Patient safety
still occur. The HSSIB investigation found there are many factors associated with the design of the reconciliation process, combined with complex interrelated system factors – tools, technology, organisation, task, environment and people – that routinely influence the reliability of the swab count. The Association for Perioperative Practice
(AfPP) states in its guidelines that although UK statute law does not dictate what system or method of accountable items, swab, instrument and sharps counts should be performed within a perioperative environment, the law is quite clear that healthcare practitioners have a ‘duty of care’ to the patient. Unintended retained objects are considered a preventable occurrence and careful counting and documentation can significantly reduce, if not eliminate, these incidents. The AfPP recommends a count must be undertaken for all procedures in which swabs, instruments, sharps and other items could be retained and a process must be in place to address any variance. As part of an effective risk management strategy, it is recommended that a suitable contained disposal system is in place. If appropriate, the system used should be sealed and the number of contents recorded on the outside of the disposal system. If there is a discrepancy in the closure counts, all bags or containers should be opened and their contents recounted. To ensure swabs are not retained and are
treated safely, an effective swab management system, backed up with a detailed protocol, is required. Without a swab management system in place, items can be lost or retained in a body cavity, causing the need for expensive, distressing and unnecessary restorative surgery. It also increases the risk of items being
To ensure swabs are not retained and are treated safely, an effective swab management system, backed up with a detailed protocol, is required. Without a swab management system in place, items can be lost or retained in a body cavity, causing the need for expensive, distressing and unnecessary restorative surgery.
misplaced in clinical waste or linen, causing hazards to other healthcare professionals. To enable Trusts to effectively manage
swabs, a safe and hygienic system for swab disposal was developed by Central Medical Supplies. Swabsafe eliminates the risk posed to operating theatre personnel by the unnecessary handling of contaminated swabs and makes swab weighing easier for blood loss calculation. It helps protect the patient, as each swab is individually visible at all times to assist with counts. Simple and easy to use, the system complies with AfPP guidelines and Health and Safety requirements. It is also produced entirely from recycled post-consumer plastic (rPET). The transparent design of the Swabsafe container allows clinicians to visually keep track of all the swabs used during an operation, while at the same time minimising the re-handling of healthcare waste. The container is available in three sizes, with each divided into five sections, along with a place for the swab tie. To aid counting, the scrub practitioner can directly discard each dirty swab into an individual section. Once all five sections are used, the swab-tie is placed into the container and the fully-fitted lid secured. When the lid is applied securely to a full container it traps air borne bacteria and
eliminates evaporation from the swabs. Joan Ingram, Head of Nursing, Theatres and Anaesthesia at Leeds Teaching Hospitals NHS Trust, has used the system. She comments: “The NHS talks a lot about Never Events and, used correctly, the Swabsafe system helps us reduce Never Events in terms of accurately being able to see and count all of the swabs being used in a surgical procedure.” The widely held view within the NHS appears
to be that swab events are ‘rare’; a belief that seems to influence the decisions and actions of staff within the operating theatre. While the number of retained swab incidents might be relatively small compared to the number of operations carried out, this doesn’t mitigate the physical and psychological suffering for patients who are affected or the increased time and cost implications for hospital Trusts. Swab retention incident reports show that outcomes for patients include distress, a further invasive procedure to remove the retained swab, prolonged hospital stays and extended time off work.1
The thematic
analysis also showed that infection could occur, which comes with a risk to life. The HSSIB recommends that NHS England
develops a framework to assess whether risks, such as retained swabs, are acceptable, tolerable and have been reduced to as low as reasonably practicable. This, in turn, will allow organisations to develop their risk strategies and document their risk acceptance criteria and tolerance. Incorrect manual counts are responsible
for retained foreign objects in approximately 62% to 88% of retained foreign object events.2 According to Cochran3
and Freitas4 additional
tools and/or technology should be used together with traditional counting methods, to reduce incorrect counts. Retained foreign object Never Event incidents continue to occur and are the second most commonly reported Never Event. The cost of claims for ‘foreign body left in situ’ for the financial year 2020/21 was over £7.7 million5
over £6.8 million in 2022/37
, over £7.2 million in 2021/226 .
and
In her article titled ‘Usage of Swabsafe Swab Management System’, published in the Journal of
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