Sharps injuries and needle sticks are a significant hazard in the operating room, and providers who don't comply with prevention practices can endanger themselves, their colleagues and their patients. Mary J. Ogg, MSN, RN, CNOR, sharps expert with the Association of periOperative Registered Nurses, discusses six ways facilities can decrease the incidence of sharps injury in the operating room.
1. Double-glove. Ms. Ogg says double-gloving, or wearing two pairs of surgical gloves, can reduce the incidence of sharps injuries and needle sticks. Some providers are reluctant to wear two pairs of gloves because they feel double-gloving decreases sensitivity, so facilities should take time to educate physicians on the importance of the practice. Fortunately, a staff member's decision to double-glove does not require buy-in from another provider, meaning the practice is relatively easy to spread throughout a team even if some members remain uncommitted.
2. Use blunt-tip suture needles. Blunt-tip suture needles are proven to be safe and effective, but providers sometimes shun the practice because they are used to working with sharp suture needles. Ms. Ogg says there are some misconceptions about the efficacy of blunt-tip suture needles among the physician population. "They don't think they glide through the tissue as easily, but the newer ones do," she says. "There are many situations where [blunt-tip suture needles] would be a good alternative if the physicians will try it."
3. Close incisions without sutures. Ms. Ogg says there are various ways of closing an incision without using a suture. She says typically, when a provider closes the skin, he or she uses a cutting needle that's sharper and more likely to injure someone. Newer adhesives can close the skin incision without a needle, and staples can also provide a safe alternative to sharps, when appropriate.
4. Implement a "safe zone." Providers can reduce the likelihood of sharps injuries by implementing a "safe zone," or an area where sharps and needles are placed to be picked up by the next provider. This "safe zone" eliminates the need to pass a sharp object directly to a staff member, decreasing the chance of injury. "Instead of handing the scalpel blade into the surgeon's hand, you put it in the neutral zone and they pick it up," she says.
5. Use safety-engineered devices. Ms. Ogg says new and improved safety-engineered devices are constantly being manufactured. Safety-engineered devices are designed to prevent injuries and exposures to blood borne pathogens in the healthcare setting, and the list includes injection devices, IV insertion equipment, surgical scalpels, lancets and a host of other devices. Ms. Ogg says there has been some resistance from surgeons when trying to introduce safety-engineered devices, in part because the devices are different from the instruments the physicians are used to. "The first generation [of devices] didn't have the same look and feel of the more typical scalpel with the blade," she says. However, she believes the devices are improving with every release, and physicians willing to try the instruments will find they are pleasantly surprised.
6. Use data to convince physicians. Physicians may be hesitant to adopt practices that decrease the incidence of sharps injuries and needle sticks, but Ms. Ogg says providing hard numbers in support of the practices can help. AORN has developed a 30-slide educational PowerPoint presentation that demonstrates the effectiveness of the practices with data. "Surgeons are more receptive to seeing evidence rather than just being told they should do this," Ms. Ogg says. The AORN toolkit on sharps injuries and needle sticks also includes a letter from retired surgeon Mark Davis, MD, that explains when a physician ignores best practices for preventing injuries, he or she puts every member of the surgical team at risk. Ms. Ogg recommends using data and testimony from other respected physicians to convince providers that the prevention practices are worthwhile and necessary.
AORN toolkits on sharps injuries and needle stick prevention are available to members. Read more about AORN membership here.
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1. Double-glove. Ms. Ogg says double-gloving, or wearing two pairs of surgical gloves, can reduce the incidence of sharps injuries and needle sticks. Some providers are reluctant to wear two pairs of gloves because they feel double-gloving decreases sensitivity, so facilities should take time to educate physicians on the importance of the practice. Fortunately, a staff member's decision to double-glove does not require buy-in from another provider, meaning the practice is relatively easy to spread throughout a team even if some members remain uncommitted.
2. Use blunt-tip suture needles. Blunt-tip suture needles are proven to be safe and effective, but providers sometimes shun the practice because they are used to working with sharp suture needles. Ms. Ogg says there are some misconceptions about the efficacy of blunt-tip suture needles among the physician population. "They don't think they glide through the tissue as easily, but the newer ones do," she says. "There are many situations where [blunt-tip suture needles] would be a good alternative if the physicians will try it."
3. Close incisions without sutures. Ms. Ogg says there are various ways of closing an incision without using a suture. She says typically, when a provider closes the skin, he or she uses a cutting needle that's sharper and more likely to injure someone. Newer adhesives can close the skin incision without a needle, and staples can also provide a safe alternative to sharps, when appropriate.
4. Implement a "safe zone." Providers can reduce the likelihood of sharps injuries by implementing a "safe zone," or an area where sharps and needles are placed to be picked up by the next provider. This "safe zone" eliminates the need to pass a sharp object directly to a staff member, decreasing the chance of injury. "Instead of handing the scalpel blade into the surgeon's hand, you put it in the neutral zone and they pick it up," she says.
5. Use safety-engineered devices. Ms. Ogg says new and improved safety-engineered devices are constantly being manufactured. Safety-engineered devices are designed to prevent injuries and exposures to blood borne pathogens in the healthcare setting, and the list includes injection devices, IV insertion equipment, surgical scalpels, lancets and a host of other devices. Ms. Ogg says there has been some resistance from surgeons when trying to introduce safety-engineered devices, in part because the devices are different from the instruments the physicians are used to. "The first generation [of devices] didn't have the same look and feel of the more typical scalpel with the blade," she says. However, she believes the devices are improving with every release, and physicians willing to try the instruments will find they are pleasantly surprised.
6. Use data to convince physicians. Physicians may be hesitant to adopt practices that decrease the incidence of sharps injuries and needle sticks, but Ms. Ogg says providing hard numbers in support of the practices can help. AORN has developed a 30-slide educational PowerPoint presentation that demonstrates the effectiveness of the practices with data. "Surgeons are more receptive to seeing evidence rather than just being told they should do this," Ms. Ogg says. The AORN toolkit on sharps injuries and needle sticks also includes a letter from retired surgeon Mark Davis, MD, that explains when a physician ignores best practices for preventing injuries, he or she puts every member of the surgical team at risk. Ms. Ogg recommends using data and testimony from other respected physicians to convince providers that the prevention practices are worthwhile and necessary.
AORN toolkits on sharps injuries and needle stick prevention are available to members. Read more about AORN membership here.
Related Articles on OR Efficiency:
Why Most ORs Are Set Up for Failure
Cardiac Catheterizations Through Wrist Reduce Recovery Time, Bleeding
Study: Checklists Most Effective When Surgical Staff Knows Why, How They Are Used