Advice on turning your OR into a sharps safety zone
No-hands passing, sharps holders decrease injuries
Major advances in reducing sharps injuries have not yet pervaded the OR, where one out of four sharps injuries takes place,1 but there are some simple steps that same-day surgery managers can take to promote safety, sharps safety experts say.
"I think it’s a rare exception to find a surgeon who doesn’t care about the safety of his co-workers," says Mark Davis, MD, FACOG, an Atlanta surgeon who has become a major proponent for sharps safety in the OR. "The problem is just getting their attention."
The overall data are convincing. While percutaneous injuries from needles, syringes, and lancets dropped by at least 55% from 1993 to 2001, injuries from suture needles declined by only 5%, according to data from the International Healthcare Worker Safety Center at the University of Virginia in Charlottesville.
It’s important that sharps injury data be shared with all OR staff, says Joan Blanchard, RN, MSS, CNOR, CIC, perioperative nursing specialist in the Center for Nursing Practice at the Association of periOperative Registered Nurses in Denver. Quality improvement projects focused on specific practices such as use of safety items and safer techniques for passing can bring improvement, she says. When you introduce new processes through QI project, staff are more likely to comply with safety requirements, Blanchard adds.
Gaining support from administration and physician leaders also is crucial, Davis notes. "The same-day surgery manager can’t do it alone," he says. "Physicians typically want to speak with physicians if they’re being asked to do something. If the top levels of administration don’t support the change, then it’s really a tough job."
Ultimately, change must come from within the OR itself. So the first step in any injury reduction program should involve building a team of OR safety champions, says Davis, who works as a consultant and wrote the book Advanced Precautions for Today’s OR. (For ordering information, see resources at the end of this article.)
Surgical programs often begin addressing sharps injuries by implementing safer practices, such as no-hands passing. At Rose Medical Center in Denver, Pat Koehmstedt, RN, CNOR, operating room educator, met with staff and helped them design a neutral zone and select a sharps holder.
To back up the new process, she made and put posters above the scrub sinks to remind everyone to use the neutral zone and sharps holders and educated surgical technicians and nurses at the monthly staff meetings. The chief of surgery discussed the new practice with surgeons.
"For a week when we started it, I went from room to room, talked to the surgeon, talked to staff," Koehmstedt notes. "It was quite difficult to start off with it, but the approach was for their benefit."
Sharps injuries related to passing declined from about four a month to two or fewer. Some months there are none. Over time, the surgeons stopped using the special plastic device because of the extra time and motions required, but the neutral zone, with no-hands passing, has remained, she says.
"The whole theory was to decrease [sharps injuries], which we have accomplished," adds Koehmstedt. "Even though they’re not using an instrument, the technique is improved."
Techniques such as the no-hands passing for transfer of sharps are a key step to take in a sharps safety program, Davis says. Hand-to-hand passing is the cause of 25% of scalpel injuries and 50% of suture injuries, he points out.
Convincing surgeons to use other safety devices, such as blunt suture needles, is more difficult. But as new products are developed, they may become more acceptable, Blanchard explains. "You really have to look at what’s being offered and work with the companies by providing feedback to help them improve the product," she says.
Other safety devices that can be used include safety scalpels, blunt retractors, and safety syringe needles, Davis says.
Some devices may interfere with access to the incision or may not be appropriate for a particular procedure, he points out. "Surgeons may need to make the decision to use certain safety devices on a case-by-case basis," Davis adds.
Surgeons are data-driven, so show them the numbers, he says. The surgeon and the scrub tech don’t know how many people got stuck last year, Davis continues. "If they weren’t the ones stuck, they don’t know anyone got stuck," he adds. "You’ve got to get the data so people will be motivated to accept change."
Awareness of the risks — medical and regulatory — can have an impact. An estimated 2.7 million Americans have chronic hepatitis C. Many of them don’t know it, and that situation creates a risk of infection from bloodborne exposures.
OR blood exposure rates from your facility should be posted in the lounge at least on a quarterly basis, Davis says. This posting increases the level of education for the staff and motivates everyone to look for ways to reduce sharps injuries, he adds.
Hospitals and surgeons may come under scrutiny from the Occupational Safety and Health Administration through its stronger enforcement of the bloodborne pathogen standard. Standard 1910.1030 says employers with employees that can be exposed to bloodborne pathogens in the course of their job responsibilities must have a plan to reduce exposure.
The employer also must document ongoing efforts to evaluate and implement new technology that reduces the risk of exposure for employees. That standard is the most frequently cited as not being met in hospitals.
Surgeons also can receive citations and fines for noncompliance, Blanchard says. "[Inspectors] want to see that you are using safety devices wherever they’re available," she adds.
Surgeons often are described as resistant to change, Davis notes. "They can actually be quite adaptable to change as long as they can be shown that the new ways of doing things, when done correctly, are not harmful to patients," he says.
And even if surgeons initially don’t embrace some of the changes that are necessary for sharps safety, they will adapt, Davis says. "To say that surgeons are resistant to change and stubborn is throwing in the towel," he adds.
- Perry J, Parker G, Jagger J. 2001 percutaneous injury rates. Advances in Exposure Prevention 2003; 6:32-36.
For more about OR sharps safety, contact:
- Mark Davis, MD, FACOG, Atlanta. Phone: (404) 233-3359. Fax: (404) 233-5662. E-mail: email@example.com.
- Advanced Precautions for Today’s OR is $14.95 plus $5 shipping and handling for one to three books. Contact Sweinbinder Publications, P.O. Box 11988, Atlanta, GA 30355. Phone: (404) 261-4595. Fax: (404) 233-5662. E-mail: firstname.lastname@example.org. To see other sharps safety educational materials, go to www.orprecautions.com.
- To obtain a checklist for sharps injury prevention, go the International Healthcare Worker Safety Center at the University of Virginia web site. Go to www.virginia.edu and choose "research and centers" on the right navigational bar. Under "Individual UVA Centers by Area" and "Health System," select "International Healthcare Worker Safety Center."
- The Centers for Disease Control and Prevention has launched an on-line workbook to help health care organizations design, implement, and evaluate sharps injury prevention programs or enhance an existing program. Go to: www.cdc.gov/sharpssafety/index.html.