and Intensive Care Medicine (DASAIM)
- Department of Health & Children, Ireland
- Department of Orthopaedics, HSE West, Mid-Western Regional Hospital Dooradoyle
- Dr Adul Muttalibali Yousif
- Dr Imad Jalilsallal
- Egyptian Society of Anesthesiologists
- Egyptian Society of Surgeons
- El Instituto Salvadoreno del Seguro Social
- Escuela Nacional de Enfermeras de Guatemala
- Ethiopian Society of Anesthesiologists Professional Association (ESAPA)
- European Association of Endoscopic Surgery
- European Board and College of Obstetrics and Gynaecology Europe
- European Hospital Healthcare Federation- HOPE
- European Operating Room Nurses Association
- Faculty Board of Orthopaedic Surgery, Brussels University
- Federacion Argentina de Asociaciones de Anestesia, Analgesia Y Reanimacion (FAAAAR)
- Federación Argentina de Enfermería
- Federation of Obstetrics and Gynecology Societies of India
- Galway Clinic
- Galway University Hospitals -University College Hospital
- Georgetown Public Hospital Corporation, Guyana
- Georgian Alliance for Patient Safety
- Georgian Association of Obstetric & Gynecology Anesthesiologits
- Georgian Association of Surgeons
- Georgian Association of Transplantologists
- Georgian Nurses Association
- German Society for Surgery
- Government of Saint Christopher and Nevis, Ministry of Health
- Great Ormond Street Hospital for Children
- Greek Operating Room Nurses Association (GORNA)
- Gulf Cooperation States, Council of Health Ministers for Cooperation Council States
- Guyana Nurses Association
- Health Information and Quality Authority
- Health Management Institute of Ireland
- Health Service Executive
- Health Service Executive South
- Health Service Executive West
- Health Volunteers Overseas
- HELIOS Hospital Group, Germany
- Hermitage Medical Clinic
- Ho Chi Minh City Infection Control Society (HICS)
- Hong Kong Academy of Medicine
- Hong Kong Association of Specialists in Dermatology
- Hong Kong College of Obstreticians and Gynaecologiests
- Hong Kong Society of Dermatology and Venereology
- Hospital Clínic – University of Barcelona
- Hospital de Ortopedia para Niños
- Hospital del Niño, Panamá
- Hospital San Juan de la Cruz Spain
- Hospital San Miguel Arcangel Panama
- International Association for Humanitarian medicine
- International Association of MDG Trainers
- International Confederation for Plastic Reconstructive & Aesthetic Surgery
- International Federation for Medical & Biological Engineering
- International Federation of Gynecology and Obstetrics
- International Federation of Nurse Anesthetists
- International Federation of Perioperative Nurses
- International Federation of Surgical Colleges
- International Society of Aesthetic Plastic Surgery (ISAPS)
- International Society for Quality in Health Care
- Irish Anaesthetic & Recovery Nurses Association
- Irish Association for Emergency Medicine
- Irish Association of Theatre Managers and Superintendents
- Irish Association of Vascular Surgeons
- Irish Higher Surgical Training Group
- Irish Hospital Consultants Association
- Irish Institute of Trauma & Orthapaedic Surgery
- Irish Medical Organisation
- Irish Nurses Organisation
- Irish Patients Association
- Irish Society for Quality & Safety in Healthcare
- Irish Society of Urology
- Jordanian Surgical Society
- Justin's HOPE at the Task Force For Child Survival and Development
- Karl Heusner Memorial Hospital, Belize
- Kimberley Hospital Complex , Northern Cape Department of Health
- Kuwait Medical Association
- Libyan Society of Anesthesiologists
- Macedonian Medical Association
- Malta College of Obstetricians and Gynaecologists
- Malta Union of Midwives and Nurses
- Mater Misericordiae University Hospital
- Mater Private Hospital
- Medical Council of Guyana
- Medical Women's International Association
- Mediterranean Council for Burns and Fire Disasters
- Ministerio da Saude, Brazil
- Ministerio de Salud, Peru
- Ministerio de Salud Publica y Asistencia Social, Guatemala
- Ministerio de Salud Publica, Viceministerio de Asistenica Medica Y Social, Direction Nacional de Servicio Hospitalarios, Cuba
- Ministry of Health and Social Development, Anguila
- Ministry of Health and Social Development, Antigua and Barbuda
- Ministry of Health, Bahrain
- Ministry of Health, Belize
- Ministry of Health and Environment, Commonwealth of Dominica
- Ministry of Health, Ecuador
- Ministry of Health, El Salvador
- Ministry of Health, Grenada
- Ministry of Health, Iraq
