ACS recommends safety needles, double-gloving

The American College of Surgeons (ACS) most recent recommendations on infection prevention and safety in the operating room are summarized as follows:

Sharps injuries and surgical glove tears continue to expose surgeons and operating room (OR) personnel to the risk of human immunodeficiency virus, viral hepatitis B, viral hepatitis C, and bacterial infections from patients. Patients' blood makes contact with the skin or mucous membranes of OR personnel in as many as 50% of operations, with cuts or needlesticks occurring in as many as 15% of operations. Surgeons and first assistants are at highest risk for injury, sustaining up to 59% of the injuries in the operating room. Scrub personnel have the second-highest frequency of injuries in the OR (19%), followed by anesthesiologists (6%) and circulating nurses (6%). For surgeons, suture needles are the most frequent source of sharps injuries.

The American College of Surgeons supports work practices that strive to eliminate, protect, or standardize the use of sharp instruments in the OR. The ACS also recommends the use of structured evaluations and user-based criteria that include performance standards, task analysis, simulation, and training programs for devices intended to reduce sharps injuries in the OR. A team approach to sharps safety is critical to reduce the risk of bloodborne infections resulting from sharps injuries in the operating room. Hospitals and health care facilities should make sharps injury-reduction techniques and instruments available for surgeons and OR personnel.

Double-gloving. Glove barrier failure is common with reported perforation rates as high as 61% for thoracic surgeons and 40% for scrub personnel. Double-gloving reduces the risk of exposure to patient blood by as much as 87% when the outer glove is punctured. Double-gloving has certain disadvantages such as decreased tactile sensation. In certain types of surgery (such as neurosurgery), where delicate manipulation of instruments and tissues is required, double-gloving may impair the surgeon's ability to safely perform the procedures. Despite a large body of data documenting the benefits of double-gloving, this technique has not received wide acceptance by surgeons. In many cases, a period of adaptation and "retraining" seems to be required before practitioners feel comfortable with the technique. New specially designed undergloves have recently become available to make the process of double-gloving more acceptable to surgeons.

The ACS recommends the universal adoption of the double glove (or underglove) technique in order to reduce body fluid exposure caused by glove tears and sharps injuries in surgeons and scrub personnel. In certain delicate operations, and in situations where it may compromise the safe conduct of the operation or safety of the patient, the surgeon may decide to forgo this safety measure.

Blunt-tip suture needles: Suture needle injuries pose the greatest risk of sharps injury to the surgeon and scrub personnel. The effectiveness of the use of blunt-tip suture needles in reducing sharps injuries is supported by a number of randomized studies and case series that demonstrate decreases in the rates of glove puncture from as high as 38% down to 6% — and down to zero in some cases — following the adoption of blunt suture needles. The use of blunt suture needles requires no changes in work practices for surgeons. A new generation of blunt suture needles is now on the market with a slightly more tapered tip profile that may provide for easier suturing compared to the earlier needles used in the referenced studies.

The ACS recommends the universal adoption of blunt tip suture needles for the closure of fascia and muscle in order to reduce needle-stick injuries in surgeons and OR personnel.

The neutral zone: The hands-free technique (HFT) requires the surgical team to designate a sharps neutral zone (for example, a towel, Mayo stand, magnetic pad, and so on) for the pickup and release of surgical sharps such as needle holders, scalpels, and syringes with needles. In this manner, there is no direct handing of instruments from scrub person to surgeon and back. If the surgeon must not break eye contact with the surgical field during critical parts of the operation where patient safety or workflow might be compromised, a partial HFT may be used whereby sharps are directly handed by the scrub person to the surgeon, but then returned to the scrub person via a neutral zone.

The ACS recommends the use of HFT as an adjunctive safety measure to reduce sharps injuries during surgery except in situations where it may compromise the safe conduct of the operation, in which case a partial HFT can be used.