This text was abstracted from the following: College of Surgeons Committee on Perioperative Care. Statement on sharps safety. Bull Am Coll Surg 2007 Oct;92(10):34-7.
The American College of Surgeons (ACS) recommends that healthcare facilities adopt certain operating room (OR) work practices to avoid surgeons’ and OR staff members’ exposure to bloodborne infections as a result of sharps injuries and surgical glove tears. The recommended practices include using the double-glove technique, using blunt tip suture needles, using the hands-free technique (HFT) in designated neutral zones, and using engineering sharps injury prevention (ESIP) devices. Preventing exposure of surgeons and OR staff members to patients’ blood reduces the need for more blood tests and venipunctures on patients.
Double gloving can reduce the risk of exposure to patient blood by nearly 90% when an outer glove is punctured; however, surgeons have not universally accepted the technique. Periods of adaptation and retraining may help improve conformity.
The ACS recommends the universal adoption of the double glove (or underglove) technique in order to reduce body fluid exposure caused by glove tears and sharps injuries by surgeons and scrub personnel. In certain delicate operations, and in situations where it may compromise the safe conduct of the operation or safety of the patient, the surgeon may decide to forgo this safety measure.
Blunt Tip Suture Needles
The efficacy of blunt tip suture needles in reducing sharps injuries is demonstrated in several studies; furthermore, use of such needles does not require surgeons to change their work practices.
The ACS recommends the universal adoption of blunt tip suture needles for the closure of fascia and muscle in order to reduce needlestick injuries in surgeons and OR personnel.
The Neutral Zone
Use of HFT includes the surgical team establishing a neutral zone for pickup and release of sharps to ensure no direct handoff of sharps between team members. If surgeons are required to maintain eye contact with the surgical field (e.g., during a critical portion of a surgery), use of partial HFT has been established; that is, the scrub person hands sharps directly to surgeon, but the surgeon returns sharps via the neutral zone. Data supporting the use of HFT is inconclusive.
The ACS recommends the use of HFT as an adjunctive safety measure to reduce sharps injuries during surgery except in situations where it may compromise the safe conduct of the operation, in which case a partial HFT can be used.
ACS stated that there were no studies available demonstrating the clinical effectiveness of ESIP devices at the time of publication of the ACS statement, but added that that such devices may contribute to minimizing sharps injuries.
The ACS recommends the use of ESIP devices as an adjunctive safety measure to reduce sharps injuries during surgery except in situations where it may compromise the safe conduct of the operation or safety of the patient.