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Do you have a policy targeting needlesticks?
Needlestick toolkit being developed
Sharps safety in the OR needs to be an institutional mandate, says Ramon Berguer, MD, FACS, chief of surgery at Contra Costa Regional Medical Center in Martinez, CA. It may be expressed in a policy that is developed by OR leadership, including the OR manager and chief of anesthesia, Berguer says.
"The OR is a service center that physicians contract with. They have a right to regulate their workplace safety," he says.
If sharps safety becomes a commonplace policy in hospitals, then surgeons will have no choice but to adapt, Berguer says.
A needlesticks toolkit being developed by the Association of periOperative Registered Nurses (AORN) will include a sample policy. Healthcare leaders need to "embrace this issue," says Linda Groah, RN, MSN, CNOR, NEA-BC, FAAN, executive director and CEO of AORN. That means setting expectations for safety and taking a close look at the OR injuries, Groah says. "If there continue to be sharps injuries [after adoption of a policy], I think ultimately there needs to be critical analysis of why those injuries occurred," she says.
If a surgeon continually fails to follow facility policy on safe practices, such as maintaining safe zone for passing instruments, leaders should follow through by curtailing privileges, Groah says.
Outside enforcement is unlikely because the Occupational Safety and Health Administration (OSHA) rarely inspects ORs, unless there is a complaint. But OSHA does expect health care facilities to be using some safety devices, including blunt suture needles in the OR, says senior industrial hygienist Dionne Williams, MPH. "We know there's a lot of evidence showing blunt sutures are capable of being used for certain kinds of closures," she says.
Managers can play a role by sharing sharps injury data and educational material with OR staff and physicians. Acting often as independent contractors, surgeons aren't necessarily aware of the hazards and how they can be reduced, says Berguer. "I don't think it's clear for many surgeons what the problem is and why they should change," he says.
An OR sharps safety policy at Contra Costa Regional Medical Center mandates the use of hands-free passing and of safety-engineered scalpels.
The hospital strongly encourages the use of blunt suture needles and double gloving, says Berguer.
Blunt suture needles
He has switched to blunt suture needles, which are now more widely available in a variety of sizes. While Berguer once had needlesticks about twice a year, he says he hasn't had a needlestick in three years.
"There is an initial increase in pressure that is required to penetrate the tissue [with blunt suture needles]," he says. "As with all safety measures, there's a minor inconvenience. I personally like it because it reminds me that I'm using a safe device."
Berguer believes that the safer sharps eventually will be like other safety initiatives that took time to gain acceptance but eventually became the standard. "The data is so overwhelming it would be very hard to make any rational argument against it," he says.