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The American College of Surgeons Recommends Sharps Safety Practices
Pa Patient Saf Advis 2008 Mar;5(1):15. 
 

Editor’s Note:

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

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.

ESIP Devices

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.
 
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Double Gloving
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THE PENNSYLVANIA PATIENT SAFETY AUTHORITY AND ITS CONTRACTORS  
PSA LOGO The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act. Consistent with Act 13, ECRI Institute, as contractor for the Authority, is issuing this publication to advise medical facilities of immediate changes that can be instituted to reduce Serious Events and Incidents. For more information about the Pennsylvania Patient Safety Authority, see the Authority’s Web site at www.patientsafetyauthority.org .      
ECRI LOGO ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research in healthcare to uncover the best approaches to improving patient care. As pioneers in this science for nearly 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. More than 5,000 healthcare organizations worldwide rely on ECRI Institute’s expertise in patient safety improvement, risk and quality management, and healthcare processes, devices, procedures and drug technology.      

ISMP Logo The Institute for Safe Medication Practices (ISMP) is an independent, nonprofit organization dedicated solely to medication error prevention and safe medication use. ISMP provides recommendations for the safe use of medications to the healthcare community including healthcare professionals, government agencies, accrediting organizations, and consumers. ISMP’s efforts are built on a nonpunitive approach and systems-based solutions.      
 
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