Many surgery patients unnecessarily endure life-threatening complications every year due to retained surgical items (RSI), such as a cotton swab or surgical instrument being left behind post-surgery. Infusion of intelligence into consumables and surgical instruments can help hospitals eliminate costly errors and avoid potential loss of lives. Nothing Left Behind, the international campaign for raising awareness on RSI, has been trying to eliminate RSI incidents in ORs worldwide virtually. These incidents, where surgical equipment and consumables left inside patients lead to fatal infections, aren’t as uncommon as we might think. Statistics suggest the number of cases reported is significantly less than actual occurrences. On average, it’s estimated that only one case of retained surgical items is reported out of every 100 to 3K instances for all surgical interventions.

In contrast, in intra-abdominal surgeries, the reported cases could be even as high as 1 in 1K to 1,500. In this study, Gossypibomas in India: A Systematic Literature Review, professors and Doctors of the Department of General Surgery and Forensic Medicine of Indira Gandhi Medical College of Himachal Pradesh found that over 8,400 RSI cases were reported in India from January 1969 to July 2016. However, only 126 cases were documented within over 100 medical publications. The global problem of such medical accidents and negligence is costly to both patients and hospitals. According to a Frost & Sullivan report, responding to these mistakes costs the US healthcare industry an estimated $2B annually. The severity of the situation is such that a patient’s life can be quickly threatened by postoperative infection or Gossypiboma. The Nothing Left Behind initiative is seeking viable solutions to end the plight of hospital staff and the unnecessary suffering of patients.

Many options have been initially found to be effective, depending on the situation and complexity of the procedure. Common items that get retained include surgical instruments, cotton swabs, sponges, towels, clamps, and other surgical materials. Every hospital attempts a meticulous counting of the used instruments and materials. However, these manual methods haven’t yielded a foolproof solution to monitor all surgical items and consumables. For example, these items can be subjected to multiple counting, especially unreliable during frenzied periods or before emergency surgeries. There are cases when the number of items used can exceed 200 per patient. When the staff suspects an RSI-related complication, the immediate step is to subject the patient to an X-ray, a rather expensive measure. Even in an X-ray film, opaque items like scissors, clamps, or needles can be more readily determined than soft items like swabs and sponges.

In the wake of such incidents, Nothing Left Behind makes several recommendations. The most followed RSI prevention system begins with sponge accounting. This is a tedious process where a nurse manually counts the number of cotton sponges, swabs, and/or towels used before the procedure and later counter-checks the amount of bloodied sponges and swabs post-procedure. This accounting is done at every step of the procedure, from when the surgeon closes the body cavity and the wound until the final sutures are in place. Any discrepancy in these numbers indicates an item may still lie within the patient’s body. This process, though widely practiced, has room for error. Manual counts leave a risk of losing count or miscalculation both before and after the procedure. There is also the awkward handling of the bloodied cotton swabs and multiple other items.

What Intelligent Swabs Do Better

With the advent of electronic technology applied in all segments of healthcare, optical barcoding has been the primary method of tracking medical supplies and equipment. However, barcodes alone have revealed sizable limitations, specifically being unable to detect if anything has been left inside the body. Further, retained surgical items cannot be scanned if the blood has obscured the barcodes during surgery. By contrast, an RFID system has proven to be a foolproof method of counting and detecting sponges. In an RFID-based solution, an RF chip is embedded into the fabric of the sponges. A wand connected to a detection console is used to scan the patient. If a sponge is detected, the console triggers an alarm.

A similar RF mat is also available, which accelerates the scanning process without manual wanding. The sponge bins are also embedded with an RFID reader, which automatically counts the used sponges. RFID monitoring ensures all quantities of sponges and other items can be monitored before and after surgeries in real-time. Nothing Left Behind has promoted this technology as a cornerstone of their global initiative. RSI remains a major cause of surgical complications and accompanying legal liabilities for hospitals around the world. RFID and other smart technologies are rapidly proving to be the most effective solution to protect patient safety.

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