Beginning to Build a Culture of Safety at the ACS Meeting on OR Safety

Dr. Vaughn Whittaker, a Transplant fellow at Columbia-Presbyterian Hospital and a CIR NY Regional VP, and Sandy Shea, CIR Policy Director, attended the 2008 American College of Surgeons Clinical Congress in San Francisco on October 12-15, 2008. 

They were on a mission: to meet the College's OR Safety "movers and shakers" and to learn about new information and best practices on the topic of OR Safety.  They found a wealth of information on promoting a culture of safety in the OR.

While there, Dr. Whittaker and Ms. Shea attended a meeting of the ACS Committee on PeriOperative Care at the invitation of Dr. Bill Schecter, a trauma surgeon at San Francisco General Hospital and chair of the committee. The meeting focused on a draft of the ACS Statement on Sharps Safety, which greatly expands on the ACS's 2005 Statement on Blunt Suture Needles.  The new statement, which is still being revised, recommends the universal adoption of double gloving and blunt tip suture needles for the closure of fascia and muscle, the use of the Neutral Zone (hands-free technique), and the continued clinical evaluation of engineering sharps injury prevention devices (e.g., retractable scalpels) and safety accessories (e.g., scalpel blade removers) to assess their effectiveness in reducing sharps injury.

Later that day at a panel session entitled "Safer Surgery 2008," more than 200 surgeons listened to compelling data presented by three surgeons involved in the national effort to make the OR a safer workplace.

Dr. Ramon Berguer from Contra Costa Medical Center reported that more than 50% of needlesticks in the inpatient setting now occur in the operating room. The number one cause of sticks to the surgeon in the OR? Suture needles.

"If you make one change today," said Dr. Berguer, "make it the universal adoption of blunt tip suture needles for the closing of fascia and muscle." He stressed that the surgeon's decision to adopt this measure affected the safety of the entire surgical team.
Double-gloving, Dr. Berguer noted could "also be done today. A 2007 survey of 399 Fellows of the College found that very few of us double-gloved and 74% rarely or never used a blunt tip suture needle." These two safety moves should become as normal and commonplace "as buckling your seatbelt before you drive off."

Dr. Berguer also described the ACS's recommended use of the "Neutral Zone" as an important adjunct safety measure to prevent sticks. He described the need for further clinical evaluation of engineered sharps injury prevention (ESIP) safety scalpels and safety accessories, like scalpel blade removers and neutral zone trays. According to some estimates, as many as 70% of injuries could be prevented with the use of these new devices.

On the same panel, Dr. Donald Fry from Northwestern University Hospital commented on "the lassitude of both physicians and the CDC community when it comes to OR safety," noting that the CDC had not updated its protocols since 2001.

Remarking that "indifference had set in since the A.I.D.S. scare declined," Dr. Fry warned that exposure to Hepatitis C was just as threatening to health care workers. "We live in a pool of viruses," he said, calling on his colleagues to adopt safety equipment, modify behavior and promptly report injuries when exposed so they could receive appropriate treatment.

"Indifference is a huge problem," said Dr. Fry. "We don't report a stick or do anything about it!"

He urged senior surgeons to "lead by example" by taking their annual OSHA training seriously, adopting systems for preventing injuries, reporting them when they do occur, and increasing prevention by adding to the "Time Out" check list:

• Are eyes covered?
• Are we double-gloved?
• Do we have blunt suture needles?

Dr. Martin McKary from Johns Hopkins, who had authored the December 2007 article in the New England Journal of Medicine reporting on the high rate of needlesticks among surgery residents across the country, noted, "We know how to prevent needlestick injuries, but there is a disconnect between our ideas and our practice."

Dr. McKrary urged colleagues to submit their innovative safety ideas to companies like Covidien, Sandel and Ethicon.  He stressed that such companies are eager to innovate and you can easily enter a non-disclosure agreement to protect your idea.  He cited a number of innovations that have already come from these companies, including blunt tip trocars for laproscopic surgery, new blunt tip suture needles which are sharper and easier to use, mats to cover cords in the OR, and retractable scalpels.

A lively question and answer period followed. One participant said that it was "the duty of senior surgeons to make sure that everyone on their team wears and/or uses proper equipment." The panelists agreed, pointing out that the "respected, cool" surgeons need to set an example.