Surgical counting is a critical, multi-professional safety practice aimed at preventing retained surgical items (RSIs), such as sponges, instruments, and sharps, during operative procedures. It is commonly defined as a rational, standardized, and replicable process designed to ensure that all items used intraoperatively are accurately accounted for at the time of wound closure. The failure of this process—retention of foreign bodies—is a rare but serious adverse event associated with significant clinical, organizational, and legal consequences, including infection, re-operation, prolonged hospitalization, increased costs, and, in severe cases, death. Despite the existence of numerous international guidelines, counting errors continue to occur, often despite a “correct count” being reported. Studies have shown that RSIs may occur in the presence of systemic factors such as time pressure, communication breakdowns, multitasking, and variable adherence to protocols. Internationally, surgical safety is guided by regularly updated, evidence-based recommendations issued by professional societies. In Italy, however, Recommendation No. 2/2008—based on WHO’s “Safe Surgery Saves Lives” initiative—remains the primary national reference document, yet it has not been updated in over 15 years and does not fully reflect evolving practices or recent literature.
Aim
this study aimed to explore current practices, perceptions, and critical issues related to surgical counting in Italy, drawing on the experience and knowledge of a multidisciplinary expert panel composed of operating room nurses, surgeons, and clinical risk managers.
Methods
to gather expert opinion, a three-round Delphi process was conducted to gather and refine expert opinions. A preliminary literature review informed the first-round questionnaire. Through iterative feedback and consensus thresholds, the study generated a set of validated statements aimed at improving surgical counting practices and informing future national guidelines.
Conclusion
the findings offer a structured, practice-informed contribution to updating Italy’s approach to surgical counting and promoting safer operative care.
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