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The mandate to reduce blood exposures is slowly moving into the area most resistant to change: the operating room. Although surgeons often balk at adopting new devices or processes, more are accepting safety measures as part of the U.S. Occupational Safety and Health Administration (OSHA) mandate to prevent blood exposures, says Mark Davis, MD, FACOG, an Atlanta-based surgeon. Davis is scheduled to speak on that topic at the upcoming annual conference of the Association of Occupational Health Professionals in Healthcare (AOHP). (For conference information, see editor’s note at the end of this article.)
About 22% of all blood exposures occur in the OR, according to EPINet, a multihospital database maintained by the International Health Care Worker Safety Center at the University of Virginia in Charlottesville. About half of those injuries are caused by suture needles, and 12% are caused by scalpel blades, according to a study conducted by the center and the Association of periOperative Registered Nurses (AORN) in Denver.1
Just using blunt sutures "would prevent the majority of suture needlesticks in the OR," Davis says. But he acknowledges that surgeons often are reluctant to use the safer needles. "Surgeons just are not used to them, but they work quite well," he says. However, OSHA has made it clear that the OR must implement safer devices and work practices under the bloodborne pathogens standard.
"It’s a problem that has to be addressed," says Davis, who wrote a book on the topic, Advanced Precautions for Today’s OR. "It has to become a team approach by the OR staff, including the surgeons."
For Davis, the need to prevent OR exposures became clear and compelling when he was cut with a scalpel while performing a hysterectomy in 1990. "Upon investigating the risk factors of the patient in the recovery room, I was somewhat shocked to find she had significant risk factors that I did not know about," he recalls. "Everyone was tested, and the tests were negative. But I had to go through an agonizing waiting period to find out that she tested negative for HIV. She was not even tested for hepatitis C."
Davis began investigating safer devices and methods. At DeKalb Medical Center in Decatur, GA, he convened an OR committee with surgeons, nurses, OR techs, and an infection control practitioner to look at policy changes. He now is surgical services bloodborne pathogens safety coordinator at the hospital.
The hospital began using blunt sutures and adopted a policy requiring no-hands passing of instruments, unless circumstances make it infeasible. In no-hands passing, OR staff place the instruments on a sterile tray rather than directly into the surgeon’s hands. The practice reduces the risk of injury during passing. The study of OR injuries found that about 15% of scalpel injuries occur during passing.
Implementing new procedures in the OR isn’t always easy. AORN recommends no-hands passing, but recognizes that the practice can’t be used in every circumstance, says Carol Petersen, RN, MAOM, CNOR, AORN perioperative nursing specialist. "It takes timing and cooperation of both the physician and the nurse and whoever’s in the sterile field." She notes that sometimes surgeons can’t take their eyes off wound sites because of bleeding and must have the instruments placed in their hands. "It truly takes teamwork and cooperation."
Davis concurs that better communication is the key to preventing exposures in the OR. "There’s just not enough communication in the OR for worker safety, as compared to patient safety," he says. "It really takes a commitment to making this an important issue." For example, educational programs on preventing exposures in the OR should be geared toward surgeons as well as OR staff, he says.
Davis is optimistic that surgeons will accept the new devices and changes that help reduce OR exposures. "We’ve gone through so many changes in health care and surgery with laparoscopic revolution. We’ve adapted very well to that. We’re learned to do many of our procedures through a scope. To me that was far more difficult than learning to pass instruments safely with a no-hands approach."
[Editor’s note: Advanced Precautions for Today’s OR: The Operating Room Professional’s Handbook for the Prevention of Sharps Injuries and Bloodborne Exposures is available for $14.95 from Sweinbinder Publications, P.O. Box 11988, Atlanta, GA 30355. Telephone: (404) 261-4595. E-mail: firstname.lastname@example.org.
The Association of Occupational Health Professionals annual conference will be held in Pittsburgh, Oct. 11-13. For more information, contact AOHP at (800) 362-4347. Web site: www.aohp.org/aohp.]
1. Jagger J, Bentley M, Tereskerz PM. Patterns and prevention of blood exposures in operating room personnel: A multicenter study. Advances in Exposure Prevention 1998; 3:61-71.