INSTRUMENT, NEEDLE AND SWAB COUNTING

MINIMISIGNG INFECTION CONTROL IN

PERIOPERATIVE CARE

Intraoperative counts of instruments

Counting

A count must be taken for all procedures where countable objects such as instruments, sharps
and swabs are used. The scrub practitioner must ensure and be able to state to the operating
surgeon that all items have been accounted for. Count must be audible to those present and
must be done by two staff members one of whom must be a registered perioperative nurse
whilst the other may be a non-registered practitioner who has attained a validated count
assessment through national or locally validated training. If the institution happens to support
students in the perioperative environment pre registered nursing students student ODPs or
student assistant theatre practitioners should have supernumerary status until deemed to be
competent to assist with the count by a certified member of the perioperative team.

The team brief should discuss the staff allocation to scrub and count which should remain
fairly constant throughout the procedure. However should it be necessary to replace the scrub
practitioner during the procedure a complete count should be done including a full instrument
check, recorded and signed by the incoming and outgoing practitioners and the names of the
replacing practitioners recorded on the intra operative record.

Items that are to remain in the patient by intention such as packaging gauze, drain tubes or
catheters must be recorded in the intra-operative record and documentation that should be
accessible to staff members and similarly its eventual removal should be recorded, its date
time and designation of the practitioner removing it.

Instruments
Staff involves in the counting procedure must be ale to recognize and identify the instruments
and medical devices in use. All instruments should be laid on the tray list so as to provide an
accurate record of all instruments.

Count discrepancy
If a count discrepancy occurs the operating surgeon must be informed immediately and a
thorough search implemented at once. At this point a plain x-ray as per the Medicines and
Healthcare products Regulatory Agency to locate the unaccounted piece.

Packaging

All swabs such as pledgets, neuro patties and packs used during invasive procedure must have
an x-ray detectable marker fixed securely across the width of the swab. However swabs that
are used as surface dressing must not be X-ray detectable.

-First count immediately before the surgery begins

-Second count before closure of cavity within the cavity, to be counted aloud and in unison,
items to be clearly separated during the counting procedure, counting sequence should be in a
logical progression from small to large. The recommended sequence of surgical counts is
swabs, to sharps then to instruments and must be performed un interrupted. Swabs are to be
counted in groups of five and the tags holding them together need to be safely managed that is
retained and kept visible
Unintended retained objects is a preventable occurrence and careful counting and
documentation can significantly reduce or if not effectively reduce if not eliminate these
preventable errors.1

Healthcare associated infections (HCAIs) are undoubtedly a major cause of morbidity and
mortality not only in the UK but also across the world.2 These infections are associated with
all aspects of health care delivery, from ambulatory care procedures to hospital admission and
from general wards to intensive care units and long-term care facilities from commission
omission and even in context. HAIs are also associated with procedures performed in the
perioperative setting from insertion of invasive devices and minimally invasive diagnostic
and treatment modalities to surgical intervention and follow-up care and treatment.
Such infections are associated with procedures performed in the perioperative care starting
from insertion of invasive devices as well as minimally invasive diagnostic and treatment
modalities to surgical intervention and follow up. Such infections include but are not limited
to urinary tract infections, surgical site infections, pneumonia and blood stream infection.
(STATS)
SSI pathogenic causes include endogenous flora from the patients skin, mucous membranes
or hollow viscera or exogenous from the surgical team members, equipment, tools and
instruments brought

Infection control

Theatre scrubs
Theatre scrubs are designed to reduce the transfer of microbes from skin and hair to patient
and conversely protecting the perioperative staff from being infected. 3 Entry into the OR
should be such that all staff should follow the required safety and sanitary policies.
The apparel can include single piece overalls or shirts, warm-up jackets (to prevent shedding
from arms and armpits and keep the staff warm if the OR is cold4 and trousers5 to prevent
bacterial shedding or skin flake, a plastic apron when cleaning the OR. Such scrub material
should be made of close-knit, resistant to fluid strike-through, antistatic, lint free and
obviously comfortable.6

On 13th July 2012 the London School of Hygiene and Tropical

Medicine published an article asserting that nearly 12,000
people die each year due to mistakes (preventable lethal events)
originating during hospital care.
It is very hard to allocate aliquots of blame to failures of medical
management versus the patients underlying illness7

1 Association of Registered Perioperative Nurses 2011 also Association of

Perioperative Practise.
2 (George, 2011)
3 Local Authority Circular (LAC) Department of Health (DH) 2010
4 Essentials of Perioperative Nursing, Terri Goodman and Cynthia
5 Trousers rather than dresses for female staff to prevent perineal fallout
6 AfPP (2011)
7 Shojania KG, Dixon-Woods M. Estimating deaths due to medical error: the

ongoing controversy and why it matters doi:10.1136/bmjqs-2016006144