What is the standard order for instrument counts in sterile technique?

• A. Count at incision start; confirm counts before incision closure and final wound closure; reconcile discrepancies.
• B. Count after the wound is closed.
• C. No counts are needed if sterile gloves are used.
• D. Count at the end of the case only.

Answer: (A)

The safety practice hinges on keeping a precise, documented tally of instruments, sponges, and sharps at specific moments during a procedure so nothing is left inside the patient. The standard sequence starts with a formal count at the beginning of the case, establishing a baseline before any incision is made. Counts are then repeated at critical points, including before closing the incision and again at the final wound closure, to verify that all items are accounted for. If a discrepancy is found, the team pauses to re-count, search the field as needed, and reconcile the difference before proceeding. This approach minimizes the risk of retained objects and ensures clear accountability throughout the operation.

Counting only after the wound is closed misses the chance to catch a missing item before closure, and relying on sterile gloves alone does not provide a reliable method for tracking items. Counting at the end of the case only likewise fails to prevent a retained item being left in the patient.