RFID 100% Accurate in Surgical Sponge Tracking Test

Surgical sponges embedded with a radiofrequency chip were identified 100% of the time, an accuracy rate far better than traditional counting or use of radiographs during surgery, according to a study at the Veteran's Affairs Medical Center in Iowa City.

The blinded clinical trial, funded by the VA, entailed the placement of 840 sponges, 619 of which had the RF chip and 221 of which did not, in opaque bags. The bags were attached to 210 participants' at the back of the torso and in each of four abdominal quadrants. Of the 210 participants, 101 were morbidly obese, a risk factor that has much higher rates of retained surgical sponges and other forgotten devices.

After the sponges were attached to the participants' torsos, the participants were asked to lie in a supine position on an exam table while operators blinded to the bags' contents waved a special RF wand, attached to a detection console made by RF Surgical Systems, over the participants.

As the wand passed that portion of the participant's torso with the sponge, the console relayed a sound with 100% accuracy indicating the presence of a tagged sponge. It was quiet, with 100% accuracy, when the wand passed over a sponge that did not have an RF chip.

The RF tagging system was far more accurate than taking X-rays before a patient is wheeled into recovery, and was more accurate than traditional practice of counting, wrote the study's principal investigator, Victoria Steelman, a member of the Board of Directors of Association of Perioperative Registered Nurses. "Studies have found that 62% and 88% of retained surgical items occurred when the count was reported as correct."

Steelman said her report is "the first systematic evaluation of RF sponge detection technology in a sample size powered to determine its sensitivity and specificity."

Additionally, the report was important she wrote, because it specifically looked at whether RF tagging technology worked in the morbidly obese. While the trial, which received institutional review board approvals, did not involve surgical insertion of the sponges in a clinical setting, it was believed to be nearly equivalent to such a study because so much tissue separated the wand from the sponges, which were attached to the backs of the supine participants.

Also, compared with X-rays, RF tagged sponges may work better than X-rays, which also have difficulty in patients with high BMI.

Her report, published in the February issue of the American Journal of Surgery, did not compare the cost of the RF tagging system against the cost of surgical teams simply engaging in routine counting of those items before or after surgery, (77% accuracy) or use of X-rays before the patient's surgical wound is closed.

Other published literature suggests the cost to providers, including medical and legal expenses for each retained surgical sponge is about $200,000 on average.

Additionally, since October, 2008, those costs have gone up. That's when the Centers for Medicare and Medicaid Services stopped reimbursing hospitals for additional patient care costs related to sponge retention, which is considered a serious reportable "never event."

CMS regulations expected to ensue from one section of the Patient Protection and Affordable Care Act dealing with hospital-acquired conditions will result in lower reimbursement for hospitals with higher rates of retained surgical sponges.

Despite all these disincentives, surgical teams continue to unintentionally leave surgical implements inside one in every 5,000 patients. Of those sponges account for between 48% and 69%.

According to a report from Saint Vincent's Hospital, 54% of those sponges are left in the abdomen, 22% in the vagina and 7% in the thorax.

A recent two-year study in California by the state Department of Public Health showed that even in recent years, sponges made up 40% of all unintentionally retained foreign surgical objects, and is the subject of an upcoming hospital-wide prevention project.

Retained foreign objects not only add to the length of hospital stays, but they add to hospital costs, put the patient at greater risk of developing an infection, and often require they undergo another invasive procedure, which some patients may not be healthy enough to withstand.

In conclusion, she wrote, RF technology in surgical sponges "is an appropriate option to consider when redesigning healthcare system to prevent 'never events' and enhance patient safety."

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