- Ministry of Health, Kingdom of Saudi Arabia
- Ministry of Health and Community services, Montserrat
- Ministry of Health, Oman
- Ministry of Health, Qatar
- Ministry of Health, Romania
- Ministry of Health and the Environment, St Vincent and The Grenadines
- Ministry of Public Health and Information, Yemen
- Moroccan Nurses Association
- Mothers Against Medical Error
- Mothers Against Medical Errors (MAME)
- Mount Carmel Hospital
- National Center of Quality, Safety & Accreditation of Albania
- National Concern for Health Care Infections, UK
- National Patient Safety Challenge (NHS) UK
- National Patient Safety Foundation
- Nederlandse Vereniging Van Anesthesiemedewerkers
- New European Surgical Academy (NESA)
- New York City Health and Hospitals Corporation
- New Zealand Society of Anaesthetists
- North American Spine Society
- North Carolina Center for Hospital Quality and Patient Safety
- Nursing and Midwifery, Sudan
- Obstetrical & Gynaecological Society of Bangladesh
- Operating Department Nurses Section- Irish Nurses Organisation
- Operating Room Nurses Association of Canada
- Operation Smile
- Our Lady of Lourdes Hospital
- Our Lady's Children's Hospital
- Pakistan Institute of Medical Sciences
- Panama-Hospital Santo Tomas
- Patient Focus
- Patients for Patient Safety Canada
- Patientsafety.hu
- Philippines College of Surgeons
- Physicians for Peace
- Prince Sultan Cardiac Center
- Programa Nacional de Calidad y Seguridad del Paciente, Costa Rica
- Riyadh Medical Complex
- Rotunda Hospital
- Royal Australasian College of Surgeons
- Royal College of Anaesthetists
- Royal College of Nursing
- Royal College of Obstetricians and Gynaecologists
- Royal College of Physicians and Surgeons of Canada
- Royal College of Physicians and Surgeons of Glasgow
- Royal College Of Physicians Ireland
- Royal College of Surgeons of Edinburgh
- Royal College of Surgeons of England
- Safe Care Campaign
- Secretaria de Salud, Mexico
- Servizio Sanitario Regionale Emilia-Romagna, Azienda Ospedaliero-Universitaria di Modena
- Shanakiel Hospital
- Sindicato Médico del Uruguay
- Slovenian Association of Surgeons
- Sociedad Chilena de Enfermeras de Pabellones Quirurgicos y Esterilization
- Sociedad Colombiana de Anestesiologia y Reanimacion (SCARE)
- Sociedad Colombiana de Cirugía Ortopédica y Traumatología
- Sociedad de Cirujanos de Chile
- Sociedad de Dominicana de Anestesiología.
- Sociedad Española de Anestesiología, reanimacion y terapéutica del dolor
- Sociedad de Gastroenterología del Perú
- Sociedad de Ginecologia de Nicaragua
- Sociedad Mexicana de Medico con Especialidad de Cirurgia de Columna (SMMECICO)
- Sociedad Paraguaya de Cirugia
- Sociedad Peruana de Cirugia Cardiaca Toracica y Vascular
- Sociedad Peruana de Cirugia Plastica
- Sociedad Venezolana de Anestesiología
- Societe Internationale de Chirurgie Orthopedique et de Traumatologie (SICOT)
- Societe Marocaine d'Anesthesie et de Reanimation (SMAR)
- Societe Sciences Medicales Mauritaniennes
- Societe Tunisienne d'Anesthesie D'Analgesie et de Reanimation
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)
- Society for Cardiothoracic Surgery in Great Britain and Ireland
- Society of Obstetricians and Gynaecologists of Canada (SOGC)
- Spectrum Clinic & Endoscopy Research Institute
- St. John's Hospital
- St. Vincent's University Hospital
- Stiftung für Patientensicherheit (Patient Safety Foundation)
- Sudan Association of Anaesthetists
- Sudan Association of Surgeons
- Suriname Nurses Association
- Swedish Association of Health Professionals
- Swedish Association of Oral & Maxillofacial surgeons (Svensk Käkkirurgisk Förening)
- Swedish Association of Otorhinolaryngology, Head and neck surgery
- Swedish Medical Association
- Swedish Orthopaedic Association
- Swedish Society of Obstetrics & Gynecology
- Swedish Surgical Society
- Swedish Transplantation Society
- Syrian Association of Surgeons
- Tanzania Surgical Association
- Theodor Bilharz Research Institute
- TOPLUM SAGLİGİ ARASTIRMA ve GELISTIRME MERKEZI (Center for Research and Promotion of Community Health), Turkey
- Trinidad & Tobago Association of Midwives
- Trinidad & Tobago Registered Nurses Association
- Union Española de Sociedades Cientificas de Enfermeria
- Universidad de San Carlos de Guatemala
- University of Minnesota Medical School
- Voluntary Health Insurance Board
- Wexford General Hospital
- World Federation of Societies of Anaesthesiologists