Surgical count process for prevention of retained surgical items: An integrative review

Patrícia Scotini Freitas, Renata Cristina de Campos Pereira Silveira, Alexander Michael Clark, Cristina Maria Galvão

Research output: Contribution to journalReview articlepeer-review

19 Citations (Scopus)


Aims and objectives: To analyse the evidence reported in the literature concerning the surgical count process for surgical sponges, surgical instruments and sharps and to identify knowledge gaps for future research on the surgical count process. Background: The surgical count process stands out among the practices advocated by the World Health Organization to ensure surgical safety. The literature indicates that this practice should be performed in all surgical processes. However, surgical items are still retained. Design: Integrative review. Methods: The literature search was conducted in the PubMed, CINAHL and LILACS databases and included studies on the surgical count process published in English, Spanish and Portuguese from January 2003-December 2013. Results: A total of 28 primary studies were included in the sample, allowing the knowledge on the surgical count process to be summarised and grouped into three categories: risk factors for retained surgical items, how the surgical count process should be performed in the intraoperative period and the accompanying technologies that collaborate to improving the manual count process. Conclusions: The correct implementation of the surgical count process by the perioperative nurse may contribute to preventing retained surgical items, thereby improving surgical patient safety. Relevance to clinical practice: Nurses can use this review to assist in decision-making directed towards preparing, updating and implementing a reliable system for the surgical count process based on recent evidence because the perioperative nurse plays a key role in the implementation of this practice in health services.

Original languageEnglish
Pages (from-to)1835-1847
Number of pages13
JournalJournal of Clinical Nursing
Issue number13-14
Publication statusPublished - 1 Jul. 2016


  • Brazil
  • Evidence-based practice
  • Integrative review
  • Patient safety
  • Perioperative nursing
  • Retained surgical items
  • Sharps
  • Surgical count process
  • Surgical instruments
  • Surgical sponges


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