When are counts performed?

• A. At critical points, documented, and reconciled before wound closure
• B. Only at the start of the procedure
• C. After wound closure
• D. When instruments are not available

Answer: (A)

Counts are a safety check that happens at defined moments in a procedure to verify every instrument, sponge, and item used is accounted for. They’re performed at critical points—before the incision to establish a baseline, as items are introduced or removed during the case, and most importantly before the wound is closed. Documentation creates a traceable record, and reconciliation ensures any discrepancy is resolved immediately so closure does not proceed until all items are accounted for. This approach protects the patient from a retained surgical item and supports clear team communication. The reason this is the best answer is that it directly ties the counting process to preventing retained items by stopping closure until the counts balance. Counts done only at the start miss items added later, and counting after closure cannot prevent a retained object; counts happen at the defined times regardless of instrument availability.