Six Surface Disinfection Concepts
The puzzle of superior surface disinfection is never solved....
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By: Charlene DiNobile, Lisa Reed
Published: 7/14/2008
You might have a surgical count policy, but reports of retained sponges, instruments and needles indicate that not everyone is sticking to the 6 C's of surgical counts.
1. Competency. Develop competency tools to test team members' count skills. A scrub demonstrates competency in counting sponges by breaking the paper tapes, separating the sponges and counting audibly with the circulator. If she misses any of these steps, more training is needed.
2. Consistency. When performing a count during a procedure or wound closure, staff must be consistent in the sequence they follow. Many facilities require counts to begin on the field, continue to the back table and then finish off field. But the order doesn't matter — as long as it's consistent with your facility-wide policy.
3. Commitment. The entire surgical team must be committed to the count. That means letting both the circulator and scrub perform the count without interruption.
4. Communication. Keep the lines of communication clear during the count process. Conduct a new count each time there's a permanent staff change in the OR. The circulator should also indicate on the count worksheet any extra items that are added to the field during the procedure and who added them.
5. Closure check. The surgeon performs the closure check by visually and manually sweeping the cavity or wound before closure. The physician notifies the circulator when the closure check is complete.
6. Check up. To ensure your surgical count protocols are being followed, review your policy and survey your staff regularly. Chances are you'll find discrepancies between policy and practice. You'll also find that interpretations of the policy differ from employee to employee. The best way to combat these inconsistencies is to conduct periodic, unannounced audits during procedures.
Create a checklist that details every step of the process as prescribed by your official policy (you can modify our "Surgical Counts Audit Tool" on page 25). The auditor should remain in the OR from the beginning of the count until final counts have been completed. This lets the auditor assess the entire count procedure — including, if necessary, the reconciliation of a missing item. The auditor should compare the count documentation to the actual items that are on the sterile field, making sure they match up. Documentation tools may include hard copies of the count sheet, whiteboard or electronic documents.
After the audit, track incorrect counts carefully. Have your entire staff openly discuss near misses — every team member is accountable for such mistakes. Then examine your existing policy and see if there's anything you should do differently to minimize the risk. For example, ask if new tracking technology — such as handheld wands that can be used to detect sponges containing radio frequency identification chips — is right for your facility.
Criteria |
Y/N |
Comments |
All Counts
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Sponge Count
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Sharps Count
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Instrument Count
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Reconciliation for Count Discrepancies
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