Finding treasure in trash: A TSA-style screening process helps recover lost surgical instruments

If you’ve ever gone through security at an airport, you likely know the drill. Take off your shoes, remove any electronics from your bag, step through the scanner, and wait for your luggage to come off the belt after x-ray screening. It’s a process that is familiar to travelers, and one that lent inspiration to teams in the main operating room (OR) in unraveling a mystery.

A bag of trash from the operating room makes its way through the scanner to check for any surgical instruments mistakenly discarded.

A bag of trash from the operating room makes its way through the scanner to check for any surgical instruments mistakenly discarded.

A common problem meets a novel solution

In late spring of 2021, the main OR had a mystery on their hands. Some surgical instruments were consistently going missing. So, a multidisciplinary team of employees from nursing, Supply Chain, anesthesia, Central Sterilization Services (CSS), and Environmental Services (EVS) came together to pinpoint where the loss was occurring and develop a safe recovery process.

“After working with the many groups that make up the OR team, we determined that some of our instruments, such as drill attachments, glass vials, needles, and scissors, were being accidentally thrown away during the OR clean-up process,” says Anna Carpenter, MSN, RN, CNOR, nurse manager. “Aside from the monetary loss of these instruments, it’s also a safety hazard to dispose of these items incorrectly.”

The solution? Introduce a technology—much like that used during the airport security process—to scan bags of trash as they came out of the OR and pass through EVS.

“It was our Supply Chain team who heard about this technology and process from another hospital who had been tackling a similar problem,” says Ben Hall, administrative director, Perioperative Services. “Once we had pinpointed where the loss of instruments was occurring, we brought in the scanner and set up a process to scan our trash.”

One person’s trash is another’s treasure

A screen show an x-ray image of trash passing through the scanner.

Trash passed through the scanner is reviewed for any accidentally discarded surgical instruments.

The process itself is simple. After the surgical team was finished in an operating room, EVS proceeded with standard cleaning to ready the room for the next procedure. Trash and linens taken out of the room are brought to the scanner, where the bags are passed through and monitored by an EVS employee. If an instrument is detected, a team member from the nursing team is called to identify it and process it correctly through CSS. Carefully numbered trash bags help identify exactly which room and surgery the bag came from.

Each instrument found is then carefully documented. In the 9 months this process has been in place, around $35,000 worth of instruments have been recovered—when factoring in the cost needed to replace the once missing instruments.

“This process not only helps with the cost aspect of the missing instruments but is a good safety reminder to the teams that even simple items need to be disposed of correctly,” says Kathie Hankemeier, coordinator of EVS. “It’s been a really strong team effort to launch this process and make sure that we’re being as efficient as possible.”

Teamwork is what has tied the success of this project together.

An instrument is placed into a box..

An instrument is located and pulled aside from the trash.

“Everyone has really stepped up to the plate to make sure things run smoothly,” says Hall. “EVS has taken on additional responsibilities, nursing has been a big partner in recovering the instruments; it’s a great example of what happens when people come together.”

Shambhavi Pokhriyal, graduate assistant, who project managed the effort, explains that although the project initially was about recapturing the lost instruments, what was also discovered was a renewed commitment to accountability.

“The leadership and staff from different departments, particularly nursing and anesthesia, took commendable steps to spread awareness about the scanning process. Consequently, many became informed about the process and how it was put in place to stop the instruments from getting misplaced,” says Pokhriyal. “Following the collaborative efforts of different departments, we stopped losing certain categories of instruments altogether.”

For Carpenter, more valuable than the dollar amount of instruments recovered is the collaboration and the ability to put patients first.

An x-ray scan shows missing scissors identified among operating room trash.

An x-ray scan shows missing scissors identified among operating room trash.

“When you think about some of the instruments we use in certain procedures, they may be one or two of a kind in terms of the supply we have here at UI Hospitals & Clinics,” she says. If an emergency pops up and we’re missing that tool, we’d be hard-pressed to provide the necessary care to that patient. This process and technology allow us to be there for our patients. It’s also a reminder to be diligent, follow best practices for disposal of trash and sharps, and to think creatively when confronted with a problem.”