Preventing Needlesticks in Surgical Personnel

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.