Be Mindful About Sharps Injuries

Knowing that suture needle sticks were our primary concern for quality improvement, the project was structured to observe wound closures for 35 cases, from completion of the procedures through to completion of the closures. Data was collected for several categories of disruptions and interruptions that occurred during wound closure — communication, coordination (change of staff), and other human or technological interruptions. Average and peak decibel levels were also recorded to better understand the noise level occurring during wound closure. Routine patient- and case-related communication is essential and was not considered a distraction or interruption, and therefore not collected as part of this project.

Distractions often combine with other distractions to create an attention-destroying cacophony. In compiling observational data, the focus was not on individual interruptions, but rather the combinations of them. The research was eye-opening because the interruptions staff experienced were heavily related to communication and the OR environment. Many unplanned or unexpected distractions affected attention to the task at hand and increased injury risk.

• Coordination interruptions. OR team members often take deep breaths when a procedure is completed and think, “We did it. We’re done. On to the next case.” Wound closure is often viewed as less critical and relatively easy to do, and it’s often delegated to novice or inexperienced staff. Attention moves toward activities required to end the case and away from the person closing the wound.

The entire team shifts to a future-oriented mindset. Relief staff often replace those who have been present throughout the procedure. The patient might be emerging from anesthesia. Nurses are focused on reconciling counts and specimens, finishing their documentation and getting ready to transfer the patient to PACU. Amid these disruptions, team members are working to close the wound. That’s when mistakes can happen. Broken concentration, not negligence, is the cause.

• Cognitive fatigue. Human beings can focus on only so many things at one time. We have natural limitations in terms of the amount of input we can receive and respond to in any given moment. In the OR, especially at the end of a case, the person closing the wound often is subjected to a constant barrage of activity going on around them. That’s mentally fatiguing and distracting. It presents ample opportunity for the person holding the sharp to lose focus and get stuck. In the OR, team members are so hyperfocused on safely caring for the patient, they often forget to consider their own well-being.
• Environmental noise. Our observations revealed there was a lot going on during wound closure. Staff members would enter the OR to ask questions about the next case; someone would receive a phone call about timing for discharge to PACU; an instrument would drop loudly onto the floor; equipment was moved from the room; there were competing conversations and crosstalk, and music playing. Just one unexpected noise can momentarily distract the attention of the person closing the wound, taking them out of the moment. Even the slightest distraction can result in an injury.

We discovered something interesting during our study: Surgical technologists seem to suffer the least amount of sharps injuries among all OR disciplines. When we looked at our institutional data from 2008 to 2018, the percentage of injured surgical techs remained the same for the whole decade. Why? It could be that they focus on sharps safety from the outset of their training, and receive reinforcement throughout their careers. In the OR, handling sharps is the bulk of what they do, every single day.

We hypothesized their injury rate was so low because they’re very familiar with proper sharps handling practices, and they reinforce those skills daily while learning to screen multiple requests and ignore distractions more effectively.