Blunt-tip suture needles reduce needle-stick injuries

AORN Journal, Sept, 2007 by Mary Ogg

QUESTION: The June edition of AORN Connections contained an article about using blunt-tip suture needles. I shared the information with our surgeons, but they are reluctant to change their current practice. Can you explain how using blunt-tip suture needles will help reduce needle-stick injuries?

ANSWER: Suture needle injuries represent 20.5% of all percutaneous injuries in hospital settings. (1) The highest incidence of percutaneous needle-stick injuries occurs in the perioperative environment, (2) and most of these injuries (ie, 44%) can be attributed to suture needles. (1) Because of the invasive nature of surgery, perioperative personnel are at risk for exposure to bloodborne pathogens, including the hepatitis B virus, hepatitis C virus, and HIV from needle-stick injuries. (3) The majority of the injuries occur to the palmar surface of the index finger of the surgeon's non-dominant hand when he or she is suturing the fascial layer with sharp suture needles. (4-7)

Numerous reasons have been postulated for the high incidence of percutaneous injuries during abdominal fascia closure. Some of these factors include

* fatigue at the end of a long procedure,

* distractibility during wound closure while the perioperative team is performing counts,

* less focused attention on a more common part of the surgery, and

* distracting conversations occurring among surgical team members. (6)

Since the late 1990s, suture manufacturers have introduced minimally blunt suture needles that penetrate tissue more easily than the traditional type of blunt needles that were in use previously. These new, blunt suture needles require minimal effort to penetrate fascia. Although the ease of use has improved, the popularity and use of blunt-tip suture needles has not increased. (4) Blunt-tip suture needles have not gained wide acceptance as a safety device, despite evidence of their efficacy and support for their use by federal regulatory agencies and professional organizations.

Evidence indicates that the use of blunt-tip suture needles has the potential to reduce the risk of percutaneous needle injuries. (5,6,8,9) The Centers for Disease Control and Prevention (CDC) conducted a study comparing the incidence of percutaneous needle-stick injuries during closure of the abdominal fascia layer with conventional sharp suture needles versus blunt-tip suture needles. The blunt-tip suture needles caused no injuries while sharp suture needles were responsible for 92% of suture needle-related percutaneous injuries. (8)

In 2005, the American College of Surgeons issued a statement supporting the use of blunt-tip suture needles. (10) AORN's guidance statement, "Sharps injury prevention in the perioperative setting," also advocates the use of blunt-tip suture needles. (11) In addition, on April 11, 2007, the Occupational Safety and Health Administration, Department of Labor, National Institute for Occupational Safety and Health, CDC, and Department of Health and Human Services issued a joint document titled, Use of Blunt-tip Suture Needles to Decrease Percutaneous Injuries to Surgical Personnel. (12)

A few suggestions to facilitate change include

* collaborating with physicians who are willing to try blunt-tip suture needles;

* discussing with physicians and perioperative staff members the current research on the benefits of blunt-tip suture needles in reducing percutaneous injuries;

* removing old technology after the safer devices have been implemented;

* educating new employees, physicians, residents, and medical students regarding the new technology;

* establishing a multidisciplinary, sharps-safety committee; and

* involving well-respected surgeons in the process. (13)

Changing current practice and creating a culture of safety is difficult but can be achieved with perseverance, patience, and commitment.

REFERENCES

(1.) Perry J, Parker G, Jagger J. EPINet report: 2003 percutaneous injury rates. Adv Exposure Prey. 2005; 7(4):42-45.

(2.) Holodnick CL, Barkauskas VH. Reducing percutaneous injuries in the OR by educational methods. AORN J. 2000;72(3):461-476.

(3.) Centers for Disease Control and Prevention. Exposure to blood: what healthcare personnel need to know. http://www.cdc.gov/ncidod/dhqp/pdf/bbp /Exp_to_Blood.pdf. Accessed July 3, 2007.

(4.) Davis MS. Sharps safety in the operating room: advances in engineering sharps injury prevention technology: suturing. In: Advanced Precautions for Today's OR: The Operating Professional's Handbook for the Prevention of Sharps Injuries and Bloodborne Exposures. 2nd ed. Atlanta, GA: Sweinbinder Publications, LLC; 2001.

(5.) Hartley JE, Ahmed S, Milkins R, Naylor G, Monson JR, Lee PW. Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen. Br J Surg. 1996;83(8):1156-1157.

(6.) Mingoli A, Sapienza P, Sgarzini G, et al. Influence of blunt needles on surgical glove perforation and safety for the surgeon. Am J Surg. 1996;172(5):512-517.

(7.) Laine T, Aarnio P. Glove perforation in orthopedic and trauma surgery. A comparison between single, double indicator gloving and double gloving with two regular gloves. J Bone Joint Surg Br. 2004; 86(6):898-900.