Minnesota Hospital Association

Quality & Patient Safety

Eliminating Retained Foreign Objects

Beginning July 2003, hospitals had to report retained foreign objects under Minnesota’s adverse health care event reporting law. Since the beginning of reporting, retained sponges in vaginal deliveries has been the object retained most often. Retained objects can result in infection, and if not found quickly, can require a subsequent procedure to remove the object.

To prevent retained objects in labor and delivery and the operating room requires cooperation and teamwork from the entire surgical team. At the foundation of prevention retained objects is a culture of safety that allows staff to speak up when a sponge or other surgical item is missing. Open communication among the team is critical. It also requires an accurate account of items that are dispensed before and during a surgical or invasive procedure.


While foreign items should never be left behind following a surgery or other invasive procedure it unfortunately does happen, but hospitals are doing everything they can to prevent such incidents from happening. In 2008, MHA initiated the Call to Action framework around retained objects. SAFE COUNT provides hospitals with resources of best clinical practices to prevent retained foreign objects following labor and delivery, a road map of best practices and a tool kit to implement the road map recommendations in their facilities. Hospitals are participate in SAFE COUNT by working toward implementing the best practices as outlined in the road map.

Due to the exceptional work of hospitals, Minnesota went more than two years without a retained object in labor and delivery.

call to action logoDownload the Road Map to Preventing Retained Objects in Vaginal Deliveries.




While hospitals have made exceptional progress in reducing retained objects, the retention of tucked and packed items continues to be a challenge. Data from the adverse health event reporting system revealed that packed items account for the majority of retained objects reported. In response, the Surgical Advisory Group developed a "mini road map" of practices related to preventing the retention of tucked and packed items. These practices will help hospitals put in place effective systems to account for the placement and removal of these items. 

Download the Road Map to Preventing the Retention of Tucked and Packed Items




In 2009, after a successful start reducing retained objects in labor and delivery, MHA expanded its efforts, focusing on counting and accounting for surgical items used in the operating room. MHA again initiated the Call to Action framework and developed SAFE ACCOUNT. Like SAFE COUNT, SAFE ACCOUNT provides a road map of best practices and a tool kit to help hospitals with implementation. Progress is being made in reducing retained surgical sponges. When SAFE ACCOUNT began, retained sponges accounted for 57 percent of retained objects. In 2011, sponges accounted for 32 percent of retained objects. With participants sustaining more than 95 percent of best practices, SAFE ACCOUNT has been retired. These practices have successfully been hardwired into the policies and procedures in Minnesota's hospitals. 

call to action logoDownload the Road Map to Preventing Retained Objects in the O.R.

Additional resources

Additional resouces for SAFE COUNT

Additional resources for SAFE ACCOUNT