Sharps Safety In the

Operating Room
Creating an Injury Prevention Program

Objectives
Discuss the regulations that impact an OR
Sharps Safety program
Describe the issues that effect sharps
safety in the OR
Discuss a process for creating an OR
sharps safety program
Identify barriers to the implementation of a
sharps safety program

Background

Workplace Safety Task Force

Position statement on Workplace Safety
Webpage
Position statement on Safe work/Oncall
practices
Guidance document on Sharps safety
Ergonomics

Epidemiology of Bloodborne Diseases:

HCV

Bloodborne pathogens are

viruses or infectious
agents carried by human
blood and body fluids.
They can enter our bodies
and cause disease and
immune deficiencies, which
can sometimes lead to death.

HIV, HBV, HCV

HIV

Transmission of Bloodborne Pathogens

Blood & Body Fluids
-from accidents, illnesses, medical procedures,
research samples and handling medical waste

Disease Transmission
-through cuts, punctures, contact with broken skin,
contact with mucous membranes

Bloodborne Pathogen

Prevalence*

Hepatitis B

1 in 20

Hepatitis C

1 in 50

HIV

1 in 250

Prevalence in an average population, prevalence is higher for

at risk populations

Prevalence of Bloodborne Pathogens in an Urban,

University-Based General Surgical Practice*
Prevalence of HIV, Hepatitis B and Hepatitis C
Among Surgery Patients
HIV

26%

HIV &
Hep B Hep C Hep C Any
4%

35%

17%

38%

* Weiss, Makary, Wang, Syin, Pronovost, Chang & Cornwell

Annals of Surgery, Volume 241, Number 5, May 2005

Percentage of Patients with HIV &

Hepatitis C for 4 common operations
70
60
50
40

HIV +
Hep C +

30
20
10
0
lymph node drainage of open ventral small bowel
biopsy
soft tissue hernia repair resection
abscess

* Weiss, Makary, Wang, Syin, Pronovost, Chang & Cornwell

Annals of Surgery, Volume 241, Number 5, May 2005

The Bloodborne Pathogens Standard

Promulgated by OSHA in 1991
Purpose: to protect all workers who may come
into contact with human blood or body fluids as a
routine part of their job

Revised in 2001
New definitions
Additional requirements regarding safety devices
Sharps Injury Log

29 CFR 1910.1030
Full text & additional information can be
found on the OSHA website at:
www.osha.gov/pls/oshaweb/owadisp.show_document?
_p_table+STANDARDS&p_id=10051

29

Joint Commission Standards &

Sharps Safety
Infection Prevention and Control
Standards:
IC.01.03.01 The hospital identifies risks for
acquiring and transmitting infections.
IC.01.04.10 Based on the identified risks, the
hospital sets goals to minimize the possibility
of transmitting infections.
Infection Prevention and Control. In Comprehensive Accreditation
Manual: CAMH for Hospitals. The Official Handbook. Oakbrook Terrace,
IL: Joint Commission;2009:01.03.01; 01.04.10.

Joint Commission Standards &

Sharps Safety
Environment of Care Standards
EC.01.01.01 The hospital plans activities to minimize
risks in the environment of care.
EC.02.02.01 The hospital manages risks related to
hazardous materials and waste.
EC.04.01.01(1)-The hospital establishes a
process(es) for continually monitoring, internally
reporting, and investigating occupational illnesses
and staff injuries.
EC.04.01.03(1) Representatives from clinical,
administrative, and support services participate in the
analysis of environment of care data.
Environment of care. In Comprehensive Accreditation Manual: CAMH for
Hospitals. The Official Handbook. Oakbrook Terrace, IL: Joint Commission;2009:
01.01.01; 02.02.01; 04.01.01(1); 04.01.03(1).

Joint Commission Standards &

Sharps Safety
Human Resources Standards
HR.01.04.01 (2) The hospital orients its staff to
the key safety content before staff provides
care, treatment, and services. Completion of
this orientation is documented.
HR.01.04.01 (4) The hospital orients staff on
their specific job duties, including those related
to infection prevention and control.
HR.01.05.03 Staff participate in ongoing
education and training.
Human Resources. In Comprehensive Accreditation Manual: CAMH for
Hospitals. The Official Handbook. Oakbrook Terrace, IL: Joint
Commission;2009: HR.01.04.01 (2) (4); HR.01.05.03.

Ambulatory Accrediting Bodies

AAAHC
OSHA standards

AAAASF
OSHA standards

Healthcare Workers Exposed to

Blood/Body Fluids
Housekeeping
3%

Dental
1%

Research
1%

Clerical
1%

Other
4%

Students
3%
Technician
13%

Nurse
44%
Physician
30%

NaSH data, 23 hospitals, 1995-1999

Needlestick Risk

Hollow-bore needles and other devices associated with

percutaneous injuries in NaSH hospitals, by % total percutaneous
injuries (n=4,951), June 1995July 1999. (Source: CDC [1999].)

Needlestick Risk

Causes of percutaneous injuries with hollow-bore needles in NaSH

hospitals, by % total percutaneous injuries (n=3,057), June 1995July
1999. (Source: CDC [1999].)

