A surgeon’s job is performing surgery; it’s the scrub nurse’s job to keep track of instruments.
Before the first incision is made, instruments are cleaned, inspected, and documented for inventory. Everyone who touches the instruments should be ‘scrubbed’.
This means they’re wearing a gown, sterile gloves, a mask, and a hat to catch their hair. If a person who is ‘scrubbed’ touches something that isn’t sterile, they must take their scrubs and gloves off and replace them with fresh, sterile ones. If an instrument is dropped on the floor or otherwise desterilized, it is likewise replaced.
Staff who aren’t scrubbed don’t touch the sterile instruments.
The scrub nurse and other theatre staff are responsible for the instruments. The scrub nurse hands them back and forth to the surgeon, ensuring they remain sterile on a separate table. If other instruments are needed, they are collected by another member of staff, who isn’t scrubbed.
This member of staff can leave the room and go to the store room freely, but never touches the sterile instruments. They’re kept in sealed packaging until they’re needed.
At the end of an operation, the ‘count’ is performed.
Every instrument, piece of gauze or suture must be accounted for. If something is missing, it must be found before the operation can finish. This is to prevent ‘Retained surgical items’. Although it sounds impossible, this is where instruments are left inside a patient after an operation. They can cause pain, infection and damage to other structures.
The whole team is responsible for keeping track of and maintaining surgical instruments. It’s not a surgeon’s job.