Bernadette Stringer, C. Infante-Rivard, and J. Hanley
Objective of the presentation: Operating room
personnel are known to be at a high risk for transmission of
occupationally acquired bloodborne infection when passing or handling
sharp instruments. A recommended work practice, the hands-free
technique, was evaluated for its effectiveness in reducing the
incidence of percutaneous injuries, contaminations and glove
tears.
Workplace setting: The main and surgical day care operating rooms of a downtown hospital in a large American city.
Description of the tool: The hands-free technique is a work practice whereby a tray or other means are used to eliminate simultaneous handling of sharp instruments during surgery.
Description of findings: The hands-free technique was used in 42% of surgeries and not used in 58% of 3,765 surgeries. A total of 143 incidents (40 percutaneous injuries, 51 contaminations and 52 glove tears) were reported. The incident rate in surgeries with 100cc or more bloodloss was 60% less (95%CI 23%-72%) when the hands-free technique was used, compared to surgeries in which it was not used, after adjusting for potential confounders. In surgeries with less than 100cc bloodloss, no effect was found.
Cost-effectiveness: The sole cost of the use of the hands-free technique is in training. Cost of follow-up of each worker potentially exposed to bloodborne pathogens has been estimated to be as great as $1000 US. There is growing evidence that occupational bloodborne disease transmission results in patient infection. The cost of ‘look-backs' -- when hundreds and even thousands of patients operated on by infected healthcare personnel must be identified, screened and tested -- is substantial
Communication: Although patient risk is less than occupational risk, all measures that reduce occupational exposures and transmissions, will decrease it further. The hands-free technique was shown to be an effective means of reducing the risk in surgeries with substantial bloodloss.
NOTE: This document is provided for historical purposes only.