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Important Information

African Partnerships for Patient Safety (APPS) Webinar

Dear colleagues,

African Partnerships for Patient Safety (APPS) is hosting a webinar series starting this Thursday! These monthly webinars over the next 6-months will provide participants a clear way of improving patient safety using a partnership based approach.

Please feel free to visit the APPS webpage and register to each session. Please note that you have to register to each of the six webinars individually.


We start this Thursday with a webinar that introduces participants to patient safety and the APPS programme as a whole. The webinar covers core patient safety concepts. It also describes how a partnership based approach can be used to improve patient safety. The webinar defines clear mechanisms for engagement with the WHO programme through registration. To swiftly register for this webinar see https://attendee.gotowebinar.com/register/3210922851624818945.

Look forward to connecting with you at the webinar.

Warm regards,
WHO Patient Safety Programme

Swab racks or Swab bags??

The counting of swabs, instruments and needles, by the peri-operative Practitioner forms part of her role as the patient’s advocate, her accountability and responsibility. These roles are defined in the Nursing Act,(Act33 0f 2005) the Health Act(2009), the Acts & Omissions (R387)and her Scope of Practise (R2598). As part of the multidisciplinary team, she subscribes to and undertakes to at all times participate in “Safe Surgery”

The importance of clear guidelines on how these items must be accounted for pre -intra and post operatively can never be over emphasised. The input of the Risk Management team in setting these guidelines is very important. The implementation and ongoing education of staff must receive high priority in order to prevent the occurrence of adverse events. Despite all these precautions taken, I believe that there has been a rise in the adverse events related to lost swabs and instruments.

Hughes& J Croucher (2012) recommend in their guidelines for the counting of swabs instruments and needles: “that universal precautions are adhered to and practised all the time”

In a study done at the Hongkong Sanatorium Hospital in 2011, the researchers found that Swab racks were introduced during the1950’s but banned in the UK during the1980’s, when infection control practises changed. It was found that the use of Swab racks caused excessive handling of contaminated swabs, that there was dripping of blood, and that this caused an increase in the spread of blood borne pathogens such as HIV and TB. Injuries while cleaning the metal hooks were also reported.

The incidents of missing swabs, instruments and needles before the implementation of the new count method (that was done April 2009-December 2009) reported a total loss of 7 retained needles or swabs out of 11524 procedures done.

After implementation of the new method of Counting (without the use of Swab racks), the reported incidents came down to 1 out of 11579 procedures done.

In the hospital where I practised as an OR Manager we stopped using Swab racks round about 1983. This was done for the very same reasons as the researchers found in their study. By the time I left the OR in 1992 we had, had not one incident of retained instrument needles or swabs.

Just recently the issue of the use of swab racks in our Hospitals was raised again. I do believe that by know all OR managers have implemented a policy for the control and checking of swabs, needles and instruments to suite the special needs of a particular hospital.

However, according to unsubstantiated information, there seems to be an increase in retained swabs. According to information at my disposal, some of our hospitals are still using swab racks, which could increase the risk to their staff. It would be interesting to know if this contributes to incorrect counts.

The use of the count bag is widely used, and I believe there are many different types of these bags, or receptacles available in the market place.

In my search for answers I contacted some peri-operative colleagues in America, England and Canada. They were all of the opinion that Swab racks are outdated, in their Countries and not recommended for safe practise.

SATS has guidelines for the above procedure in their Basic Peri-operative Guideline, which can be obtained from your local Chapter or from the Journal editor M Hicklin.

Research is presently being conducted on this issue. While this has not yet been concluded why not share your view or ideas on this topic with all of us?

Some dialogue on this very important matter or procedure can help all of us to find the safest way to deal with it in every peri-operative practitioner’s daily effort to insure Safe Surgery to all in their care.

Your opinion about using or discarding the use of swab racks or bags when dealing with the retaining of swabs, needles and instruments will be of great value to all concerned. Send your comments to myself or to Carma@gonet.co.za

Whether this is old or new information it remains of importance ,in our ongoing search for the best way to ensure SAFE Surgery!

Villi Pieterse (082 747 7187)

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