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OSHA, NIOSH make point about blunt suture needles

Call for use of devices to reduce injuries in OR

Consider yourself forewarned: It's time to switch to blunt suture needles in the operating room. In a rare joint bulletin, the U.S. Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) advise hospitals that "employers must use safer devices to replace corresponding conventional sharp-tip suture needles in their workplaces when clinically appropriate."

Both the American College of Surgeons (ACS) and the Association of Perioperative Registered Nurses (AORN) have endorsed the use of blunt suture needles for suturing fascia. The bulletin states that "OSHA and NIOSH strongly encourage the use of blunt-tip suture needles, whenever feasible and appropriate, to decrease percutaneous injuries to surgical personnel. Clinical use and scientific studies have established the effectiveness of blunt-tip suture needles in decreasing the risk of percutaneous injuries. Employers in workplaces that use suture needles have the responsibility under the bloodborne pathogens standard to evaluate the use of blunt-tip suture needles as well as other appropriate safer medical devices."

Many hospitals have faced resistance from surgeons, who are concerned that the blunt needles will not perform as well. But three New York hospitals experienced a dramatic reduction in injuries due to blunt suture needles when the devices were implemented in gynecologic surgery in 1994, according to the bulletin. Other studies also have shown that blunt suture needles are "technically satisfactory" and effective in reducing injuries, the bulletin says.

The main barrier is a cultural one. Switching to a new device and technique always is challenging, says Larry Reed, MS, deputy director of the Division of Surveillance, Hazard Evaluations, and Field Studies at NIOSH in Cincinnati. "I think it will be difficult [to change], but I am optimistic that we can have some significant impact in terms of injury reduction," he says. The bulletin arose out of a NIOSH-sponsored sharps safety workshop held last year. "There was a clear sense of strong concern that we should be telling OR health care personnel about [the benefits of] these blunt instruments," Reed says.

The "encouragement" to use blunt suture needles is made stronger by OSHA's enforcement of the bloodborne pathogen standard. It is the most frequently cited standard in hospital inspections. Hospitals are required to implement sharps safety in the OR. "Where an employer has determined that the use of available safer devices is not feasible, the clinical justification for this determination must be documented in the facility's exposure control plan and the employer must implement alternative means of protecting surgical personnel from percutaneous injuries," the bulletin states.

Sharp-tip suture needles are the leading source of percutaneous injuries to surgical personnel, causing 51% to77% of these incidents.^1,2 Sharp-tip suture needles not only injure surgical staff, but also present a risk to patients from potential exposure to injured staff's blood. Suture needle injuries can occur when surgical personnel:

load or reposition the needle into the needle holder;
pass the needle hand to hand between team members;
sew toward the surgeon or assistant while the surgeon or assistant holds back other tissue;
tie the tissue with the needle still attached;
leave the needle on the operative field;
place needles in an overfilled sharps container; or
place needles in a poorly located sharps container.

Suture needle injuries frequently occur during suturing of muscle and fascia. In 2005, the ACS issued a statement supporting universal adoption of blunt-tip suture needles for suturing fascia and encouraging further investigation of their appropriate use in other surgical applications. The ACS stated that "all published studies to date have demonstrated that the use of blunt suture needles can substantially reduce or eliminate needle-stick injuries from surgical needles."³ AORN endorsed this ACS statement in support of blunt-tip suture needle use where effective and clinically appropriate.⁴

References

Jagger J, Bentley M, Tereskerz P. A study of patterns and prevention of blood exposure in OR personnel. AORN J 1998; 67(5):979-981, 983-984, 986-987 passim.
Berguer R, Heller PJ. Preventing sharps injuries in the operating room. J Am Coll Surg 2004; 199(3):462-467.
American College of Surgeons (ACS). Statement on blunt suture needles. Bull Am Coll Surg 2005; 90(11):24.
Association of Perioperative Registered Nurses (AORN). AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting [56 KB PDF, six pages]. In: 2005 Standards, Recommended Practices, and Guidelines 2005; pp. 199-204.

(Editor's note: A copy of the bulletin is available at www.osha.gov.)