Manual counts – in which the surgical team verifies that all sponges are accounted for before concluding the procedure – are standard practice , but counts can be inaccurate . If miscounts result in a retained sponge , complications can ensue , with consequences for both the patient and the healthcare facility .
These include :
• Subsequent patient health impacts , such as infections or the need for secondary operations .
• Prolonged surgical times when a sponge is , or is thought to be , missing . In addition to potential adverse health consequences for the patient – such as increased risks of infections , hypothermia , cardiac arrhythmias , and other postoperative complications – prolonged surgeries can lead to increased costs or reduced revenue for the facility .
• Financial and reputational harm to the healthcare facility when a retained surgical sponge results in litigation or negative publicity .
Technologies that supplement the manual counting process are available and have been found to be effective when used correctly and consistently . ECRI contends that broader adoption of these technologies could further reduce the risk that a surgical sponge will be unintentionally retained during a procedure .
ECRI states that manual counting protocols are standard practice for reducing the risk that sponges or any other surgical soft goods will be unintentionally retained within the patient . However , manual counts have limitations – the possibility of a miscount being an obvious one . For instance , staff may conclude that all sponges have been accounted for when in fact a sponge is missing . In this case , the surgical team might not learn of the discrepancy unless ( or until ) the patient returns with a complaint of pain or discomfort . Several studies have found that in most cases in which an unintentionally retained sponge was later identified , surgical staff had thought that the manual count was correct . In other situations , staff may determine that a sponge is missing . Whether this determination is correct or incorrect , the surgical team must try to locate the sponge before surgical closure , extending the surgery and likely requiring an intraoperative X-ray .
Technology options consist of a scanning device that can count or detect proprietary sponges that incorporate a detectable tag . These technologies can be used to aid in the counting and / or detection of sponges ( and other soft goods ), thus serving as a technological adjunct to manual counts . Current systems offer the following :
• Counting , using a bar-coding system – These systems use a scanning mechanism to count uniquely coded items in and out of the procedure ( i . e ., before incision and then before any type of surgical closure ).
• Detection , using a radio-frequency ( RF ) system – These systems can verify the presence of a misplaced or unaccounted-for sponge , which may be inside the patient or elsewhere in the OR ( e . g ., in the trash , on the floor ).
• A combination of counting and detection , using a radio-frequency identification ( RFID ) system .
ECRI notes that despite their apparent effectiveness , such technologies have not yet been implemented widely . ECRI estimates that approximately 20 percent of U . S . hospitals use some form of adjunct technology to supplement the manual counting process or to aid in the detection of missing sponges .
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Although accurate data is hard to come by , available research suggests that every year thousands of U . S . patients could experience a retained surgical item ( RSI ), with surgical sponges being the most commonly retained item .
Barriers to implementation likely include the added steps involved in incorporating the technologies into a surgical procedure as well as the added expense associated with their use . “ It might take some time for OR staff to get used to a new workflow ,” notes Julie Miller , senior project engineer in ECRI ’ s Health Devices Group , “ but facilities should also take into account the time and expense associated with a retained sponge .”
A cost analysis using ECRI ’ s PriceGuide data shows that the use of proprietary tagged sponges could cost an additional $ 12 per procedure , compared with using traditional sponges . Additionally , ECRI found during its testing that using a sponge counting or detection technology added about one minute ( or less ) to each testing scenario . Miller counters : “ A minute of OR time isn ’ t cheap , but compare that to 18 minutes of OR time that might be required to locate a missing sponge , or to the unreimbursed costs associated with an RSI , which can add up to hundreds of thousands of dollars per occurrence if it results in litigation .”
It ’ s worth noting , however , that these systems are not designed to prevent retained suture needles , device fragments , or other types of RSIs . Rather , they address only surgical sponges , which are the most commonly retained items .
While the use of counting or detection technologies is not currently required in the standard of care , ECRI encourages broader adoption of such technologies as a supplement to the manual counting process . When employing an adjunct technology , ECRI recommends that healthcare facilities :
• Use the technology correctly – that is , in accordance with the manufacturer ’ s instructions for use .
• Use the technology in every procedure requiring the application of surgical soft goods , not just for selected cases .
• Remove untagged sponges from stock unless there is no tagged alternative .
• Inspect sponges removed from the sterile field for tears , verifying that all fragments are retrieved before closure .
• Make confirmation of adjunct technology use a mandatory field in your facility ’ s electronic health record .
References :
AORN . Guideline for Preventing Unintentionally Retained Surgical Items . AORN Center of Excellence in Surgical Safety . Prevention of Retained Surgical
Items : Product Evaluation of Adjunct Technology . ECRI . 2019 Top 10 Health Technology Hazards report . www . ecri . org / 2019Hazards Steelman VM , Shaw C , Shine L , Hardy-Fairbanks AJ . Retained surgical sponges : a descriptive study of 319 occurrences and contributing factors from 2012 to 2017 . Patient Saf Surg . 2018 ; 12 ( 1 ): 20 .
Steelman VM , Shaw C , Shine L , Hardy-Fairbanks AJ . Unintentionally retained foreign objects : a descriptive study of 308 sentinel events and contributing factors . Jt Comm J Qual Patient Saf . 2019 ; 45 ( 4 ): 249-258 .
Steelman VM , Thenuwara K , Shaw C , Shine L . Unintentionally retained guidewires : a descriptive study of 73 sentinel events . Jt Comm J Qual Patient Saf . 2019 ; 45 ( 2 ): 81-90 .
www . healthcarehygienemagazine . com • march 2022
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