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ADVANCES IN EXPOSURE PREVENTION: summary of latest issue

Volume 7, No. 3, 2005 (published April 2005)

  • Perry J, Jagger J. “Reducing Sharps Injury Risk in Intensive Care Settings” (pp. 25-28). Healthcare workers in intensive care and critical care units face unique challenges, and some unique risks, when it comes to sharps safety. Like emergency departments, ICUs are often fast-paced; crises and codes requiring high-intensity therapies and rapid interventions are common in this environment. To understand more about sharps injury risks in ICUs, we analyzed five years of EPINet data (1998-2002) from the EPINet Multi-Hospital Needlestick and Blood Exposure database. We found a higher ratio of injuries from hollow-bore, blood-filled needles (those with the highest risk of bloodborne pathogen transmission) compared to other settings: 42% for ICUs, compared to 25% for all other hospital settings. The data revealed significant opportunities for reducing exposure risks in ICUs.

  • Perry J, Jagger J. “The Benefits of Sharpless Surgery: An Interview with Martin Makary, M.D., M.P.H.” (pp. 29-31). Surgeon Martin Makary is working on a quiet revolution in the operating room: sharpless surgery. Assistant Professor of Surgery at the Johns Hopkins University School of Medicine, he holds a joint appointment as Assistant Professor of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. Makary defines “sharpless surgery” as a protocol for performing an operation without any sharps that could potentially cause a percutaneous injury to operating room personnel. In a sharpless protocol, sharps are reserved for emergency-only use during an operation. This article explores the benefits of this technique, and other practices that can help reduce risk for OR personnel.

  • Perry J, Jagger J. “Reciprocal Blood Exposures During Surgery: Does Your Facility Have a Policy?” (pp. 32-34). One study of percutaneous injuries in surgical settings found that 25% of injuries to surgeons occurred in the operative site—that is, the worker sustained the injury while working in an open body cavity or wound. These injuries create a potential for a “double” or reciprocal exposure: the healthcare worker (HCW) may be exposed to the patient’s blood (through the wound caused by the sharps injury), and the patient may be exposed to the HCW’s blood (if the sharp object that caused the injury recontacts the patient’s open wound, or if blood from the HCW’s wound drips into the patient). This article discusses the implications of such exposures and the need to have an institutional policy in place to deal with them.

  • David, Mark S. “How Blunt is Blunt? Choosing and Using Blunt Suture Needles.” (p. 35). Mark Davis, M.D., an OR safety consultant, discusses how to choose an appropriate blunt suture needle for procedures where such devices are appropriate. The range of bluntness in commercially available blunt suture needles varies considerably: the least-blunt needles currently available require almost no additional effort by the surgeon to penetrate tissue, while extremely blunt-tipped needles do not penetrate tissue such as fascia easily and should not be used for this purpose. The selection criteria for blunt suture needles should be determined primarily by the density of the tissue being sutured.