Associations between patient safety culture, occupational exposure behaviours and patient safety behaviours among operating theatre nurses: a multicentre cross-sectional study

Abstract

Patient safety in operating theatres is influenced by organisational safety culture and nurses’ safety-related behaviours. Occupational exposure remains a frequent hazard in perioperative settings; however, its relationship with patient safety culture (PSC) and patient safety behaviours (PSBS) has not been fully clarified. This study aimed to examine the associations among PSC, occupational exposure behaviours (OEBS), and PSBS among operating theatre nurses. A multicentre cross-sectional study was conducted between March and June 2025 in the operating theatres of two tertiary general hospitals. Of 185 nurses invited, 173 completed the questionnaire, corresponding to a response rate of 93.5%. After prespecified exclusions, 130 questionnaires were retained for analysis, corresponding to a data-retention rate of 75.1%. PSC was measured using the Hospital Survey on Patient Safety Culture 2.0, whereas OEBS and PSBS were assessed using two self-developed scales that underwent preliminary within-sample psychometric evaluation; Pearson correlation, multivariable linear regression, and exploratory indirect-association analyses were performed to examine associations, adjusting for study centre and prespecified demographic and work-related covariates. The overall positive response rate was 72.8%, while the mean OEBS and PSBS total scores were 39.8 ± 5.6 and 41.2 ± 4.9, respectively. PSC was positively correlated with OEBS ( r = 0.32, p < 0.001) and PSBS ( r = 0.41, p < 0.001). OEBS was also positively correlated with PSBS ( r = 0.36, p < 0.001). In the fully adjusted joint model including both PSC and OEBS, PSC (β = 0.29, 95% CI 0.15–0.43, p < 0.001) and OEBS (β = 0.24, 95% CI 0.08–0.40, p = 0.002) were both statistically associated with PSBS. Exploratory statistical decomposition indicated an indirect association between PSC and PSBS through OEBS (B = 0.74, 95% BCa CI 0.21–1.60). PSC was positively associated with both OEBS and PSBS among operating theatre nurses. OEBS may represent a behavioural domain associated with organisational safety culture and frontline perioperative safety practices. These exploratory findings identify potential areas for further safety assessment, but do not establish intervention effectiveness. Not applicable.