What is it considered when a general surgeon (GS) forgets a glove in the abdominal cavity after skin closure?

Retained Surgical Item: Forgotten Glove in Abdominal Cavity

A forgotten glove in the abdominal cavity after skin closure is considered a "Never Event" (option D), which represents a serious, preventable medical error that should never occur in healthcare. 1

Understanding Retained Surgical Items

Retained surgical items (RSIs) represent a serious patient safety concern that can lead to significant morbidity and mortality. A forgotten glove in the abdominal cavity is classified as a "never event" because:

1. It is entirely preventable through proper surgical counting procedures
2. It can lead to serious complications including:
   • Infection
   • Abscess formation
   • Peritonitis
   • Need for reoperation
   • Prolonged hospitalization

Prevention Guidelines

The World Society of Emergency Surgery and Enhanced Recovery After Surgery (ERAS) Society provide clear recommendations for preventing retained surgical items:

• Surgical count protocols: All items including instruments, sponges, and gloves must be meticulously counted before closure 1
• Wound protectors: Use of fascial abdominal wound protectors is recommended to reduce surgical site infections and improve visualization 1
• Glove changes: Routine change of gloves before wound closure is recommended to reduce surgical site infection by up to 13% 1

Glove-Related Risks in Surgery

Surgical gloves serve multiple purposes:

• Protecting patients from contamination
• Protecting surgical team from exposure to blood-borne pathogens

However, gloves can become a hazard when:

• They are perforated during procedures (occurs in 15-24% of cases) 2
• They are retained in the surgical field
• They are not properly accounted for during surgical counts

Classification of Medical Errors

To clarify why this is a "never event" rather than other options:

1. Commission (Option A): Refers to performing an incorrect action (e.g., operating on wrong site)
2. Omission (Option B): Refers to failing to perform a necessary action (e.g., not giving prophylactic antibiotics)
3. Near miss (Option C): An error that was caught before causing harm
4. Never event (Option D): A serious, preventable adverse event that should never occur

Implications and Management

When a retained glove is discovered:

• Immediate reoperation is typically required
• Documentation of the event is mandatory
• Root cause analysis should be performed
• Implementation of preventive measures to avoid recurrence

Best Practices to Prevent Retained Items

1. Standardized counting protocols before and after procedures
2. Methodical wound exploration before closure
3. Use of surgical safety checklists
4. Proper communication among surgical team members
5. Consideration of technological adjuncts (e.g., radiofrequency detection systems)

The American College of Surgeons and World Society of Emergency Surgery strongly recommend these practices to prevent the serious complication of retained surgical items, which represent a significant patient safety concern and are classified as never events that are entirely preventable through proper protocols.