According to international patient safety standards and the WHO Surgical Safety Checklist, what mandatory procedure must be performed by the surgical and scrub nursing team prior to closing the fascia and skin of a surgical wound?

Answer and explanation

Correct answer: A. Vocal count and reconciliation of all sponges, needles, and instruments

  1. Step 1: Retained Surgical Items (RSIs / gossypiboma) represent a major preventable sentinel event and surgical error.
  2. Step 2: Operating room safety standards mandate a standardized count of all sponges (lap sponges, ray-tecs), needles, sharps, and instruments performed by the circulating and scrub nurses:
  3. Step 3: Counts are verified before the procedure, before cavity closure (e.g., peritoneum/fascia), and at final skin closure.
  4. Step 4: Any discrepancy requires immediate notification of the surgeon, surgical recount, and intraoperative plain radiography before wound closure.
Answer
Vocal count and reconciliation of all sponges, needles, and instruments.
Why not the others: 'Administering antibiotics at closure' is ineffective as prophylaxis must be present at incision; 'High-pressure suction' does not prevent retained sponges; 'Frozen section of normal skin' is medically unnecessary.

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