How to make the OR a sharps safety zone

EHPs gain support for safer OR practices

Major advances in reducing sharps injuries have not yet pervaded the operating room, where one out of four sharps injuries takes place. Employee health must be involved in helping change attitudes in the OR 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.

But employee health professionals must share the injury data from their own OR with the 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 can bring improvement, she says.

"I have been out in the field and found that when you do that, there is more apt to be compliance," Blanchard says.

Gaining support from administration and physician leaders also is crucial, says Davis. "The infection control or occupational health nurse 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."

QI project gains advocates

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 (Sweinbinder Publications, $14.95).

Hospitals often begin by implementing safer practices, such as no-hands passing. At Rose Medical Center in Denver, operating room educator Pat Koehmstedt, RN, CNOR, met with staff and helped them design a neutral zone and select a sharps holder. Instead of passing the instruments directly to OR staff, the surgeon would place them in the neutral zone.

To back up the new process, Koehmstedt put posters above the scrub sinks and educated surgical technicians and nurses at their 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," says Koehmstedt. "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. But the neutral zone, with no-hands passing, has remained, Koehmstedt says.

"The whole theory was to decrease [sharps injuries], which we have accomplished," she says. "Even though they’re not using an instrument, the technique is improved."

Convincing surgeons to use other safety devices, such as blunt sutures, is more difficult. But as new products are developed, they may become more acceptable, says Blanchard.

"You really have to look at what’s being offered and work with the companies to help them improve the product," she says.

For example, adhesives may be an alternative that could remove the risk in some circumstances.

Use data to build your case

Surgeons are data-driven, so show them the numbers, says Davis. "The occupational health nurse knows how many people got stuck last year. The surgeon doesn’t. The scrub tech doesn’t," he says. "If they weren’t the ones stuck, they don’t know anyone got stuck. You’ve got to get the data so people will be motivated to accept change."

OR blood exposure rates should be posted in the lounge at least on a quarterly basis, Davis says.

Awareness of the risks — both medical and regulatory — also can have an impact. An estimated 2.7 million Americans have chronic hepatitis C, many of them without knowing it; and that creates a risk of infection from bloodborne exposures.

Both hospitals and surgeons may come under scrutiny from the U.S. Occupational Health and Safety Administration through their stronger enforcement of the bloodborne pathogen standard. That is the most frequently cited standard 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 says.

The bottom line: Surgeons may not initially embrace some of the changes that are necessary for sharps safety, but they will adapt, Davis says.

"To say that surgeons are resistant to change and stubborn is throwing in the towel," he points out.

(Editor’s note: For more information on OR sharps safety or to order Davis’ book Advanced Precautions for Today’s OR, go to: www.orprecautions.com.)