Study shows surgical teams still at risk for accidental sharps injuries
It’s time for hospitals to adopt preventive measures to protect all the members of surgical teams performing procedures in their operating rooms (OR), says California surgeon Ramon Berguer, MD, FACS.
That call for action follows a new study that shows the number of surgeons, residents, and nurses experiencing accidental injuries from sutures, scalpels, syringes, and other devices in the OR has actually increased by 6.5% since the introduction of the Needlestick Safety and Prevention Act in 2000. Berguer, chief of surgery at Contra Costa Regional Medical Center in Martinez, CA, and a lead author of the study, says he is not surprised by the findings.
“I work in the operating room; I know what the culture is like,” says Berguer. “I have adopted safety strategies myself and I have pushed my hospital to do so. I understand the struggle that is taking place.”
For instance, although statistics show that blunt-tip suture needles help reduce injury rates for every staff member participating in a surgery, many surgeons still won’t use them.
This is why Berguer argues that it’s time for hospitals to change their thinking and adopt policies to protect everyone in the OR.
The study, published in the April Journal of the American College of Surgeons, found that many surgical teams and hospitals are not using devices and procedures proven to reduce the risk of accidental needlesticks in the OR, such as blunt-tip suture needles and sheath scalpels. You can find the study, “Increase in Sharps Injuries in Surgical Settings Versus Nonsurgical Settings After Passage of National Needlestick Legislation,” at www.journalacs.org/article/S1072-7515(09)01654-8/abstract.
It’s not just surgeons who are at risk from accidental exposure to bloodborne pathogens from sharps injuries, but all members of the surgical team, says Berguer, a spokesperson for Ethicon, the major manufacturer and seller of blunt-tip needles in the United States.
Use of blunt-tip suture needles—which have been specially engineered to reduce the risk of accidental needlesticks and meet the standards under the Needlestick Safety and Prevention Act—have been met with resistance from some surgeons. Although they can’t be used in all instances, surgeons can use blunt-tip suture needles for suturing soft tissues, such as muscle.
What the study found
The study looked at data from 87 hospitals in the United States. Researchers analyzed findings from more than 31,000 reported accidental sticks from 1993 to 2006, including 7,186 sticks reported in OR settings. According to the study, most injuries were caused by:
- Suture needles (43.3%)
- Scalpel blades (17%)
- Syringes (12%)
The study also found that 75% of accidental sticks in the OR occur when medical devices are in use or are passed from one hospital worker to another. Nurses and surgical technicians are the ones typically injured by devices originally used by surgeons and residents.
More than 384,000 healthcare workers in the United States suffer needlestick injuries each year, putting them at risk for hepatitis, HIV, and other serious diseases.
The failure to reduce sharps injuries in the OR is a result of hospitals’ reluctance to adopt safety devices and strategies that are proven to work, Berguer says.
Part of the reason is the culture of the OR, where surgeons are in charge and there is an acceptance of risk. And up until recently, some safety devices have not been widely available or prominently marketed, he says.
There were also problems with some of the earlier safety devices.
“The first generation of sheath scalpels were both ineffective as scalpels and poorly constructed as safety devices,” Berguer says.
Further, there may not be an accurate picture of just how problematic the issue of sharps injuries is in ORs. Most needlesticks go unreported, Berguer says, as it can be a laborious process to report a sharps injury.
“For all these reasons, we’ve made little progress in the OR,” he says.
Ready for change?
Berguer says he hopes all that will change. “Right now we’re actually at a point where we can make an impact on needlesticks in the OR,” he says.
Surgeons now have the appropriate data to prove that sharps injuries in the OR are problematic, Berguer says. The industry has also progressed, adding better safety devices to the market.
OSHA’s Bloodborne Pathogens standard requires the use of devices to reduce needlestick injuries. However, OSHA does qualify its safe needle mandates by giving leeway to surgeons in its guidance documents.
For instance, surgeons don’t have to use a safer device if it “compromises either patient safety or medical integrity,” OSHA indicated in its 2007 bulletin developed with the National Institute for Occupational Safety and Health, titled “Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel.”
However, studies like Berguer’s now make it clear surgeons aren’t the only ones at risk.
“I think what’s been missing in the discussion is the fact that the needlestick risk is a shared risk among the team,” Berguer says. A decision made by a surgeon to use a sharp needle, for example, puts the entire surgical team at risk.
“I think that changes the tone of the discussion because now it becomes an employee safety issue,” says Berguer.
What happens next?
To bring about change in the OR, Berguer says he is in favor of ORs adopting a sharps policy that mandates the use of four strategies listed in the American College of Surgeons’ (ACS) statement on sharps safety:
- The universal adoption of the double glove technique or use of specially designed undergloves to reduce body fluid exposure caused by glove tears and sharps injuries
- The universal adoption of blunt-tip suture needles for the closure of fascia and muscle
- The use of the hands-free technique, which requires the surgical team to designate a sharps neutral zone for the pickup and release of surgical sharps, thus eliminating the direct handling of instruments from scrub person to surgeon and back
- The use of engineering sharps injury prevention mechanical devices as an adjunctive safety measure
Like OSHA, the ACS recommendations allow for discretion by the surgeon if circumstances could compromise safety. You can find the full statement at www.facs.org/fellows_info/statements/st-58.html.
“I think the strategy has been to try and have surgeons adopt them voluntarily, and that just hasn’t worked,” Berguer says. “But the fact that it is a shared risk puts the responsibility now on the hospital to protect its employees regardless of what the surgeon decides to do.”
“I think implementing a policy in the OR is the way to move this forward,” he says, and this needs to come from a hospital’s OR leadership group.
Currently, Berguer is working with several groups—the ACS, the Association of periOperative Registered Nurses, and the Council on Surgical and Perioperative Safety—to develop a template for a sharps policy that hospitals can adapt for their own institutions.
Safety devices are more expensive but save you the cost of sharps injuries
It may be more expensive for hospitals to use safer sharps devices in their ORs, but facilities will ultimately save money by avoiding injuries to members of their surgical teams, says Berguer.
Although safety devices can be more expensive, hospitals will save on costs associated with sharps injuries, says Berguer. Studies that have looked at the increased cost of safety needles versus the cost of reporting and treating a needlestick show a significant cost savings for hospitals, he says.
For example, blunt-tip surgical needles cost about 20% more than other sharp needles, Berguer says. However, each needlestick injury costs about $700 to report and $3,000 to treat with antibiotics. There is an additional expense if a hospital worker is injured and files a workers’ compensation claim. Needlestick injuries are the most common cause of accepted workers’ compensation claims in U.S. hospitals, he says.
“I think the C-suite can look at the numbers and definitely see these are substantial cost savings even with the slightly higher unit cost,” Berguer says.
Hospital Safety Center, August 2010, HCPro, Inc.