Surgical personnel are at risk of occupational exposure to bloodborne pathogens
from injuries caused by sharp instruments. Sharp-tip suture needles are
the leading source of percutaneous injuries to surgical personnel, causing
51% to77% of these incidents. Suture needle injuries frequently occur during
suturing of muscle and fascia. Blunt-tip suture needles are identified by
OSHA and NIOSH as an example of an engineering control to reduce percutaneous
injuries. As an alternative to sharp-tip suture needles, blunt-tip suture
needles can be used to suture less-dense tissue such as muscle and fascia.
Since as many as 59% of suture needle injuries occur during suturing of
muscle and fascia, the replacement of conventional sharp-tip suture needles
with blunt-tip suture needles for these surgical tasks will reduce percutaneous
injuries to surgical personnel. Multiple studies have reported the effectiveness
of blunt-tip suture needles in decreasing percutaneous injuries. One study
showed an 80% decrease in injury rate. (Methods) The Occupational Safety
and Health Administration (OSHA) and the National Institute for Occupational
Safety and Health (NIOSH) joined efforts to develop a joint safety and health
information bulletin (OSHA SHIB # 03-23-2007, NIOSH #2008-101). Input from
diverse organizations including the American College of Surgeons, the Association
of Perioperative Registered Nurses, the Joint Commission (Formerly JCAHO),
and practicing surgeons was received.
OSHA and NIOSH strongly encourage the use of blunt-tip suture needles,
whenever feasible and appropriate, to decrease percutaneous injuries to
surgical personnel.
Background
Sharp-tip suture needles are the leading source of percutaneous injuries
(51% - 77%) in the operating room.
As many as 59% of suture needle injuries occur during suturing of muscle
and fascia. Surgical personnel at risk include surgeons, nurses, surgical
technicians, anesthesiologists, and other healthcare personnel in and out
of the OR.
Needlestick injuries expose workers to bloodborne infectious diseases such
as HIV, HBV, HCV.
The Occupational Safety and Health Administration's (OSHA's) Bloodborne
Pathogens standard (29 CFR 1910.1030) protects employees against occupational
exposure to bloodborne pathogens (BBP). Needlestick injuries also present
a risk to patients from potential exposure to injured staff's blood.
American College of Surgeons Statement: "All published studies to date
have demonstrated that the use of blunt suture needles can substantially
reduce or eliminate needle-stick injuries from surgical needles." 2005 American
College of Surgeons (ACS) statement supporting universal adoption of blunt-tip
suture needles for suturing fascia.
All Members of the Council on Surgical and Perioperative Safety endorsed
this ACS statement:
American College of Surgeons (ACS)
Association of Perioperative Registered Nurses (AORN)
American Association of Nurse Anesthetists
American Association of Surgical Physician Assistants
American Society of Anesthesiologists
American Society of Perianesthesia Nurses
Association of Surgical Technologists.
Approach
OSHA and NIOSH jointly developed a Safety Health Information Bulletin.
The document was extensively peer-reviewed by internal and external experts
in the affected healthcare community and was also made available to the
public for comment as a prepublication document on the NIOSH website.
Results
Why did OSHA and NIOSH issue this SHIB?
OSHA'S Bloodborne Pathogens standard requires that employers:
use engineering and work practice controls to eliminate or minimize
occupational exposure to bloodborne pathogens
evaluate and implement appropriate, available, and effective safer devices.
NIOSH recommends that blood-exposure prevention practices be prioritized
following the principles of the hierarchy of controls prevention model. In
this model, blunt-tip suture needles are an example of engineering controls.
Blunt-tip suture needles are not yet widely used: 3% of suture needle sales
in 2004.
Engineering and work practice controls shall be used to eliminate or minimize employee exposure.
(OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030))
Why Use Blunt-Tip Suture Needles?
Use of blunt-tip suture needles can substantially reduce needlesticks
Blunt-tip suture needles can be used to suture less-dense internal tissue
like muscle and fascia.
Blunt-tip suture needles are a safety-engineered device.
Blunt-tip suture needles have been found to be technically satisfactory
when used appropriately
FIGURE 1. Rate of injury associated with use of curved suture needles during
gynaecologic surgical procedures and percentage of suture needles used that
were blunt, by quarter- three hospitals, New York City, April 1993 - June 1994
(Please see reference # 8 for complete citation)
CDC found:
A statistically significant reduction of injury rates when blunt-tip suture
needles were used (see Figure 1).
