Reducing Blood Exposures During Orthopedic Surgical Procedures - Statistical Data Included

AORN Journal,  March, 2000  by Ann Folin,  Bjorn Nyberg,  Gun Nordstrom

• E-mail
• Print
• Link

Infection control is essential in quality surgical patient care, and precautions against infection must be included in nursing care plans. Staff members should take precautions to prevent serious injuries caused by needles, scalpels, and other sharp instruments or devices used during surgical procedures.

Surgical staff members are exposed to blood during procedures. Accidents and the absence of protective equipment expose them to the risk of occupational transmission of bloodborne pathogens.(1) The frequency of accidents and injuries in the OR are determined by

* the surgical specialty,

* working position (ie, surgeon, first assistant, scrub person),

* amount of blood loss,

* irrigation fluid used,

* type of protective equipment used,

* type of procedure, and

* length of procedure.(2)

Some staff members' injuries put patients at risk by exposing them to bloodborne pathogens during surgical procedures. Bloodborne pathogen transmission is likely to result from accidental introduction of the health care worker's blood into the patient's tissue or by exposing patients to recontact (Table 1).(3) Many injuries are self-inflicted, but coworkers may inflict injuries as well. One observational study conducted in four university teaching hospitals found 24% of sharp objects causing injuries were held by coworkers.(4) The risk of sustaining percutaneous injuries during surgical procedures varies. Contamination and percutaneous hand injuries occur during orthopedic procedures because surgical team members deal with sharp bone fragments, surgical wire, sharp instruments, needles, and scalpels.

Table 1

GLOSSARY OF STUDY TERMS

* Blood: Blood or other bloody body fluids, irrigation fluids, tissues, or samples.(1)

* Contamination: Blood on hands and/or forearms.

* Incident: Accidental exposure to blood (ie, contamination, percutaneous injury).

* Neutral zone: Specific location where sharp instruments are placed and retrieved, thereby eliminating passing instruments hand to hand.

* No-touch technique: Surgical technique using instruments instead of fingers to minimize manual manipulation with sharp instruments and devices.

* Percutaneous injury: Penetration of a health care worker's skin by a needle or other sharp object contaminated with a patient's blood(7)

* Recontact: Introducing a sharp object into a patient's open wound after the object penetrated the health care worker's skin, or a health care worker's injury from a bone fragment, surgical wire, or anything fixed in the patient's body.(3)

* Surgical procedure: Orthopedic surgical procedure that includes a skin incision.

NOTES

(1.) H Jorbeck et al, Incidenter med blodkontakt bland sjukvadspersonal [Incidents with blood contact among health care workers, report 2], Swedish National Board of Occupational Safety and Health, Medical Division (August 1990).

(2.) J I Tokars et al, "Percutaneous injuries during surgical procedures," JAMA 267 (June 1992) 2899-2904.

(3.) Ibid.

To decrease the risk of infection by bloodborne diseases carried by increasing numbers of patients, OR team members have become more concerned with practicing preventive methods than with preventing intraoperative contamination and percutaneous injuries. Reducing the risk of occupational exposure to blood in the OR requires specific strategies. Though no perfect solution exists, recommendations provide major protection improvements in several areas compared with traditional methods. These recommendations concern surgical teamwork, surgical technique, instruments used, and the barrier. Preventive working methods are used with increasing frequency. Literature describes this method's technique as hands free, no pass, and no touch.(5) AORN recommends using the hands-free technique when possible and practical instead of passing needles or sharp items hand to hand between surgeons and scrub people.(6)

One study reported accidental exposure to blood (ie, contamination, percutaneous injury) occurred in 11% of procedures performed during an eight-week period.7 Most incidents affected staff members who assumed they would be protected by changing work techniques and using protective equipment. Introducing these quality assurance programs would benefit the department's clinical and management systems.(8) This potential benefit and earlier study results motivated the department's perioperative nurses (n = 12) to begin a 15-month (ie, December 1993 to March 1995) quality improvement project to formulate and introduce intraoperative prevention strategies to avoid accidental contamination and hand injuries during orthopedic surgical procedures. Investigators conducted this study to evaluate effects of the recommended changes.

MATERIAL AND METHODS

The objective of this study was to improve the safety of patients and staff members involved in orthopedic surgical procedures. The study's purpose was to investigate if changes in working methods (ie, reducing the use of sharp instruments, introducing a neutral zone, using the no-touch technique) during procedures reduced the risk of intraoperative exposure to blood for the scrub person, surgeon, first assistant, and patient.