Preventing Needlesticks in Surgical Personnel
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Each year an estimated 385,000 needlesticks and other sharps-related injuries are sustained by hospital-based healthcare personnel; an average of 1,000 sharps injuries per day. Healthcare workers are at risk of exposure to bloodborne pathogens such as hepatitis B virus, hepatitis C virus and HIV if they come in contact with a patient’s blood. Surgical personnel such as surgeons, nurses, surgical technicians, and anesthesiologists are at risk of exposure to bloodborne pathogens if they receive a percutaneous injury (a penetrating injury to the skin) from sharp surgical instruments.
In October 2007, the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) together released a Safety and Health Information Bulletin titled Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel. The final document developed by NIOSH and OSHA reflects months of extensive peer review by internal and external experts in the affected healthcare community as well as public comment to a prepublication copy of the bulletin posted to the NIOSH website.
The Bulletin emphasizes that sharp-tip suture needles are the leading source of percutaneous injuries to surgical personnel, causing 51%-77% of these incidents. Suture needle injuries can occur when surgical personnel:
- Load or reposition the needle into the needle holder
- Pass the needle hand-to-hand between team members
- Sew toward the surgeon or assistant while the surgeon or assistant holds back other tissue
- Tie the tissue with the needle still attached
- Leave the needle on the operative field
- Place needles in an over-filled sharps container
- Place needles in a poorly located sharps container
However, there are proven alternatives that can decrease percutaneous injuries to surgical personnel. Up to 59% of suture needle injuries occur during suturing of muscle and fascia. Blunt-tip suture needles are an effective alternative for suturing less-dense tissue such as muscle and fascia. Studies have shown that the use of blunt-tip suture needles results in substantial reduction or elimination of injuries to surgical personnel with minimal adverse effects on patient care and a general acceptance by participating surgeons. Conventional sharp-tip suture needles may be needed to suture skin, bowel, and blood vessels although suture-less techniques for these procedures are also available.
In 2005, the American College of Surgeons (ACS) issued a statement supporting universal adoption of blunt-tip suture needles for suturing fascia and encouraging further investigation of their appropriate use in other surgical applications. All members of the Council on Surgical and Perioperative Safety have endorsed this statement.
The Safety and Health Information Bulletin is not a standard or regulation, and it does not create new legal obligations. The document emphasizes OSHA’s requirement and NIOSH’s recommendation to use safer medical devices where clinically appropriate. Given that clinical use and scientific studies have established the effectiveness of blunt-tip suture needles in decreasing percutaneous injuries, employers in workplaces that use suture needles have the responsibility under the Bloodborne Pathogens standard to evaluate the use of blunt-tip suture needles as well as other appropriate safer medical devices. As with any new device, the introduction of blunt-tip suture needles must include training of staff in proper use and follow-up to ensure a successful transition from conventional to safer devices.
Additional information and resources on bloodborne pathogens and percutaneous injury prevention can be found on NIOSH’s Bloodborne Infectious Diseases HIV/AIDS, Hepatitis B Virus, and Hepatitis C Virus page and OSHA’s Safety and Health Topics page, which also includes the complete text of OSHA’s Bloodborne Pathogens standard and the Needlestick Safety and Prevention Act. The NIOSH page also links to the Centers for Disease Control and Prevention’s Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program, which contains detailed information on how to select and evaluate sharps devices with engineered sharps-injury prevention features as well as a sample device evaluation form.
Walter Alarcon, MD, MSc
Dr. Alarcon is a Senior Service Fellow in NIOSH’s Division of Surveillance, Hazard Evaluations & Field Studies.
The author would like to thank Sheila Arbury, Elise Handelman, Laurence Reed, and Ahmed Gomaa for their contributions to the Safety and Health Bulletin.
6 comments on “Preventing Needlesticks in Surgical Personnel”
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We can all be greatful to the pioneering work of Dr. June Fisher in driving design research and adoption of new devices by healthcare personnel.
The shere statistics are scary here, Isn’t there a national insurance fund that covers these type of injuries?
In answer to the 2nd comment, the question from Mr/Ms Palonek, I offer the following answer:
Workplace injuries, including needlesticks, are covered by Workers Compensation. Each state has its own Workers Compensation system with its own laws.
The German Institute for Occupational Safety and Health of the German Social Accident Insurance published an English review of the international literature on the prevention of needle stick injuries, titled “Effectiveness of measures to prevent needlestick injuries among employees in health professions” in 2006:
[http://hvbg.de/e/bia/pub/rep/rep05/nadelstich.html]
The study also discussed the scientific papers on suture needles. The study showed a clear positive effect of safe instruments in general to prevent needle stick injuries.
I am a graduate student at Old Dominion University in a Risk Assessment course. While reading this article, the first thing that came to my mind concerning injury prevention would be the use of some kind of material (similar to what is used in bulletproof vests to prevent knife injuries) in gloves. Looking through the links in the post, I did not see this sort of preventive measure listed. Looking up field testing done on puncture resistant gloves I found that the primary reason for physicians favoring nitrile plastic gloves over puncture resistant ones was due to comfort.
Whether this comfort actually affected job performance was not immediately clear from the articles I read. This seems like a vital issue in risk management for people involved in the use of sharp instruments. Is there any plans for the future to work toward enforcement in the use of puncture resistant equipment?
Responding to the concern raised by Eric Speigel, the issue of puncture resistant gloves is a valid one. There are some “puncture resistant” gloves available which are marketed and used for protecting against sharps injuries. However, the selection of PPE has to be based on the appropriateness for the job/tasks being performed and, in healthcare, it is important to include consideration of both employee and patient safety issues. One of the issues often raised regarding use of puncture resistant materials is the level of dexterity afforded to the practitioner. For some surgeries for instance, it is argued that these materials greatly reduce dexterity and can negatively affect patient safety. One measure that is often used is “double-gloving”. The use of a second glove provides and additional level of protection which makes it more difficult to sustain a cut or a needlestick injury.