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Sharps Safety

Why should health care practitioners double-glove during invasive procedures?
How can we get our surgeons to use the neutral or hands-free zone when passing sharps?
How can we convince our surgeons to try the newer safety scalpels and sheathed scalpels?
How can you convince surgeons to try blunt suture needles for closing fascia?
How do you create a neutral zone on ophthalmology and microsurgery procedures?
Do you always need a specially purchased container to establish a hands free zone?
How do you obtain a comfortable fit when you double-glove?
Do you have to use an indicator under glove when you double-glove?
When I double glove my fingers fall asleep, what can I do to prevent that?
When I double-glove, I lose dexterity, what can I do?
How can we convince our scrub persons to use the neutral or hands-free zone when passing sharps?
How can we get our scrub persons to use blade removal devices?
How do we convince our scrub persons to double-glove? 


Why should health care practitioners double-glove during invasive procedures?

Answer:

Recommendation IV.1. of the AORN Recommended Practices for Prevention of Transmissible Infections in the Perioperative Practice Setting states: Health care practitioners should wear two pairs of gloves, one over the other, during invasive procedures. A systematic review of 18 clinical trials of gloving practices clearly demonstrates that double-gloving minimizes the risk of exposure of health care works to blood during invasive procedures. Meta-analyses of nine of these studies demonstrate the following:

  • Perforation rates of the glove closest to the skin are significantly less when wearing double gloves compared to single gloves (P<0.00001).

  • Perforation rates are no different when wearing single gloves compared to the outer glove when two pairs of gloves are worn (P = 0.3).

  • More glove perforations are detected when using a colored under-glove indicator system when compared to two pairs of standard latex gloves (P = 0.002).

Resources

Recommended Practices for Prevention of Transmissible Infections in the Perioperative Practice Setting, 2011 Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2011: 293. For references, refer to the original text.

Updated July 7, 2011 

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How can we get our surgeons to use the neutral or hands-free zone when passing sharps?

Answer:

An OR sharps safety policy and procedure should be developed, implemented, and enforced to protect the safety of OR staff members and surgeons. The neutral or hands-free zone is an integral part of sharps safety. Including surgeons in the education about and implementation of its use is important. This technique takes time to develop and adapt to each institution and procedure. A few implementation tips include using a long basin that accommodates long needle holders; placing only one sharp in the basin at a time; using a separate basin for the local anesthesia medication syringe. The policy should identify the cases where it cannot be used or where a partial technique (eg, direct handoff to surgeon, instrument returns to neutral zone) must be used.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014  


How can we convince our surgeons to try the newer safety scalpels and sheathed scalpels?

Answer:

Using newer-generation scalpels that are better designed and more naturally weighted on a trial basis to determine which will work best for your facility may help. An OR sharps safety policy and procedure should be developed, implemented, and enforced to protect the safety of OR staff members and surgeons based on the Occupational Safety and Health Administration (OSHA) requirements. The OSHA's bloodborne pathogens standard requires that employers use engineering and work practice controls to eliminate occupational exposure or reduce it to the lowest feasible extent. One type of engineering control is using a sharp with engineered sharps injury protection (SESIP) (eg, sheathed scalpel). Where feasible, hospitals must implement the use of SESIPs.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014 


How can you convince surgeons to try blunt suture needles for closing fascia?

Answer:

Provide a selection of #0 and #1 sutures in blunt needle sizes that are comparable to previously used sharp needle suture for fascial closure. Update preference cards and list blunt needles first on every card. Your suture company representative can assist with advice and provide charts listing comparable needle sizes. Use blunt suture needles only for fascial closure, and allow surgeons to use the suture needle of choice for procedures where the patients fascia is thickened form repeat surgeries. Identify a surgeon at your facility who uses blunt needles and who can champion the cause. An OR sharps safety policy and procedure should be developed, implemented, and enforced to protect the safety of the OR staff members and surgeons based on OSHA requirements.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014 


How do you create a neutral zone on ophthalmology and microsurgery procedures?

Answer:

Ophthalmology and microsurgery procedures present unique challenges to creating a neutral zone because the surgeon must view the surgical site through a microscope. A partial technique (eg, direct handoff to surgeon, instrument returns to neutral zone) can be used on microsurgery procedures. Using this technique, the scrub nurse can place the instrument in the surgeon’s hand and alert him or her verbally as the sharp is being passed. A neutral zone can be established on the surgical field or Mayo stand for the surgeon to deposit the used sharp.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014 


Do you always need a specially purchased container to establish a hands free zone?

Answer:

A specially purchased device is not needed to establish hands-free zone. Magnetic mats, basins, or a designated area on the Mayo stand are examples of ways to create a hands free or “neutral zone.” Use of a towel may be an acceptable hands-free technique if it can be placed on a flat surface. The neutral zone should be easily accessible to the involved team members and an area that assures that a sharp item does not slide off the sterile field.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014 


How do you obtain a comfortable fit when you double-glove?

Answer:

Experiment with different combinations and sizes of gloves to find a comfortable fit. One method does not work for everyone. Possible double-gloving combinations are wearing a half-size larger glove as the underglove and the user’s usual size as the outer glove, wearing two similarly sized gloves, and wearing an outer glove that is a half size larger.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014 


Do you have to use an indicator under glove when you double-glove?

Answer:

An indicator underglove is not required when double gloving. Studies have shown, however, that punctures are detected more often with an indicator under glove. When wearing a perforation indicator system, 77% of punctures were detected compared to 21% when wearing standard double gloves.1 Punctures are more apparent in the outer glove, which allows team members to see the indication of a punctured glove and replace it in a timely manner.

Resources

Ramon Berguer, MD, FACS
Tanner J, Parkinson H. Double gloving to reduce surgical cross-infection. Cochrane Database Syst Rev. 2009;3:CD003087

Updated March 17, 2014 


When I double glove my fingers fall asleep, what can I do to prevent that?

Answer:

This may be happening because you are wearing an underglove that is too tight. Try varying combinations of under and outer glove sizes such as wearing a larger size as the underglove and a glove that is your actual glove size as the outer glove.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014 


When I double-glove, I lose dexterity, what can I do?

Answer:

Ensure that your double gloves are fitted properly. Acquiring dexterity may be a matter of getting used to the sensation of having two gloves on.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014 


How can we convince our scrub persons to use the neutral or hands-free zone when passing sharps?

Answer:

Education is the key to success for compliance with the use of a neutral zone. Experienced scrub persons can have a false sense of security regarding sharps handling. They may be more comfortable handling the sharp than using a neutral zone. Encouraging them to use basins, mats, or an identified place on the mayo may help ease their anxiety about using a neutral zone.

Resources

Ramon Berguer, MD, FACS

Updated March 17, 2014 


How can we get our scrub persons to use blade removal devices?

Answer:

It will help to provide documentation and education on the blade removal system in use at your facility, and have the device on hand for the surgical technologists to practice with prior to use in the OR. Once they get the feel for the device they will most likely feel more comfortable using it.

Resources

Sheri Alexander, CST

Updated March 17, 2014 


How do we convince our scrub persons to double-glove?

Answer:

Provide documentation and education on the safety of double gloving. Often people new to double gloving will attempt to use two of the same sized pairs of gloves and in most cases this will not work. Encourage scrubbed personnel to try several combinations of glove sizes until they find the combination that feels the most natural.

Resources

Sheri Alexander, CST

Updated March 17, 2014 

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