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One Surgeon's Crusade for Safer ORs
Jane Perry
Publish Date: October 10, 2007   |  Tags:   Staff Safety

Jane Perry, MA Mark Davis, MD, is a gynecologic surgeon, an OR-safety consultant and author of the book Advanced Precautions for Today's OR: The Operating Room Professional's Handbook for the Prevention of Sharps Injuries and Bloodborne Exposures.

His interest in preventing occupational exposures began in 1990, when a scalpel cut him during a hysterectomy. Dr. Davis assumed the patient was low-risk, but asked her to be tested for HIV. Her response: "I recently found out my husband is an IV drug user, so yes, I'd like to be tested - for my own peace of mind as well as yours." Although the test results were negative, that day was a turning point for Dr. Davis.

"I had sustained many sharps injuries from suture needles and other devices over the course of my career, but by dumb luck I had thus far avoided being infected with a bloodborne pathogen," says Dr. Davis. "I decided that from then on I would actively seek ways to reduce my exposure risk, including faithfully practicing universal precautions."

Since he stopped operating in 2001, Dr. Davis has focused on educating OR professionals worldwide about effective safety devices and safe work practices. Here, he talks about what he did - and what you can do - to implement safety strategies.

JP: After your 1990 sharps injury, what did you change about your approach to safety in the OR?
MD: I developed many simple injury-prevention strategies that proved to be very effective. I was able to essentially eliminate [suture and scalpel] injuries by adopting blunt suture needles and a neutral zone, with no-hands-passing of sharps. I used blunt suture needles and no-hands-passing routinely from 1990 on. These simple changes made surgery significantly safer - and more enjoyable, knowing that everyone on my team was much less likely to be injured. Unfortunately, such strategies are under-utilized in many ORs. But OSHA expects them to be used where applicable and is issuing citations to facilities that don't implement them.

JP: OSHA's 2001 revised bloodborne pathogens standard mandated that healthcare employers keep a log of sharps injuries, evaluate and implement safety devices, and monitor compliance. Are these requirements starting to have an impact on how surgeons practice?
MD: The regulations are based on common sense and feedback from experts around the country. The changes that I've been advocating for years don't just ensure regulatory compliance - they also make healthcare more cost-effective [by preventing expensive injuries]. It's a good business decision for hospitals and for their insurers. Surgeons, as well as other clinicians and hospital administrators, are starting to understand that it's not only the right thing to do, but also the smart thing.

Setting Up a Sharps Injury Prevention Program

After a healthcare worker at a South Carolina hospital became infected with hepatitis C - with treatment costs and lost wages in excess of $300,000 - the company that provides the hospital with risk management services, PHT Services, Ltd., realized it needed to find ways to reduce the exposure risk for employees. The cornerstone of that initiative was to develop and implement a Sharp-Object Injury Prevention Program (SOIPP). The SOIPP for the OR has seven major components:
  • communicating top management's commitment to safety;
  • finding a safety champion to help lead the effort;
  • appointing a safety committee, chaired by a medical director, to facilitate implementation of the program;
  • conducting ongoing surveillance and risk assessment;
  • analyzing adverse events and near-misses through accident investigations;
  • developing a protocol for evaluating safety devices; and
  • educating hospital and attending OR staff on safer devices and work practices.

We've seen significant reductions in sharps injuries in hospitals and ORs that have fully implemented the SOIPP. And as better safety products emerge, they will be integrated into surgical practices, further reducing injury rates.

- Mark S. Davis, MD

JP: Why is the OR such a difficult place in which to effect change?
MD: There are several reasons. First, older surgeons, myself included, were not educated about sharps injuries and blood-exposure risks during their training, because HIV and hepatitis C were not issues until the mid- to late-1980s. Second, it is hard to get surgeons' attention, because their schedules are always packed. Surgeons are more receptive to hearing about safety devices and prevention strategies from another surgeon than from someone outside their specialty. And some still have the attitude that injuries are part of the job and that people just need to be more careful; fortunately, they are in the minority. Most surgeons are adaptable and open to change; with effective education, OR professionals - including surgeons - will embrace safer surgical devices and work practices.

That's why I wrote my book - to create a common ground for communication and to emphasize that effective strategies for preventing sharps injuries are already available.

JP: In your work, do you see a connection between medical errors and occupational sharps injuries, between patient safety and worker safety?
MD: Absolutely. Surgery is the leading source of both medical errors and sharps injuries in hospitals. If we examine our near-misses and analyze the root causes of adverse events, as has been done in the aviation industry, we'll better understand how to build safety into existing systems in order to protect patients from medical errors and workers from sharps injuries.

JP: Can the problems of patient safety and worker safety be dealt with using the same approach?
MD: Certainly - and they should be. Separating the two is artificial. Infection of either a healthcare worker or a patient with a bloodborne pathogen is as much a medical error as incorrect administration of a medication that injures or kills a patient. By following the money trail - the cost of adverse events - administrators can easily see the need for education in the OR to protect the worker as well as the patient. A culture of safety does not discriminate between worker safety and patient safety.

JP: Are you optimistic about improvements in OR safety for both healthcare workers and patients?
MD: I view the large number of adverse events as a great opportunity for improvement. Sharps injuries are costly - but the good news is that the majority are preventable. Healthcare facilities need to be dedicated to creating a culture of safety institution-wide, from the top down. Some people believe, and I'm one of them, that if the CEO or top-level hospital administrator isn't dedicated to improving safety, for patients and staff alike, it will be a long and frustrating process. But in my travels, I've met more than one hospital CEO who has said, "I want our hospital to be the safest in the country." All CEOs should think that way, but they also need to articulate their vision to their staff and actively seek ways to make it a reality. Clearly, we already have the tools and the knowledge to prevent most occupational sharps injuries.

Fortunately, focus and vigilance are hallmarks of OR professionals. Given the necessary education and safer technology, they will find and follow the safest path to protecting themselves and their patients. I think the future is bright.

Safety Monitor: Hand Gels, Back Pain, OR Fires

  • Emergency code changes to the 2000 National Fire Protection Association (NFPA) 101 that would let you install alcohol-based hand-gel dispensers at hand-level may be one step closer after the NFPA Technical Committee on Healthcare Occupancies meets Feb. 5. The current life-safety code - which you must comply with for Medicare certification - bans the dispensers in exit corridors unless they protrude no more than 3.5 inches into an exit corridor and are mounted at or below 38 inches. Just one vote nixed an interim amendment when the committee met in December, says Robert Solomon, the NFPA's assistant vice president for building and life safety codes. If the changes pass this time, they"ll be sent to the NFPA Standards Council and may be implemented by April.
  • More than four-fifths of nurses (84 percent) report lower-back pain at work, according to a study published in the January Journal of Occupational and Environmental Hygiene. Yet just 11 percent of nurses said they used patient lifts routinely. The top reasons they don't: unavailability of lifts (76 percent), time constraints (19 percent) and lack of training (17 percent).
  • The Paragon Service PS8000 SmartBlend oxygen/air blender can help prevent surgical fires in local anesthesia and conscious sedation cases in which the delivery of 100 percent oxygen is not necessary or desired, says the manufacturer. By setting the Smartblend to deliver 21 to 100 percent oxygen and setting the desired LPM flow, you can deliver less open oxygen, which decreases the risk of oxygen-enriched surgical fires, says the company.

- Stephanie Wasek