Creating a Sharps Safety Program

in the OR
Engineering Controls
Tools, instruments, sharps shelters

Work Practices
Safe zone, double gloving, one-hand re-capping only when
unavoidable

Making Changes
Assembling committee, evaluating product and selecting safety
sharps, participating in education & in safety conversion

Implementation Suggestions
Use scalpel blades with safety blades

Reusable

Disposable

Implementation Suggestions
Use mechanical /instrument tissue
retraction

Implementation Suggestions
Use blunt retractors

Implementation Suggestions
Alternative cutting methods
Cautery
Harmonic scalpel

Cautery
Harmonic Scalpel

Implementation Suggestions
Use blunt suture needles, stapling devices
or steristrips

Blunt suture needle

Steristrips

Stapler

Implementation Suggestions
Keep used needles on the sterile field in a
disposable puncture resistant needle container

Implementation Suggestions
Adopt a hands-free technique of passing suture
needles and sharps between perioperative team
members

Implementation Suggestions
Use a one handed or instrument assisted
suturing technique to avoid finger contact
with needles
Use control-release or pop-off needles

Implementation Suggestions
Double glove during all surgical
procedures

Implementation Suggestions
DO NOT bend, break or recap contaminated needles

If re-capping is absolutely required, use

one-handed scoop technique: (1) Place needle cap on table
(2) Holding the syringe only,
guide needle into cap
(3) Lift up syringe so cap is
sitting on needle hub
(4) Secure needle cap into place

Sharps disposal
Closable orange or red, leakproof
puncture resistant containers
Located close to the point of use
maintained upright
Replaced routinely and not allowed to
overfill
Wall mounted
Floor mounted

Sharps disposal: new containers

Safety sharps containers
Goal: to Prevent Needlesticks
Counter-balanced drop in
prevents childrens fingers from
getting in

Automatically closes at full

prevents overfilling

Reusable sharps containers

Goal: to reduce landfill waste
Outside contractor removes

contaminated sharps, cleans container

and returns it

Worker Responsibilities
Observe regulations
Comply with methods available to protect
yourself
Practice using safety devices
Use safety devices
Actively participate in evaluation and safety
conversion process

Worker Responsibilities
Use appropriate personal protective equipment
Use appropriate sharps containers
Participate in education and follow
recommendations
Support others to follow the recommendations
Follow your exposure control policy

Worker Responsibilities
Reporting Exposures
Employers required by OSHA to document all staff
exposures to blood / body fluids anonymously
OSHA 300 Log
Sharps Injury Log
Location, job title, description of incident, type
& brand of sharps involved
Source testing, risk analysis & post-exposure
prophylaxis if indicated

Employer Responsibilities

Comply with regulations

Create a safety-oriented culture
Encourage reporting
Analyze data
Provide training
Evaluate devices
Establish safe staffing patterns

Implementation Statistics
In a nationwide survey
71% of respondents indicated they had not evaluated
use of blunt tip suture needles in the OR
2% had fully implemented blunt tip suture needles
14% of respondents had implemented safety scalpels
into the OR

AORN Guidance Statement: Sharps Injury Prevention in the Perioperative Setting

BARRIERS TO
IMPLEMENTATION

Psychosocial and organizational factors

Attitude/Resistance to Change
Shortcomings associated with safety devices
Perceived cost associated with engineered
devices
Inadequate training
Time limitations

Overcoming Obstacles to
Compliance
Frequent and multiple training methods
Multidisciplinary sharps injury prevention plan
Educate new employees and incoming residents and
medical students
Multidisciplinary sharps safety committee
Network with other facilities
Involve front-line workers in evaluation and selection of
safety devices

Overcoming Obstacles to
Compliance
Collaborate with personnel who use the device
and facilitate change
Discuss current research
Work with resistant team members
Remove old technology when new is trialed and
available
Create a Culture of Safety

Whats new
Collaboration with NIOSH Memorandum of
Understanding
Alliance with OSHA
ACS statement on the use of blunt suture Needles
Letter to ACS
CDC National Sharps Injury Prevention Meeting
9/12/2005
ACS Statement on Blunt Suture Needles 6/05
OSHA Safety and Health Information Bulletin: Use of
Blunt-Tip Suture Needles to Decrease Percutaneous
Injuries to Surgical Personnel 3/07

Further resources
www.aorn.org
http://www.osha.gov/OshDoc/data_BloodborneFacts/bbf
act01.pdf
http://www.osha.gov/SLTC/bloodbornepathogens/index.
html
http://www.cdc.gov/sharpssafety/
http://www.cdc.gov/niosh/topics/bbp/
http://www.jointcommission.org/
http://www.isips.org/
http://www.nursingworld.org/MainMenuCategories/Occu
pationalandEnvironmental/occupationalhealth/SafeNeedl
es/NeedlestickPrevention.aspx
www.premiersafetyinstitute.org

Developed by
Deborah G. Spratt
RN, MPA, CNAA, CNOR
Edited by
Mary J. Ogg
RN,MSN, CNOR