Compliance with Health and Safety Standards in Selected Operating Rooms of Public and Private Hospitals in Baghdad, Iraq: A Cross-Sectional Comparative Audit

Abstract

Background: Operating rooms are among the most demanding areas of a hospital because infection control, sterilization, environmental conditions, equipment, staffing, documentation, and teamwork have to work together. This study examined how well selected health and safety requirements were being followed in operating rooms in public and private hospitals in Baghdad, Iraq.

Methods: We conducted an observational cross-sectional audit in eight hospitals, four public and four private, from 1 March to 28 April 2026. One operating room from each hospital was assessed with a structured checklist containing 30 indicators. An indicator received a score of 1 when the requirement was met and 0 when it was not. For each hospital, the compliance percentage was obtained by dividing the number of compliant indicators by 30 and multiplying the result by 100. Means, sample standard deviations, minimum and maximum values, and range widths were then summarized for the two sectors.

Results: The public hospitals had compliance values between 53.3% and 100.0%, whereas the corresponding range in the private hospitals was 66.7%–90.0%. The mean compliance was 80.8% (SD 21.8%) for the public hospitals and 77.5% (SD 10.0%) for the private hospitals, giving a difference of 3.3 percentage points. The wider spread among the public hospitals was more noticeable than the difference between the two means. Problems were repeatedly noted in sterilization monitoring, ventilation, fire safety, hand-hygiene facilities, staffing, training records, and clinical documentation.

Conclusion: The audited hospitals differed considerably in their level of compliance, and the public/private classification by itself did not account for that variation. The findings point to the need for audits at facility level, written corrective-action plans, and follow-up assessments. Since the hospitals were purposively selected and only one operating room was assessed in each, these results should be viewed as a local descriptive audit and not as an estimate of compliance across all hospitals in Baghdad.