Table 1:

Protocols for preventing the retention of a foreign object after surgery

Manual counting of surgical items
Perioperative nurses (circulating and scrub nurses) manually and audibly count and document all surgical sponges and instruments at the beginning and end of the surgery

  • Sensitivity 62%–88% (9)

  • Many occurrences of retained foreign objects have had correct counts (3), (4)

Perioperative radiographic screening
Radiograph is obtained during abdominal surgery to identify radiopaque sponges and instruments

  • Less costly and more effective than traditional counting of surgical items

  • May be routine or restricted to high-risk operations

  • Detection rate 85.8% for selective and 95.5% for universal application of protocol (9)

CT scanning
Most often used as a follow-up investigative tool

  • Detection rate 61% (2)

Use of bar-coded sponges
Sponges with a bar code are scanned with a hand-held device at the beginning and end of the surgery

  • Detection rate 97.5% (9)

  • Increased time in operating room and new technical difficulties introduced (10)

Use of radiofrequency-tagged sponges
Sponges with an embedded electronic chip are detected with a hand-held device that is scanned over the patient’s body

  • Sensitivity and specificity 100%

  • Susceptible to electronic interference, mechanical failure and user error (11), (12)

  • Note: CT = computed tomography.