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Francis Aka-ebila Aka-eri | Sterile Forensics | Vendor Medical Inc.

The risk of Surgical Count Sheets to patient

Research has shown that fine particles in the bloodstream of a person could lead to heart and lung disease and death. In addition, research also indicates that surgical count sheet paper under high temperatures of sterilization emit fine paper and carcinogenic ink particles, which contaminate surgical instruments and implants and thus render them harmful to patients. This research confirms the AORN recommendation that surgical count sheets should not be placed inside wrapped sets and rigid surgical instrument containers.


Surgical count sheets emit fine paper and carcinogenic ink particles in high temperature sterilization. These particles clog implants and cling to surgical instrument surfaces during and after sterilization and could potentially enter the bloodstream of patients during the cut to close phase of a surgical procedure.

Project Overview

This experiment proves that surgical count sheets though useful to insuring accurate counts of surgical instruments before and after surgical procedures, can severely harm patients in many ways beyond the scope of this research.

Variables / Research

Controlled variables
  • Sterile surgical trays were opened in a positive air controlled area.
  • All parameters were met and surgical instruments deemed sterile.
  • Paper from one batch of A4 sheets were used as count sheets
Independent variable
  • This research focused on the capture of count sheet paper particles.
  • This experiment examined instruments from rigid containers.
Dependent variable
  • A high powered electron microscope was not use and fine particles less than 0.1 microns, though deadly were not the focus of this research to capture.
  • Due to the lack of sufficient funding, the basic of supplies were used.



Materials Quantity
Sterile Surgical Instrument sets 500
Magnifying Glass 1
Microscope 1
Laptop Computer/ Data Sheet 1
Surgical Count Sheet Holders 500
A4 Printing Paper/Count Sheets 2000


Step 1
Step 2
Step 3
Step 4
  • Sort trays:
  • With particles
  • Without partticles
  • Present both as percentage on a pie chart
  • Put surgical count sheets in instrument sets.
  • Steam sterilize:270 degree, 4 minutes, 30 minutes dry time.
  • Open sets in surgical environment.
  • Examine for paper particles
  • Sort trays:
  • With particles
  • Without partticles
  • Present both as percentage on a pie chart
  • Repeat experiment with Alma Sac Surgical count sheet holders.
  • Examine mechanical washer minimal debris.
  • Filter debris appears to increase where count sheets are not in use.

Data / Observations

pict-a pict-b pict-c
Ink on surgical instrument Ink on surgical rigid container Best practice
  • Count sheets placed in sets occasionally leave behind ink marks on surgical instruments during sterilization.
  • Count sheets in surgical sets displays debris burden on mechanical washer filters every 24 hours and must be cleaned regularly. Unfortunately, sterile processing technicians often forget to clean their washer filters for days insome facilities.
  • When surgical count sheet holders were used, minimal debris was found. This indicates that count sheets are indeed a significant part of the debris found on surgical instrument washers.
  • Sterile processing departments that used surgical count sheets holders therefore - have much cleaner mechanical instrument washers than those who do not use surgical count sheet holders.


Main Heading


  • For a surgical instrument to be sterile, it must first be designed to clean and sterilize. Since the cleanliness of count sheets cannot be verified and they are therefore deemed dirty understand aseptic principles.
  • Surgical count sheets papers contain known industrial toxins, which in contact with surgical instruments could render such instruments unclean. Even as unclean surgical instruments cannot be sterile.
  • Surgical count sheets do emit microscopic ink and paper particles when exposed to the high temperatures of sterilization. These harmful particles; if not isolated, could potentially contaminate surgical instruments and implants in the set. The adverse effect of which are surgical site infections such as; aseptic loosening of implants, chronic unexplained pain after surgery and even death.
  • For the health and safety of patients, it is imperative that medical centers leverage technology to isolate surgical count sheets from making contact with surgical instruments and rigid containers during and after sterilization.
  • In conclusion, the AORN recommendation to isolate surgical count sheets from making contact with surgical instruments is hereby scientifically proven.

Works Cited