After an open abdominal surgery, the OT nurse needs to do which of the following activities first before suturing? (Give priority answer)

1. A

   Disinfection of OT

2. B

   Change the gown

3. C

   Checking the sponge count and instrument counts before suturing

4. D

   Clean the instruments

Appeared in: NORCET 1 - 2020

Explanation

Listen in Hindi

• The primary responsibility before closing a surgical cavity is to prevent Retained Surgical Items (RSI), a serious and preventable medical error classified as a 'never event'.
• This safety-critical task is achieved by performing a meticulous and standardized count of all sponges, sharps, and instruments used during the procedure.
• The count is a collaborative effort, typically between the scrub nurse and circulating nurse, and must be verbally confirmed as correct before the surgeon begins closing the wound.
• Failure to account for all items requires an immediate halt to the procedure and a thorough search until the item is found or definitively ruled out.

Why Other Options Were Wrong

• Option A: This is incorrect timing. Disinfection of the operating theatre, known as terminal cleaning, is performed after the surgical procedure is complete and the patient has been moved to the recovery area.
• Option B: Changing a gown is not a routine, universal priority before closure. It is only done if the gown's sterility is compromised (e.g., by a splash of body fluids).
• Option D: This is incorrect timing. Cleaning and decontamination of used instruments begin after the surgery is completely finished and the instruments are no longer needed.

Related Visual

• Visual 1: Infographic - 'Timeline of Surgical Counts'. This would illustrate the key moments for performing counts: before the procedure, before cavity closure, and at skin closure, emphasizing its place in the workflow.
• Visual 2: Diagram - 'WHO Surgical Safety Checklist'. This visual would highlight the 'Sign Out' section, where the nurse verbally confirms to the team that the sponge, needle, and instrument counts are correct.

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Perioperative nursing care and surgical safety protocols in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• The nurse's role in the surgical count is a cornerstone of patient advocacy and safety in the operating room, directly preventing a 'never event' (RSI).
• This responsibility underscores the nurse's critical function as a vigilant member of the surgical team, ensuring protocols are followed without exception.
• What if the count is incorrect? If a discrepancy is found, the nurse must immediately inform the surgeon. The closure is halted. A systematic search is initiated, starting with the sterile field, then the surrounding area, and finally may require an intraoperative X-ray to locate the missing item before the patient leaves the OR.

How to Approach the Question

• First, identify the question as a priority-based clinical procedure question.
• Pinpoint the specific time frame given in the stem: 'after an open abdominal surgery' but 'before suturing'. This is a critical transition phase.
• Evaluate each option based on standard operating room (OR) workflow and patient safety protocols for this specific time frame.
• Eliminate options that occur at a different time. 'Disinfection of OT' and 'Clean the instruments' are post-procedure tasks.
• Eliminate options that are conditional rather than a universal priority. 'Change the gown' is only done if contamination occurs.
• Select the option that represents the most critical, non-negotiable patient safety check required at this stage, which is accounting for all items before closing the body cavity.

Concept Tested & Keywords

• Concept Tested: Perioperative nursing care and surgical safety protocols.
• Stem keywords: open abdominal surgery, OT nurse, before suturing
• Lead-in keywords: first, priority

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