Needlesticks and OR Safety

The very nature of our work exposes us on a daily basis to occupational injury and the possibility of contracting a blood-borne disease – HIV, HCV and HBV. Too often, however, we respond to that danger with denial.

Learn more about the scope of the needlestick problem and what residents can do to protect themselves.

In 1999, the National Institute for Occupational Safety and Health (NIOSH) estimated that between 600,000 and 800,000 needlesticks and other percutaneous injuries were reported annually among U.S. health care workers.

After a long campaign by occupational health advocates and union members--including CIR residents working with our national affiliate the Service Employees International Union (SEIU)--Congress passed the Needlestick Safety and Prevention Act of 2000.

SEIU Health and Safety Director Bill Borwegen points out that “Needlesticks have dropped in half since the law was passed and hospitals were required to use needles with integrated safety features, such as retractable syringes. Cases of Hep B went from 17,000 a year to less than 300 according to data from the Centers for Disease Control and Prevention.”

But needlesticks have by no means been eradicated. “We have to be eternally vigilant,” Borwegen warns.

To find out more, check out the following resources:

• International Health Care Worker Safety Center, University of Virginia Health System – Started by Dr. Janine Jagger, this site offers a wealth of information about prevention, regulation, and safety devices (by type and manufacturer). It also contains a comprehensive bibliography of articles on needlestick injury and prevention.

• International Sharps Injury Prevention Society – education, information and product knowledge to help reduce the number of sharps injuries.

• NIOSH Alert: Preventing Needlestick Injuries in Health Care Settings

• Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV and HIV and Recommendations for Postexposure Prophylasix

• OSHA: Bloodborne Pathogens and Needlestick Prevention

Unfortunately, needlestick safety in the operating room has not improved since passage of the federal Needlestick Safety and Prevention Act of 2000 and continues to be a significant cause of occupational exposure for surgical residents, attendings, and nurses.

Dr. Martin Makary, et. al, writing in the New England Journal of Medicine (“Needlestick Injuries among Surgeons in Training,” 6/28/07) reports that “Needlestick injuries pose a significant occupational risk for surgical trainees” and that “underreporting [of needlesticks] may result in a substantial underestimation of the magnitude of the problem.”

Safety equipment does exist, but it is largely absent from operating rooms in the U.S., despite recommendations by the CDC, OSHA, NIOSH and the American College of Surgeons. What is the scope of the problem? What are some solutions? Why has the ‘surgical culture’ resisted moves to increase safety?

• The impact of U.S. policies to protect healthcare workers from bloodborne pathogens: The critical role of safety-engineered devices (10/17/08)
•  Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personal, Safety and Health Information Bulletin (3/23/07)

• Statement on Blunt Suture Needles. American College of Surgeons (11/05)

•  Preventing Sharps Injuries in the Operating Room (Journal of American College of Surgeons (9/04)

• Evaluation of Blunt Suture Needles in Preventing Percutaneous Injuries Among Health Care Workers during Gynecologic Surgical Procedures. (1/17/97)

•  Perioperative Use of the Hands-Free Technique (8/06)

•  Infected Health Care Workers and Patient Safety: A Double Standard (6/06)
•   Extended Work Duration and the Risk of Self-reported Percutaneous Injuries in Interns (9/06)

Additional information on OR safety can be found on the websites of the American College of Surgeons and the Council on Surgical & Perioperative Safety.