Evaluation of Surgical Site Marking Practices Before Orthopaedic Procedures at Irrua Specialist Teaching Hospital

Surgical site errors, including wrong-site and wrong-side surgery, represent preventable patient safety events with severe consequences. Proper surgical site marking is a WHO-recommended safety checkpoint that guards against such errors. This study evaluates compliance with and barriers to surgical site marking practices before orthopaedic procedures at Irrua Specialist Teaching Hospital (ISTH), Edo State, South South Nigeria, from 2022 to 2023. A prospective observational audit and concurrent cross-sectional staff survey were conducted. Sixty orthopaedic surgical procedures were observed, and 40 surgical and nursing staff members completed a validated questionnaire on attitudes toward and practice of site marking. Compliance with surgical site marking was observed in only 52% of procedures. The most common barriers identified were lack of formal training (cited by 60% of respondents), absence of an institutional protocol, and time pressure in emergency settings. Awareness of WHO surgical safety standards was high, but implementation was inconsistent. The study recommends mandatory surgical site marking training incorporated into residency curricula, development of a standardized hospital-wide orthopaedic safety protocol, and surgical safety committee oversight at ISTH and comparable institutions in South South Nigeria. Keywords: surgical site marking, patient safety, orthopaedic surgery, Irrua, wrong-site surgery