With the wave of a wand or the scan of a bar code, you can count and validate surgical sponges faster and more accurately than doing so by hand. Today's high-tech products not only remove the tedium of counting sponges, but also help you prevent the most frequently retained foreign object — yes, the sponge. You'll pay for the scanning technology and for sponges with RFID tags or bar codes sewn into them, but isn't greater efficiency and safety worth a slightly higher ($12 to $40) cost per case?

'There's got to be a better way'
We begin with a product a surgical nurse invented that doesn't require you to touch blood-soaked and stuck-together sponges when counting them. The idea of the SmartSponge System dates back to the mid-'90s, when Sharon Morris, RN, BSN, CNOR, the product's original visionary, was working a particularly difficult radical prostatectomy case that involved several transfusions and what seemed like too many sponges to count. Afterward, while digging in a bucket and separating bloody sponges for the count, she had an epiphany of sorts. "There's got to be a better way," Ms. Morris re-members thinking. "Digging in buckets is so antiquated. Why am I touching this? This is so hazardous to me."

She put her inventor's cap on and came up with an idea that would keep nurses' hands off of soiled sponges and deliver accurate counts: Throw used sponges into a bucket and instantly identify them all with a handheld scanner at case's end. She drew some pictures and called an engineering friend. Together they built a prototype in her garage. The scanner looked like a policeman's billy club. "It worked," says Ms. Morris, "but it was very, very raw."

Ms. Morris then partnered with ClearCount Medical Solutions, and the billy club became a wand. "The wand is nothing like I had envisioned," says Ms. Morris, "but it does what I'd envisioned."

ClearCount offers its sponge-count solution in 2 versions: The original bucket-and-wand setup known as the SmartSponge System or the newly FDA-approved wand known as SmartWand-DTX, a smaller and lower-cost device that provides detection and assists the manual count, but doesn't provide a direct reconciliation. Medline Industries will exclusively distribute SmartWand-DTX. "If you don't need a bucket on every case, you can just buy the wand," says Ms. Morris.

Smart-Sponge System and SmartWand-DTX employ RFID-technology, a technology that gives each sponge a unique ID so each sponge is accounted for at all times and you maintain a count throughout the procedure. Unlike bar codes, RFID technology doesn't need a direct line of sight to count sponges. You simply wave the wand over the bucket or the patient at case's end. "It's constantly interrogating all the sponges in the bucket," says Ms. Morris. "You just scan the body and know if you lost anything."

Chasing zero
Each year, the Mayo Clinic in Rochester, Minn., performs about 55,000 operations and uses more than 1.5 million sponges. Historically, the Clinic experienced 3 retained foreign objects (RFO) a year (about half of which were sponges). That's well within national standards of 1 RFO in 2,000 abdominal surgeries or 1 RFO in 18,000 of any operation, but not at all pleasing.

"Because we host so many surgeries, we were having 2 or 3 incidents per year. That number really sticks out. We just found that unacceptable," says Robert R. Cima, MD, MA, a colorectal surgeon and vice chair for quality and safety in the department of surgery at the Mayo Clinic. "When Minnesota became the first state to require mandatory reporting of retained foreign objects, this became a very visible marker of performance. We weren't happy with our performance."

Talk about a turnaround: Since last February, the Mayo Clinic has used sponges with bar codes in all 113 of its operating and procedure rooms — including main ORs, outpatient surgery ORs, labor and delivery rooms and procedural rooms — and hasn't had a single retained object.

The Mayo Clinic uses SurgiCount to confirm the human count before surgeons close patients. "We don't rely on human counts," says Dr. Cima. "The scan validates the count before you're done. It can't be done as an afterthought."

Before SurgiCount came along, Mayo tried on its own to get its RFOs down to zero, but no sponges left inside remained an elusive goal for the surgical staff of more than 5,000. From speak-up campaigns to mass meetings, no amount of education and training worked. "With each one, we saw incremental improvements," says Dr. Cima, "but we'd still come to an event and find out that there was some type of confusion, mental error or miscommunication that led to the retained object. After a 4-year period, we came to the conclusion that we needed some type of technological help."

What technology has done, says Dr. Cima, is truly standardize the counting process. "The thing that screws you up is variation," he says. "Any type of variation will interfere with high performance." As a surgical nurse said, "The machine never gets tired, never gets distracted and it's there to reinforce our counting techniques."

The Mayo Clinic helped SurgiCount refine its system for 2 years before its adoption in the OR. Dr. Cima says that about 15% of the staff who trialed the system loved it, 15% hated it and the rest were neutral. Early on, SurgiCount increases the length of the count by about 5 minutes, but added time spent validating counts should be negligible once staff get comfortable with it. Scanners, sponges and software add $11.50 to per-case costs.

"Weigh that against the cost of 1 retained foreign object," says Dr. Cima. "Each time, you have multiple sentinel event meetings. There's disruption to the patient, the cost of reoperation, the possible cost of litigation, time spent trying to sort out root cause analysis. All that time costs the institution."