Use of blunt-tip suture needles resulted in minimal clinically apparent
adverse effects on patient care and were generally accepted by participating
surgeons.
Will OSHA cite employers who are not using blunt-tip suture needles?
The decision to issue a citation will be made on a case-by-case basis.
Where engineering and work practice controls will reduce employee exposure
to bloodborne pathogens they must be used.
Blunt-tip suture needles may not be clinically appropriate for all surgical
closures and procedures. Conventional sharp-tip suture needles may be needed
to suture skin, bowel, and blood. vessels, although suture-less techniques
for these procedures are available for use at the discretion of the surgeon.
If using a safer device compromises either patient safety or medical integrity,
its use would not be required.
How do employers maintain compliance regarding blunt-tip suture needles?
Evaluate the use of suture needles and implement appropriate, commercially
available, and effective blunt-tip suture needles.
Include non-managerial front-line employees potentially exposed to injury
from suture needles in the evaluation and selection process.
Train employees on the use of selected safer suture needles and on any work
practices to ensure safe use.
Document the device selection process and employee training in the facility
Exposure Control Plan.
Where an employer has determined that the use of available safer devices
is not feasible:
Document this in the facility's Exposure Control Plan
Implement alternative means of protecting surgical personnel from percutaneous
injuries.
Conclusions
Clinical use and scientific studies have established the effectiveness
of blunt-tip suture needles in decreasing the risk of needlesticks.
OSHA and NIOSH strongly encourage the use of blunt-tip suture needles, whenever
feasible and appropriate, to decrease needlestick injuries to surgical personnel.
Disclaimer: This Safety and Health Information Bulletin is not a standard or
regulation and it creates no new legal obligations. The Bulletin is advisory
in nature, informational in content, and is intended to assist employers in
providing a safe and healthful workplace.
Future Directions
NIOSH is partnering with OSHA and other healthcare organization to disseminate
and assist in the implementation of these recommendations.
References
Jagger J, Bentley M, Tereskerz P. A study of patterns
and prevention of blood exposure in OR personnel. AORN J. 1998; 67(5):979-81,
983-4, 986-7.
Berguer R, Heller PJ. Preventing sharps injuries in the
operating room. J Am Coll Surg. 2004; 199(3):462-7.
Makary MA, Al-Attar A, Holzmueller CG, Sexton JB, Syin
D, Gilson MM, Sulkowski MS, Pronovost PJ. Needlestick injuries among surgeons
in training. N Engl J Med. 2007 Jun 28; 356(26):2693-9.
Davis MS. Advanced Precautions for Today's OR: The Operating
Room Professional's Handbook for the Prevention of Sharps Injuries and Bloodborne
Exposures, 1st ed. Atlanta; Sweinbinder; 1999.
American College of Surgeons (ACS). Statement on blunt
suture needles. Bull Am Coll Surg. 2005 Nov; 90(11):24. Available from http://www.facs.org/fellows_info/statements/st-52.html
Association of Perioperative Registered Nurses (AORN).
AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting.
In: 2005 Standards, Recommended Practices, and Guidelines. 2005; 199-204.
Available from www.aorn.org/about/positions/pdf/SECTI-2esharpssafety.pdf
Dauleh MI, Irving AD, Townell NH. Needle prick injury
to the surgeon-do we need sharp needles? J R Coll Surg Edinb. 1994; 39(5):310-1.
Centers for Disease Control and Prevention (CDC). Evaluation
of blunt suture needles in preventing percutaneous injuries among health-care
workers during gynecologic surgical procedures-New York City, March 1993-June
1994. MMWR Morb Mortal Wkly Rep. 1997; 46(2):25-9. Available from www.cdc.gov/mmwr/preview/mmwrhtml/00045660.htm
CFR (Code of Federal regulations). Title 29 Part 1910,
OSHA. Washington, DC: U.S. Government Printing Office, Office of the Federal
Register.
Disclaimer
The findings and conclusions in this poster are those of the author(s) and do not necessarily represent the views of the National
Institute for Occupational Safety and Health. Citations to Web sites external to NIOSH do not constitute NIOSH endorsement of
the sponsoring organizations or their programs or products. Furthermore, NIOSH is not responsible for the content of these Web sites.
