One of the most agonizing moments in surgery for me is the dreaded needlestick. Yes, after 26 years of doing this most wonderful of vocations, I still experience surgical misadventures whereupon I pierce my integument with a pointed object, already bathed in the patient's bodily fluids.

Essentially bodily punctures are the result of a momentary lapse of concentration, where the surgeon, nurse or tech simply forgets that there is a sharp object in the vicinity.

Most surgeons possess at least a small measure of ADHD. That is why we all love to operate. The thrill of surgery fulfills our need for stimulation. Problem is, when the excitement of reducing the rotator cuff tear totally occupies our attention, there is simply little room for awareness of neighboring sharp objects.

Case in point: Just last week, while preparing a graft for an ACL reconstruction, I was transfixed on trimming the graft to the appropriate size that I forgot that I had placed a prominent needle near the field. While reaching for the graft, yes, you guessed it: I speared my palm with the prominent needle tip. Three Hail Mary's and 2 expletives later, I inquired about the patient's risk profile. Thank God the patient was risk-averse: His idea of shooting up was the enema bag.

Since I am married with 2 children, I take these events with more reverence and report to our trusty charge nurse. Which means I earn a trip to occupational health (or ER if after 3 p.m.) and have every bloodborne disease titer known to man checked in my blood. In addition, I have to obtain consent from my patient to draw blood to check for everything from HIV infection to mad cow disease. Four hours and minus one unit of blood later, I am usually assured that my hepatitis titers are okay and that the patient was clean.

My 4 rules of prevention
When you're aware of your surroundings and practice good safety hygiene, punctures simply shouldn't happen, right? But they do. Here are my 4 sharps prevention practice tips that everyone scrubbed should practice:

1. Know the domain of sharps. First of all, sharps should not be near the operating field. For last week's mea culpa, I should have disposed of the sharp needle ASAP. A good friend recently lacerated his ulnar nerve when he rested his elbow on a Mayo stand, only to find that a prominent 11 blade had penetrated his cubital tunnel. Be aware.
2. No-passing zone. The seemingly mundane task of placing sharps in a basin and not directly transferring to OR personnel is a game-changer and will lessen punctures immensely. Yes, it is one extra step, but less direct handling equals less chance of injury.
3. Be quick, but don't hurry. This admonition, preached by legendary basketball coach John Wooden, reminds us all to stay present and not impulsively grab instruments or rush through a case. Well-executed and planned steps lead to hyperefficient cases. Hurried motions often lead to much collateral damage — to both patient and surgeon.
4. Double glove. Many of us omit this step, but those extra few microns of latex may mean the difference between puncture and pressure. Is the seeming loss of dexterity from donning an extra pair of gloves really a big deal? In my case I'm equally clumsy whether wearing 1 or 2 pair! OSM