Blunt’ suture needles protect surgeons, patients
CDC study underscores efficacy of safety devices
A clinical trial of "blunt" suture needles has yielded promising findings that may signal a greater role for the equipment in preventing bloodborne infections in both surgeons and patients, the Centers for Disease Control and Prevention reports.
The findings of a study at three hospitals in New York City reveal that blunt needles curved suture needles that have a relatively blunt tip were associated with statistically significant reductions in percutaneous injuries, minimal adverse effects on patient care, and general acceptance by gynecologic surgeons.1 Indeed, the findings suggest that suture needle injuries could be virtually eliminated in some procedures, as none of the 6,139 blunt needles used in the study caused a percutaneous injury to a surgeon.
"Having been stuck myself a zillion times, heck yes it makes me feel better [using blunt needles]," says Janet Stein, MD, a surgeon who participated in the study and associate director of maternal fetal medicine at Beth Israel Medical Center in New York City. "Anytime you have a breach in the integrity of a glove from a needlestick, there is a risk of infectious fluids going in either direction. If you have less chance of percutaneous injuries, it is a benefit to the patient as well."
With recent reports of provider-to-patient transmission of bloodborne pathogens during surgery, such safety-designed needles could become a more widely implemented preventive measure for certain procedures. Though noting a caveat regarding the need for additional studies to determine for which procedures the needles are best suited, the CDC concluded that the findings support the use of blunt needles as an effective component of needlestick prevention programs.
"The main function of these devices is to protect health care workers, but they may also have the effect of protecting the patient," says Louise Short, MD, medical epidemiologist in the HIV infections branch of the CDC hospital infections program and principal investigator in the study. "I think it does show a lot of promise, but one of the things that needs to be further evaluated is how good this needle would be in other areas of surgery."
Some surgeons likely will continue to favor sharper needles for delicate procedures, as a blunt needle could damage tissue if too much pressure is required in suturing, Stein says.
"But in surgery where delicacy is not so much of an issue it is absolutely adequate," she says. "I don’t think it is going to replace sharp needles in every instance, but for procedures like cesarean sections there is no reason why we shouldn’t use a needle like this."
Blunt design requires adjustment
In 25 (6%) of the 402 gynecologic procedures during which blunt needles were used, surgeons reported difficulties, including problems penetrating tissue (18), tearing of tissue (three), needle slippage (three), and bleeding when the needle entered the tissue (one). However, none of those incidents were determined to be clinically important, and procedures performed with and without blunt needles had roughly equal patient blood loss and operative times, the CDC reported. Regardless, some surgeons still will prefer the traditional feel of a sharper suture needle, rather than making the adjustment to get used to the blunt design, Stein adds.
"It does take getting used to it’s a different feel," the surgeon says. "For people who are set in their ways and used to things a certain way, it’s an adjustment; there is no question about it."
The "blunt" label notwithstanding, the needle is designed to be sharp enough to suture through tissue but dull enough not to puncture the surgeon’s fingers or hands on contact. Some of the surgeons in the study worked with the manufacturer (Ethicon Inc. in Somerville, NJ) to refine the sharpness without increasing the risk of needlestick, and the company confirmed the refined version used in the study is now commercially available. (See editor’s note at end of article.)
The study compared the blunt curved suture needles with conventional "sharp" curved and straight needles used in gynecologic surgery. The speciality is among those that have been cited by the CDC as "exposure-prone" due to high needle injury rates. 2-4 From March 1993 through June 1994, trained nurse observers at the hospitals systematically recorded information about the nature and frequency of all percutaneous injuries and the number and type of suture needles used during gynecologic surgical procedures. Needlesticks observed or reported during surgery were confirmed by inspection of the health care workers’ hands before they left the operating room. Beginning in February 1994, investigators replaced conventional curved suture needles with blunt needles on all gynecologic surgical instrument trays. However, surgeons retained the option of requesting conventional needles.
During March 1993–June 1994, a total of 87 percutaneous injuries occurred during 84 (6%) of 1464 procedures. Of those, 61 (70%) involved suture needles. None of the 61 injuries involving suture needles involved blunt needles, but 56 (92%) were associated with conventional curved needles and five (8%) with straight needles. The percentage of blunt needles used increased during the study and was associated with declining injury rates from 5.9 needlesticks per 100 procedures in 1993 to 1.1 needlesticks per 100 procedures in 1994. (See related chart, above.)
In addition, conventional straight suture needles emerged as a greater hazard than conventional curved needles, yielding respective injury rates of 14.2 per 1,000 needles used as compared to 1.9 injuries per 1,000 needles used. Noting that the injury rate for straight needles was more than seven times greater, the CDC recommended surgeons consider using conventional curved needles, blunt needles, or staplers to close skin.
One limitation of the assessment was the lack of systematic long-term follow-up of patients to assess possible delayed complications of surgery, including surgical site infections. However, a previously published report on a small number of patients did not document infections in association with use of blunt needles, the CDC reported.5
[Editor’s note: For more information on the availability and cost of the blunt needles, readers can contact Ethicon at (800) 255-2500.]
References
1. Centers for Disease Control and Prevention. Evaluation of blunt suture needles in preventing percutaneous injuries among health-care workers during gynecologic surgical procedures New York City, March 1993-June 1994. MMWR 1997; 46:25-29.
2. Centers for Disease Control and Prevention. Recom mendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991; 40:1-9.
3. Short LJ, Bell DM. Risk of occupational infection with blood-borne pathogens in operating and delivery room settings. Am J Infect Control 1993; 21:343–50.
4. Tokars JI, Bell DM, Culver DH, et al. Percutaneous injur ies during surgical procedures. JAMA 1992; 267:2899–2904.
5. Miller SS, Sabharwal A. Subcuticular skin closure using a "blunt" needle. Ann R Coll Surg Engl 1994; 76:281.
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