Examining the implementation and impact of surgical guidelines in Level 4 and 5 hospitals in Kenya

Introduction: Surgical guidelines are essential for improving safety, reducing errors, and optimizing outcomes. Developed in 2009, Kenya’s national clinical guidelines aim to standardize surgical practices across healthcare facilities. However, there is limited evidence on their dissemination, adaptation, and utilization, especially in county hospitals. This study investigates the use of surgical guidelines in Kenya’s Level 4 and 5 hospitals, identifies barriers to implementation, and evaluates their impact on surgical outcomes. Methods: We conducted a cross-sectional study across four counties in Kenya, focusing on hospitals capable of providing emergency and specialized surgical services. Data were collected through structured, in-person interviews with surgical department heads, staff, and medical superintendents. Trend analysis of interview data was employed to examine access, training, enforcement, barriers to implementation, and impacts on surgical practices. Results: Forty-three participants from five hospitals reported that 91% had access to surgical guidelines. The World Health Organization (72%) and Ministry of Health (40%) guidelines were most commonly used, primarily covering preoperative (58%), intraoperative (44%), and postoperative (56%) care. In-person training (65%) was most common, and guidelines were credited with improved services (43%), reduced errors (38%), and enhanced infection control (28%). However, resource constraints (50%), staff attitudes (24%), and human capital shortages (15%) were significant barriers. While 76% used enforcement mechanisms, inconsistent application and resource limitations hindered effectiveness. Conclusion: Surgical guidelines are seen as valuable for improving care, but barriers such as resource limitations, poor dissemination, and inconsistent enforcement undermine their full potential. Addressing these challenges through better training, resource allocation, and leadership support is essential.