OPERATING

ROOM
“Caring for intraoperative patients.”
 TABLE OF CONTENTS

01 02 03
SPONGE & WHO SPECIMEN &
INSTRUMENT CHECKLIST FORENSIC
COUNT EVIDENCE
MANAGEMENT
Counting & Recording Procedure
 01
SPONGES, SHARPS &
INSTRUMENT COUNT
● The primary responsibility for accounting for all sponges, sharps,
and instruments before, during, and after every surgical
procedure rests with the circulating nurse and scrub
person.

● A counting procedure is a method of accounting for items put on

the sterile table for use during the surgical procedure.

● Sponges, sharps, and instruments should be all accounted for all

surgical procedures.
RATIONALE:
1.This is a serious safety breach that is inexcusable if an item from
the surgical procedure was retained inside the patient.

2.Any item put into the patient should be documented as part of the
count and reconciled at the end of the procedure.

3.Instruments are costly and should “not vanish into thin air.”

4.Many instruments and devices have sharp tips or cutting surfaces.

If an instrument is in the trash or laundry it can become a source of
injury to unsuspecting hospital personnel.
ITEMS TO BE COUNTED FOR:

1. Sponges
2. Sharps
3. Instruments
4. Miscellaneous
Items that are
small enough to
be retained
 PLANNING &
IMPLEMENTATIO
N
 SPONGE COUNT
ACTION RATIONALE
1. Hold the entire pack of sponges of whatever type, including
tapes/rings, in one hand. The thumb should be over the
edges of the folded sponges.

2. Shake the pack gently.to separate the sponges and loosen To separate the sponges and
them from the pack. loosen them from the pack.

3. Pick each sponge separately from the pack with the other For a more accurate counting.
hand, and number it aloud while placing it in a pile on the
sterile instrument table.

4. If a pack contains an incorrect number of sponges, the To avoid confusion when doing
scrub nurse should hand the entire pack to the circulating nurse the final count.
for removal from the room and not to be use.
 COUNTING OF SPONGES

Abdominal Sponge
4x8 Gauze
Peanuts Surgical Patties/
Cottonoids
 COUNTING OF NEEDLES & SHARPS
1. Reusable eyed needles are placed in a needle
rack or a suture book and counted into sets in
multiples of two or three of each type and size.

2. Each needle or packet containing needles is

separated for individual counting.

3. The count is taken according to the label on

each packet. Some packets contain multiple
needles.
Sutures
Free Needles
4.If a needle or blade
has broken, both the
scrub person and the
circulating nurse must
make sure all pieces
are recovered or
accounted for.
 COUNTING OF INSTRUMENTS

1. Remove the rack of instruments

from the instrument tray and place
it on a rolled towel.

2. Instruments are counted as they

are assembled.
3. Expose all instruments left in the
tray for counting. Remove knife
handles, towel clips, tissue forceps,
and other small instruments from
the tray, and place them on the
instrument table.
4. Account for all detachable
and disassembled parts, such
as screws or ratchets.

5. Recover and retain all

pieces of an instrument that
breaks during use. A
replacement instrument is
added to the count sheet by
the circulating nurse.
6. After the initial count is taken, count any
instruments added to the table, with one
exception.

If the circulating nurse decontaminates

and sterilizes an instrument for
immediate use that has dropped to the
floor or has been passed off the table,
an adjustment in the count is
unnecessary.

Instruments that are recovered from the

floor or passed off the table and not
sterilized are retained by the circulating
nurse and reconciled at the closing
count.
SPONGE AND
INSTRUMENT
COUNT RECORD

NOTE: RECORD ARE

DEPENDENT ON THE
INSTITUTION POLICY
REPORTING
Sponge count

Before closure of the operative site

Washing/ irrigation; site inspection

“Excuse me doctor. All sponges, instruments &

sharps are counted, checked & complete.”
 02
THE PATIENT
SAFETY & SURGICAL
CHECKLIST (WHO)
 The WHO Surgical Safety Checklist is
a simple tool designed to improve the safety
of surgical procedures by bringing together the
whole operating team (surgeons, anesthesia
providers and nurses) to perform key safety
checks during vital phases of perioperative
care: prior to the induction of anesthesia, prior
to skin incision and before the team leaves the
operating room.
The checklist requires items to be checked at three points
before the patient’s surgical procedure.

SIGN IN
01 Before anesthesia is induced

TIME OUT
02 Before start of the
surgical procedure

SIGN OUT
03 Before eny member leaves
the operating room
 5 STEPS:
#1 Briefing

 Introduction of team/individual roles

 List order of concerns relating to staff/equipment/surgery/anaesthesia
 Local arrangements will determine when the first patient on list is sent
for
 Could be an opportunity to discuss anticipated breaks during the list (e.g.
lunch)
 5 STEPS:
#2 Sign In

 Before induction of anaesthesia

 Confirm patient/procedure/consent form
 Allergies
 Airway issues
 Anticipated blood loss
 Machine/ medication check
 Surgical site marking should be checked by the surgeon at this point
 5 STEPS:
#3 Time Out (Stop moment)

Before the start of surgery:

•Team member introduction
•Verbal confirmation of patient information
•Surgical/anaesthetic/nursing issues
•Surgical site infection bundle
•Imaging available
 5 STEPS:
#3 Time Out (Stop moment)

•In practice most of this information is discussed before, so this is used as a

final check
•Surgeons may use this opportunity to check that antibiotic prophylaxis has
been administered
 5 STEPS:
#4 Sign Out

 Before staff leave theatre, confirmation of recording of procedure:

Instruments, swabs and sharps correct
 Specimens correctly labelled
 Equipment issues addressed
 Post operative management discussed and handed over
 Should include all team members (including PACU and ward nurses,
surgeons and anaesthetists)
 5 STEPS:
#5 Debriefing

 At the end of the list evaluate list

 Learn from incidents
 Remedy problems (e.g. equipment failure)
 Evaluation of the list includes a discussion of what went well
HOW TO DO THE SURGICAL SAFETY CHECKLIST
 03
SPECIMEN & FORENSIC
EVIDENCE
MANAGEMENT
1. Save and care for all tissue
specimens according to policy
and procedure of the agency.

2. Some facilities require that

all tissue removed from a
patient, including exudates, be
sent for pathologic
examination.
3. Any other unusual item
such as a retained foreign
object should be sent to
pathology for accession.

4. Forensic evidence is
handled according to facility
policy (e.g. bullets from gun
shot wound)
5. Specimens are put in a
specimen basin or another
container.

6. Proper labeling and

documentation should be
observed.
7. Specimen for cytology,
gram stain and culture
are immediately sent to
the laboratory while
specimens for
histopathology are
stored in a cabinet and
sent to the laboratory in
batches. Make sure that
specimens are fully
submerged in formalin.