OR remains a sharps safety hold-out
Surgeons, nurses push for safer devices
Amid the successes in sharps safety in hospitals in the 21st century, there is one glaring gap: The operating room. Sharps injuries there remain as much of a problem as they were in 2000, when the Needlestick Safety and Prevention Act was signed into law.
Safety advocates, including some surgeons who have emerged as sharps safety champions, are hoping that the momentum is finally beginning to change.
"We do now have a critical mass to make some change," says Ramon Berguer, MD, FACS, chief of surgery at Contra Costa Regional Medical Center in Martinez, CA. "We have the data. We have second-generation devices that are well-made and well-marketed. We have the endorsement of leading surgical associations."
The American College of Surgeons endorsed blunt suture needles, double-gloving, using a neutral zone for passing instruments, and other safety devices in the OR, although adoption of those safety efforts has been slow.
Berguer, a member of the ACS Committee on Perioperative Care, has been a vocal proponent of sharps safety in the OR. With Janine Jagger and Elayne Kornblatt Phillips of the International Healthcare Worker Safety Center, he co-authored an analysis of sharps injuries at 87 hospitals around the country from 1993 to 2006. It showed that sharps injuries actually rose by 6.7% in the OR while they declined by 31.6% elsewhere in the hospital.1
That information may be a turning-point in the effort to improve sharps safety in the OR. "It was very sobering," says Linda Groah RN, MSN, CNOR, NEA-BC, FAAN, executive director and CEO of the Association of periOperative Registered Nurses (AORN). It caused the association to question, "What can we do to enforce the practices that we know make a difference?" she says.
AORN recently issued "A Call to Arms to Prevent Sharps Injuries in Our ORs" through its AORN Journal.2 The association also plans to release a toolkit for reducing OR sharps injuries, which will be available on the web site (www.aorn.org).
Two-thirds of sharps injuries in the OR are incurred by nurses and surgical technicians, according to data from the center's Exposure Prevention Information Network (EPINet). "Decisions made by one member of the team affect the risk of other members of the team. To me, that's the key leverage point I'm taking to my colleagues," says Berguer.
Start with a hospital policy
Sharps safety in the OR needs to be an institutional mandate, says Berguer. It may be expressed in a policy that is developed by OR leadership, including the OR manager and chief of anesthesia, he 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, he says.
AORN's toolkit will include a sample policy. Hospital leadership needs to "embrace this issue," says Groah. That means setting expectations for safety and taking a close look at the OR injuries, she 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 hospital policy on safe practices, such as maintaining safe zone for passing instruments, hospital leadership should follow through by curtailing privileges, Groah says.
Outside enforcement is unlikely because the U.S. Occupational Safety and Health Administration rarely inspects ORs, unless there is a complaint. But OSHA does expect hospitals 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.
Employee health can play a role by sharing sharps injury data and educational material with OR staff and physicians. 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.
Berguer himself has switched to blunt suture needles, which are now more widely available in a variety of sizes. While he once had needlesticks about twice a year, now 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 will eventually 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.
1. Jagger J, Berguer R, Phillips EK, et al. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation. J Am Coll Surg 2010; 210:496–502.
2. Guglielmi C. A call to arms to prevent sharps injuries in our ORs. AORN Journal 2010; 92:387-392.