Sharps, swabs and instruments.

It is recommended that counts of swabs, instruments (including scratchpads and diathermy tips), and sharps (needles and blades) should be undertaken at strategic points during an operation. This is to ensure no foreign body remains in a patient after closure of a wound. The scrub practitioner is responsible for counting all items used in an operation before incision, at first layer closure, and at skin closure. It is also standard practice to give a verbal report to the surgeon at the end of the procedure to the effect that all sharps, swabs, and instruments are correct. The count requires full concentration, should be audible, and should be carried out by two people, one of whom must be qualified. Both people should sign the theatre register. The initial count should be recorded before the operation begins and any items that are added during the course of the operation should be recorded by the circulating nurse. All items counted during the course of the operation should be recorded clearly on a dry-wipe board. Items removed from the sterile field should be visibly deleted with a scoring line or cross. Each swab counted must be checked to ensure its radiopaque strip is intact. This is because, in the event of a lost swab (or sharp, or instrument), the surgeon might request an X-ray to ensure that it has not been left in the patient. Any item deliberately left inside the patient should be clearly documented in the patient’s notes. Every sharp object in a theatre should be regarded as a potential source of injury. Accepted practices in the handling of sharps should be adhered to, for example avoiding manual re-sheathing of needles, and disposing of sharps in containers. Needles, blades or instruments should never be passed directly hand to hand, but should be passed via a ‘neutral zone’. Needles and blades should be mounted for use using the correct instrument, never the fingers. Any sharps injury should be managed and reported to occupational health according to local policy.

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