Instrument counting in the operating room: what RFID measures and what it does not replace

Published on November 7, 2026 · 7 min read

How counting is done today

Every box has to come back complete, clean and sterilized, and the check today is manual. In the operating room, that means checking the items before the procedure and again after it, item by item.

When identification is instant, the count after surgery takes less time and the room turns over faster. That is the time several RFID studies on instruments have measured.

What RFID studies measured

The results below come from studies that used RFID on surgical instruments. Each one applies to the setup of that study, not to any hospital.

1. Sets of 75 and 98 instruments. In simulated scenarios, the manual count took 130.0 s against 53.5 s with RFID, and 263.3 s against 67.5 s. Observed result. [1]
2. Count of 41 instruments. RFID 64.0 s against barcode 190.4 s, with an experienced team. Observed result. [2]
3. About 130 items. The count went from 7 to 5 minutes at a Japanese hospital. This is an operational report. [3]

How counting works in the room with SureKits

SureKits is the RFID identification and reading layer. It integrates with the CME software the hospital already uses and is not CME management software. In the room, the flow is this:

1. Before surgery. With the instruments on the reading table, or checked with the collector over a non-metallic table, the count checks every item.
2. During the procedure. If an instrument is thrown into the monitored bin, the CME is warned to check for possible breakage.
3. At the end of surgery. The scrub nurse or the nurse separates what was used from what was not used, and the count is done with the collector in two stages, one for each group.
4. Patient and procedure. Each instrument is linked to the patient and the procedure. When the module integrates with the operating room's patient identification system, the record is made without typing.

What RFID reading delivers

Instant identification shortens the count after surgery and frees the room sooner. The system also alerts about items missing from the count, as support for the check, and records instruments that are contaminated, need maintenance or broke.

There is also an indirect effect. By separating used from unused over dozens of surgeries, the hospital starts to see which instruments in each kit are really used. That information is the basis for trimming kits and reducing reprocessing, always with the approval of surgeons and the CME.

What stays with the manual count

AORN treats RFID as an aid to counting. None of the studies justifies dropping the manual count from the protocol without validation and approval by the hospital. [21]

That is why SureKits comes in as support for the check. The hospital decides if, when and how the protocol changes, after validating the reading on its own kits with its own team.

What is not proven yet

The list below comes from the Evidence and ROI page.

1. Clinical outcomes. There is no robust study attributing to individual RFID on instruments a reduction in surgical site infection, mortality, retained objects or cancelled surgeries.
2. Complete reading on every pass. In a test with 125 instruments, the full count happened in 2 of 4 tests, and in the other two 124 of 125 were detected. During the procedure, a study with 15 patients recorded 95% detection on a single pass and 100% cumulative, with electrocautery interference. [6]
3. Different technology, different result. Several studies use high-frequency RFID. A UHF architecture needs its own validation of reading, proximity to metal and sterilization.
4. Mandatory counting. RDC 15/2012 deals with the traceability of sterilization batches and does not require individual RFID per instrument. [20]

How to start

The hospital can start with simple counting using Identix RFID collectors, such as the ID50, with the instruments laid on a non-metallic table. The same tag base later grows to the DR-max reading tables and to the operating room module.

Tags are applied at the hospital itself, without taking instruments out of the institution: no transport cost and no surgeries cancelled because of the application. If the hospital has Datamatrix, it stays valid, because the platform works with both technologies.

Before expanding, a pilot is worth running that measures checking time and accuracy with the same kit types and the same team, including exceptions and rework.

Sources

1. Hendricks W, Mecca J, Rahimi M, et al. Evaluation of a Novel System for RFID Intraoperative Cardiovascular Analytics. IEEE J Transl Eng Health Med. 2022;10:1900309. doi.org/10.1109/JTEHM.2022.3196832
2. Kusuda K, Yamashita K, Morishita E, et al. Comparison of Reading Times of RFID-Tagged and Barcode-Engraved Surgical Instruments. J Surg Res. 2024;304:121-125. doi.org/10.1016/j.jss.2024.09.087
3. Hanada E, Hayashi M, Ohira A. Introduction of an RFID Tag System to a Large Hospital and the Practical Usage of the Data Obtained. ISMICT. 2015. doi.org/10.1109/ISMICT.2015.7107508
6. Yamashita K, Kusuda K, Ito Y, et al. Evaluation of Surgical Instruments With Radiofrequency Identification Tags in the Operating Room. Surg Innov. 2018;25(4):374-379. doi.org/10.1177/1553350618772771
20. Anvisa. Resolução RDC nº 15, de 15 de março de 2012, arts. 24 a 26. anvisalegis.datalegis.net
21. Cochran K. Guidelines in Practice: Prevention of Unintentionally Retained Surgical Items. AORN J. 2022;116(5):427-440. doi.org/10.1002/aorn.13804