OR becomes last frontier for move to sharps safety
ACS endorses blunt needles, spurring change
American operating rooms may finally be ready to move toward sharps safety.
The American College of Surgeons (ACS) has endorsed the use of blunt suture needles and is poised to begin an educational push to reduce one of the most persistent remaining causes of sharps injuries. While sharps injuries have declined overall by about one-third, suturing injuries have remained stable.
Meanwhile, sharps safety experts are focusing on pre-packaged kits and trays, which often contain conventional devices.
"It's really astonishing how impenetrable the OR has been," says Janine Jagger, PhD, MPH, director of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville, who has made OR safety a priority. "We have a considerable amount of data demonstrating the lack of implementation of safety technology [in the OR] and a lack of consequent improvement in percutaneous injury rates."
Jagger lauded the efforts by ACS to promote sharps safety and predicted that change will come to the OR. "This endorsement by the ACS will be extremely important," she says.
The problem is largely one of awareness, says Lena M. Napolitano, MD, FACS, FCCP, FCCM, chair of the ACS Committee on Perioperative Care. She also is chief of surgical critical care and associate chair of surgery for critical care at the University of Michigan Health System in Ann Arbor.
Surgeons are beginning to recognize their personal risk from sharps injuries, she says. A 1998 study by Jagger and colleagues found that residents and attending surgeons experienced 55% of all exposures in the OR, and scrub nurses accounted for another 19% of exposures. Cardiovascular surgery was the most exposure-prone, accounting for 15.8% of exposures.1
Double-gloving and the use of blunt suture needles for suturing muscle and fascia reduce the risk of sharps injuries, according to a review of literature published in the Journal of the American College of Surgeons. The authors called for further research to validate the effectiveness of the hands-free technique for passing sharp instruments. They found there is insufficient evidence to show that hands-free passing significantly reduces exposures.2
"Although we're not right now as comfortable with [blunt suture needles], they're well worth the effort because they reduce sharps injuries," says Napolitano, who has been trialing the needles in her own practice. "There's just no question that they should be used."
Behavior change has been a difficult aspect of the transfer to safer sharps devices overall. But in the operating room, surgeons need to be convinced that blunt suture needles used for fascial closure and double-gloving can be just as effective as their previous techniques, Napolitano says.
"Surgeons tend to use the routine they know is
successful in ending up in good patient outcomes," she says. "They're hesitant to change unless they're certain it's going to end up in good patient outcomes."
Blunt needles work in Japan
Japan provides an example for the effective use of blunt suture needles, which are used there in about 60% of all muscle and fascial closures, says Brian Luscombe, group director, marketing for Syneture, a division of U.S. Surgical in Norwalk, CT.
"In 2000, when Congress passed the Needlestick Safety and Prevention Act, it was Japan's belief that blunt needles would become standard use in the United States," he says. "They began the process to convert their market to blunt needles. It wasn't until a few years later that they found out the U.S. had not in fact made the switch. They were surprised because they had fairly effectively switched over a large percentage of their usage to blunt needles."
In fact, traditionally, suture needle manufacturers had touted the sharpness of their needles. But with changes in technology, blunt suture needles require less penetration force than before and yet have a high resistance toward penetrating surgical gloves, Luscombe says. "It's a combination of the geometry of the needle as well as the coating that's applied to the needle," he says.
Surgeons now need to request the needles to spur development of the technology, safety experts say.
Syneture has several thousand product codes for suture needles in various sizes and with various sutures. Fewer than one hundred of those are blunt suture needles. The company has created blunt versions of its most popular items, but will broaden the offerings as interest increases, says Luscombe. "As a manufacturer, we will increase the number of codes that are available as demand increases," he says.
Even with better technology, not all suture needles can be converted to a blunt version. So what potential do they have to reduce OR exposures? Some 59% of suture needle injuries occur during the suturing of fascia. By contrast, the 1998 Jagger study found that only 6% of OR injuries occurred during the hand-to-hand passing of instruments (and 1.6% occurred during hands-free passing).1
Blunt suture needles don't just protect surgeons, notes Jagger; they also protect patients who could be exposed to surgeons' blood and other surgical team members who may handle and dispose of the used suture needle, she says.
With ACS backing and a bigger marketing push by manufacturers, Jagger is optimistic. "There's some resistance to get past, but I think we're on the verge of making a really big difference [in the OR]," she says.
References
1. Jagger J, Bentley M, and Tereskerz PM. Patterns and prevention of blood exposures in operating room personnel: A multi-center study. AORN Journal 1998; 67:979-996.
2. Berguer R and Heller PJ. Preventing sharps injuries in the operating room. Journal of the American College of Surgeons 2004; 199:462-467.
The American College of Surgeons (ACS) has endorsed the use of blunt suture needles and is poised to begin an educational push to reduce one of the most persistent remaining causes of sharps injuries.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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