Incorrect Number of Sponges in the Initial Count

An incorrect surgical sponge count must be managed immediately in order to minimize the risk of harm to the patient. This educational video explains the appropriate actions to take when an incorrect sponge count is identified during the initial sponge count.

Retained surgical items remain one of the most serious and preventable adverse events in surgical practice.^1,2 It has been estimated that retained foreign bodies occur in approximately 1 in 5,500 to 1 in 18,760 surgical procedures, with sponges accounting for the majority of cases.³ The consequences include reoperation, sepsis, organ damage, and in some instances, patient death.^4–6 Educational resources that clearly demonstrate correct counting technique, error identification, and appropriate remediation protocols are of considerable clinical and institutional value.

Sponges are supplied by manufacturers in banded packs of 10 (Ray-Tec) or 5 (laparotomy). The band is broken by the surgical technologist in view of the circulator at the start of the initial count. The count is incorrect if there are too many sponges or too few.

Surgical sponge counts must be performed by the surgical technologist and circulator simultaneously. Each must see both sides of each sponge, verbally count each sponge, and agree on the number counted.

When a pack appears to contain more or fewer sponges than expected (in this instance 9 sponges instead of the expected 10), a repeat count must be performed. If the discrepancy is confirmed, the entire pack of sponges must be isolated.

If the patient has not entered the operating room (OR), the circulator may remove the deficient pack from the room and dispose of it appropriately. If the patient is in the OR when the discrepancy is discovered, the deficient pack must remain in the room and must be bagged, identified, and kept isolated until the surgery is finished and the final count has been performed.

Adherence to standardized counting protocols, including the proper management of deficient packs, is essential to minimizing the risk of retained surgical items and ensuring patient safety throughout the perioperative period.

Video-based educational content offers a structured, reproducible, and visually immersive format that can supplement textbooks, lectures, and clinical placements.

We report no conflicts of interest, financial relationships, funding, sponsorship, equipment support, or other relationships that could be perceived to influence the content of this article.