Knowledge, Safe Practices, and Safety Culture Related to the Prevention of Retained Surgical Items Among Surgical Instrumentation Students in Clinical Training in Barranquilla, Colombia: A Cross-Sectional Study

Background: Retained surgical items (RSIs) remain preventable never events associated with failures in counting processes, communication, documentation, and perioperative safety culture. Although patient safety in the operating room has been widely studied in healthcare teams, evidence remains limited regarding how these competencies are developed during undergraduate surgical instrumentation training, particularly in Latin American settings. Objective. To assess knowledge, safe practices, and perceived safety culture related to RSI prevention among surgical instrumentation students in clinical training at a university in Barranquilla, Colombia. Methods. A quantitative cross-sectional study was conducted among students in advanced semesters of a Surgical Instrumentation program. Data were collected through a structured, self-administered questionnaire that included sociodemographic characteristics, knowledge of RSI prevention, safe perioperative practices, perceived safety culture, and need for further training. The instrument showed good internal consistency (Cronbach’s alpha = 0.88) in the 48 completed questionnaires analyzed. Descriptive statistics were calculated for all variables. Because of sample size and ordinal outcomes, Mann-Whitney U, Kruskal-Wallis H, and Spearman’s rho were used. Results. A total of 48 complete questionnaires were analyzed. Mean age was 21.10 years (SD 2.25), and 75.0% of participants were women. Global knowledge scores were high (mean 8.60/9; SD 0.92), with ceiling effects across several items. Safe practices (mean 4.58/5; SD 0.63) and safety culture (mean 4.67/5; SD 0.49) were also high overall. However, lower-performing items were institutional count documentation, verification during staff handovers, and requesting a formal count pause. Knowledge scores were significantly higher among students reporting prior training in count/recording procedures (p=0.018). The strongest association was a moderate positive correlation between safety culture and safe practices (rho=0.520; p<0.001). Conclusions. Surgical instrumentation students showed strong theoretical knowledge and favorable self-reported preventive practices regarding RSI prevention. Nonetheless, important gaps persisted in handover verification, institutional documentation, and count-pause activation. The positive association between safety culture and safe practices suggests that undergraduate perioperative education should integrate technical counting skills with structured communication, supervision, teamwork, and speaking-up behaviors.