Sharps related injuries are especially common in the perioperative setting. Anesthesia providers, perioperative nurses, and surgical staff are at particular risk for sustaining injuries from sharp instruments, given their need to administer medications, draw samples of blood and bodily fluid, place lines, and perform surgical procedures with frequent passing of instruments between team members.
The Association of Perioperative Registered Nurses (AORM) is a useful resource in providing evidence-based guidelines for sharps safety for health care facilities and their personnel. Below are some of their recommendations.
Many studies have borne out the benefit of safety engineered devices, which reduce sharps related injuries anywhere from 22% to 100%. Retractable scalpels, shielded or sheathed scalpel blades, and scalpel removal devices decrease scalpel-related injuries. Using adhesives and staplers instead of suturing may sometimes be appropriate. In one review article, adhesives showed no statistical difference from suturing in regard to infection, patient and user satisfaction, and cost; however sutures were superior in preventing wound dehiscence and were faster to use.
Needleless systems for collecting blood or bodily fluids should be available and used after initial establishment of access. Likewise, Medication administration should be done without needles whenever possible. When needles are required, they should have safety engineering features such as sliding sheaths, hinged or sliding needle guards, or retractable needles. If these devices are not available, needles should not be recapped unless using the one handed scooping technique if absolutely necessary.
Needleless or blunt entry devices to withdraw contents from multi-dose vials is another recommendation from the AORM guidelines. When opening glass ampules, an ampule breaker or a piece of gauze can be used to protect the operator’s hand.
Disposing sharps in a puncture-resistant containment device is essential to protect both the user and others in the work environment. In the operating room, sharp instruments should be passed using a neutral zone – i.e. set down first and picked up rather than passed directly hand to hand. Using a no-touch technique (i.e. manipulating needles only with blunt instruments instead of with hands) is also helpful in decreasing needle sticks.
In summary, sharps safety is of particular relevance in the perioperative setting. Providers and facilities should be aware and supportive of methods to reduce sharps-related injuries. A plan for post-exposure care should be implemented in all health care facilities in addition to the prevention strategies discussed above.
References
Dumville J.C., Coulthard P., Worthington H.V., et al: Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev 2014; 11: pp. CD004287
Spruce, L. Back to Basics: Sharps Safety. AORN J. 2016 Jul;104(1):30-6. doi: 10.1016/j.aorn.2016.04.016.
Sharps Safety in the Perioperative Setting