Strengthening Surgical Safety in Somalia: The Role of Scrub Nurses in Infection Prevention and Team Communication in Resource-Limited Operating Theatres

Surgical safety in resource-limited health systems is undermined by workforce shortages, limited equipment, inconsistent sterilisation systems, incomplete use of standardised safety tools, and hierarchical team cultures. In Somali operating theatres, scrub nurses are close to the sterile field and procedural workflow, yet their safety role is often treated as technical support rather than recognised clinical leadership. This commentary addresses the gap between scrub nurses' substantial responsibility for infection prevention, counts, equipment readiness, and checklist communication and their limited authority to shape systems or halt unsafe practice. It argues that improving surgical safety requires hospitals to recognise scrub nurses as patient-safety leaders and to address three linked tensions: responsibility without authority, safety expectations amid resource scarcity, and professional accountability within hierarchical teams. The commentary interprets global guidance and published Somali evidence through these tensions and proposes practical responses, including locally adapted checklist use, standardised counts, escalation pathways for sterility and equipment concerns, structured briefings and debriefings, nurse participation in procurement and quality governance, and locally relevant professional development. These measures can convert scrub nurses' proximity to risk into formal influence over prevention and learning. The distinctive contribution of this commentary is therefore not simply to restate scrub nursing duties, but to show that safer surgery in Somalia depends on aligning nurses' safety responsibilities with the authority, resources, and organisational support needed to fulfil them.