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

Forgotten Glove in Abdominal Cavity is a Never Event

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

Understanding Never Events in Surgery

Never Events are serious, preventable patient safety incidents that should not occur if available preventive measures are implemented. They include:

• Retained surgical items (like forgotten gloves)
• Wrong-site surgery
• Wrong-procedure surgery
• Wrong-patient surgery

Retained surgical items specifically refer to any items unintentionally left inside a patient after surgery, including:

• Surgical instruments
• Sponges
• Needles
• Gloves

Prevention Strategies

The World Society of Emergency Surgery recommends several measures to prevent retained surgical items:

1. Standardized counting protocols:

   • All items including instruments, sponges, and gloves must be meticulously counted before closure 1
   • Documentation of counts before and after procedures

2. Methodical wound exploration:

   • Thorough exploration of the surgical field before closure
   • Systematic visual and manual inspection of the abdominal cavity

3. Surgical safety checklists:

   • Implementation of WHO Surgical Safety Checklist
   • Team time-out procedures that include verification of counts

4. Technological adjuncts:

   • Radiofrequency detection systems
   • Barcode scanning systems for surgical items

Management When a Retained Item is Discovered

When a retained glove is discovered after skin closure:

• Immediate reoperation is typically required 1
• Mandatory documentation of the event
• Reporting to appropriate quality and safety departments
• Root cause analysis to prevent future occurrences

Clinical Implications

Retained surgical items like gloves can lead to significant morbidity:

• Increased risk of surgical site infections
• Formation of adhesions and potential bowel obstruction
• Need for reoperation
• Prolonged hospital stay
• Increased healthcare costs
• Potential legal consequences

Common Pitfalls and Prevention

1. Failure of communication:

   • Clear communication among all surgical team members is essential
   • Verbal confirmation of counts should be standard practice

2. Rushed closure:

   • Hurried closures increase the risk of retained items
   • Methodical approach to closure is necessary regardless of time pressure

3. Failure to recognize risk factors:

   • Emergency procedures
   • Unexpected changes in surgical plan
   • High body mass index
   • Multiple surgical teams

4. Reliance solely on counting:

   • Counts should be supplemented with visual inspection
   • Consider technological adjuncts in high-risk cases

By understanding that a forgotten glove is classified as a Never Event, surgical teams can implement appropriate preventive measures to avoid such serious and preventable errors.