Incidence and Awareness of Near Miss And Retained Surgical Sharps: A National Survey
Authors: Weprin Samuel , Meyer Dielle , Li Rui , Carbonara Umberto , Crocerossa Fabio , Kim Fernando J. , Autorino Riccardo , Speich John E. , Klausner Adam P. 
Published: January 2021

Abstract
Introduction. A retained surgical sharp (RSS) is a never-event and defined as a lost sharp (needle, blade, instrument, guidewire, metal fragment) that is not recovered prior to the patient leaving the operating room. A near-miss sharp (NMS) is an intraoperative event where there is a lost surgical sharp that is recovered prior to the patient leaving the operating room. With underreporting of such incidents, it is unrealistic to expect aggressive development of new prevention and detection strategies. Moreover, awareness about the issue of near miss or retained surgical sharps remains limited. The aim of this large-scale national survey-based study was to estimate the incidence of these events and to identify the challenges surrounding the use of surgical sharps in daily practice. Methods An IRB approved and anonymous national survey composed of eleven questions was distributed electronically to operating room team members across the United States. There were 447 survey responses, in which 411 were used for further analysis. 36 responses were removed due to incomplete respondent data. The 411 were then categorized by group to include 94 (22.9%) from anesthesiologist, 132 (32.1%) from resident/fellow/attending surgeon and 185 (45%) from surgical nurse and technologist. Results. Overall, most of each respondent group reported 1-5 lost sharp events over the last year. Roughly 20% of surgeons believed they never had a miscounted sharp over the last year, where only 5.3% of anesthesiologist reported the same (p=0.002). Each group agreed that roughly 4 lost events occur every 1,000 surgeries, but a significant difference was found between the three groups regarding the number of lost sharps not recovered per 10,000 surgeries with anesthesiologist, surgeon and nurse/technologist groups estimating 2.37, 2.56 and 2.94 respectively (p=0.001). All groups noted x-ray to offer poor effectiveness at 26-50% with 31-40min added for each time x-ray was used. More than half (56.8%) of surgeons reported using x-ray 100% of the time when managing a lost sharp whereas anesthesiologists and nurses/technologists believe it is closer to 1/3 of the time. An average of 21-30min is spent managing each NMS, making a lost sharp event result in up to 70min of added OR time. Conclusions. Near miss and RSS are more prevalent than what is reported in current literature. Surgeons perceive a higher rate of success in retrieving the RSS when compared to anesthesiologists and OR nurses/technologists. We recognize several challenges surrounding near miss and never events as contributing factors to their underreported nature and the higher degree of surgeon recall bias associated with these events. Additionally, we highlight that current methods for prevention are costly in time and resources without improvement in patient safety. As NMS and RSS have significant health system implications, a strong understanding of these implications is important as we strive to improve patient safety.