Four Breaks in One Case

In practice

The case is a breast lumpectomy. The first break comes during setup: the circulating nurse pours warm saline into a basin on the back table, and a splash lands on the drape beside it, soaking through to the table beneath. Kai, the scrub person, says so, covers the wet area with a sterile towel as facility procedure allows, and moves the instruments away from it. The second break comes early in the case: a fine needle holder slips from the Mayo stand to the floor. Kai says it fell, leaves it on the floor to be collected after the count, and opens a spare from the back table. The third break: a medical student, observing, steps toward the field to see better and her shoulder comes close to the back table's corner. Kai asks her, kindly, to step back. She has not touched it, so no break occurs, but the warning prevents one. The fourth break comes near the end: Kai notices that the outer glove on the right hand has a small puncture at the fingertip, probably from a needle. Kai says so, steps back, has the circulating nurse help with a glove change, checks the inner glove and skin, and finds no puncture to the skin. The closing count is correct. At the debrief, the team notes the four events briefly, and the circulator reports the saline splash pattern, because it was the second that week with that basin placement.