April 15, 2022

Recommendations include using adjunct technology to supplement manual counts.

The Association of periOperative Registered Nurses (AORN) has updated its guideline for preventing unintentionally retained surgical items (RSIs) with a recommendation to use adjunct technology to locate surgical soft goods or verify the accuracy of manual counts. The change is significant in light of this serious, ongoing surgical safety issue.

RSIs are the most common sentinel event reported to The Joint Commission. Unintentional RSIs in a patient's abdomen, pelvis or vagina can cause infections, abscesses and even death. These events can also inflict emotional harm on patients, impact facilities' reputations and cause second-victim syndrome among surgical staff who were stunned about the occurrence. Reoperations to remove RSIs are often devastating for patients and expensive for facilities.

Distractions or fatigue can contribute to an RSI event, says Valerie Marsh, DNP, MSN, RN, CNOR, a clinical assistant professor at the University of Michigan School of Nursing and former perioperative education specialist supervisor at the University of Michigan Health System in Ann Arbor. "Staff involved in RSI incidents believe their counts were correct most of the time," says Dr. Marsh. "The literature shows that manual counting isn't good enough. Technology can take the human error element out of counts, which truly is tremendously beneficial to patients."

"Manual counting, while important, is susceptible to human error and is unlikely to improve to higher levels of accuracy as it stands right now," says Julie Cahn, DNP, RN, CNOR, RN-BC, ACNS-BC, CNS-CP, a senior perioperative practice specialist at AORN and lead author of the latest guideline revisions. "Retained soft goods continue to occur despite manual counting processes and the use of radiography during count discrepancies."

Adjunct tools based on barcode scanning or radio-frequency identification (RFID) technology are currently available for many of the soft goods used in surgery today, although AORN's updated guideline does not endorse a specific product or device. The updated guideline emphasizes that these technologies should always augment, never replace, manual counts. When purchasing this adjunct technology, implement it all at once rather than phasing it in over time, advises Dr. Cahn.

Implement these strategies to protect your staff from harm.

Effective sharps safety requires awareness, consideration and action, even if you've never had an injury at your facility. "Something that's never happened before happens every single day," says Gail Horvath, MSN, RN, CNOR, CRCST, patient safety analyst and consultant of patient safety risk and quality at ECRI in Plymouth Meeting, Pa. "Tomorrow might be your turn." Here are several factors facilities should take into account to ensure surgeons and staff don't get stuck during a case.

Ensure safety features are actually used. Safety scalpels feature either an extendable sheath that the provider pushes forward with their thumb to cover the blade when not in use, or a box cutter-like mechanism that retracts the blade back into the handle. "Safety-engineered scalpels are meant to protect people during passing of the instrument, not during use," says Ms. Horvath. "Once unsheathed, they're as sharp as any other blade."

Julie Miller, MS, senior project officer of the Device Evaluation Group at ECRI, warns that the sheathing and unsheathing tasks are considered time-wasters by some OR providers. "There is a perception that these devices take too long to activate," she says, but notes that a study ECRI conducted showed the actual time involved in the tasks to be negligible. Still, that doesn't prevent some providers from leaving the sharps unsheathed at all times, which defeats the purpose of the safety feature.

Surgeons who avoid safety sharps for "feel" reasons should know that manufacturers over the years have bulked up handles to feel sturdier and more like traditional instruments, says Ms. Miller.

Ms. Horvath adds that unlike scalpels, safety-engineered suture needles do require some clinical concessions. "The only engineering controls out there are blunt needles or reverse-cutting needles," she says. "Blunt suture needles have not gained much traction because they're very difficult to work with, don't penetrate muscle very well, are not as gentle on tissue and require more force from the operator."

Use fewer sharps. Surgeons are opting for alternative devices in situations where scalpels and suture needles are traditionally used, according to Ms. Horvath, who lists two examples: electrocautery to dissect and create initial openings in the skin, and endomechanical devices and staples for closing incisions.

Double-glove. If the top glove is torn or stuck, the provider will see the different color glove underneath and immediately address the breach. Double-gloving is a recommended practice by both the American College of Surgeons and AORN. "You'll find very few orthopedic surgeons who do not double-glove, but you might find that physicians who perform very delicate surgeries in plastics, neurology or ophthalmology do not like to double-glove because of decreased tactile sensation," says Ms. Horvath.

Employ competency-based training. "Education is a low-impact strategy for sharps safety," says Ms. Horvath. "There needs to be monitoring and reinforcement and consequences in a just-culture algorithm." She recommends including sharps safety in annual competencies and bloodborne pathogen training.

Modify behaviors. Minimizing distractions in the OR can help keep surgeons and staff more focused when handling sharps. Also account for provider fatigue. Ms. Horvath says it's worthwhile to observe how surgeons and staff handle sharps at 8 a.m. and compare it with how they do so at 4 p.m., after a long day of surgeries and patient care.

Report and analyze injuries. Ms. Horvath says root cause analyses of sharps injuries aren't performed nearly enough. "You might be surprised by what you learn, and then be able to create and implement an effective action plan to prevent these injuries," she says.

Many sharps injuries go unreported not only to OSHA, but also to facility administrators. "You often hear, ‘It's never happened to me or anybody I know,' but maybe they just didn't tell you about it," says Ms. Miller. "Increasing surveillance can help quality improvement in terms of sharps safety."

Ultimately, successful sharps safety requires address the culture of your workplace. Are your surgeons held accountable to use safety-engineered devices and adhere to other sharps-related policies and protocols? "I find that facilities where surgeons are not employees are more likely to cater to what the surgeon wants than organizations with an employed surgical staff that can hold them to certain behaviors and limit what they can and can't use," says Ms. Horvath.

Delivering surgical gloves to healthcare facilities as demand continues. 

Global demand for surgical gloves has continued to outpace manufacturers' production capabilities over the last 12 months. Many healthcare facilities are actively addressing the backlogs from the cancellation of elective procedures at the peak of COVID and ongoing shutdowns in the previous two years.

Labor limitations at productions facilities to adhere to COVID protocols and general issues in logistical distributions observed in many industries are the leading contributors to the shortfalls in delivering product to healthcare providers. In addition, several surgical glove manufacturers outsource sterilization capability or have limited access to key raw materials to fully conduct sterilization, which is a critical component in surgical glove manufacturing.

As a global leader in surgical glove manufacturing, Ansell has made significant investments in our production capabilities over the last two years to ensure continuous delivery of surgical gloves to healthcare facilities to meet their needs for today and in the future. Our strategic resource planning has led to the addition of four new surgical dipping lines that will be fully operational in 2021.

Ansell has added a brand-new 17-acre production facility that will be joining the three Ansell affiliated manufacturing plants to produce a wide range of surgical products. The state-of-the-art Ansell Kovai facility will be the only glove manufacturer in India with integrated Gamma sterilization, dipping and packaging capabilities. This manufacturing plant will serve as another driver in addition to Ansell's two other manufacturing plants with in-house gamma sterilization, a critical component in manufacturing sterile surgical gloves.

These new capacity additions will significantly increase the capacity output to meet the growing demand for surgical gloves in the United States and worldwide with a 50% increase in non-latex gloves and a 70% in natural rubber latex gloves.

Ansell has a multi-sourcing strategy for the raw material needed to produce surgical gloves to lower the risk of supply disruption to ensure we can meet customer demand and a dual-source strategy for Co60, the raw material required for sterilization.

These new capital investments coupled with our integrated multi-sourcing strategy for critical raw materials are just some of the key elements that drive Ansell's ability to remain Future Ready.

Note: Learn more about how we are prepared to deliver in today's dynamic environment.