Sharps-handling practices among junior surgical residents: A video analysis

Division of Pediatric Surgery, University of British Columbia, Vancouver, BC.
Canadian journal of surgery. Journal canadien de chirurgie (Impact Factor: 1.51). 08/2012; 55(4):S178-83. DOI: 10.1503/cjs.031210
Source: PubMed


Although "universal precautions" are standard for sharps handling, there has been poor compliance among surgeons. We used video analysis to assess sharps handling practices among junior surgical residents.
Postgraduate year (PGY)-2 general surgery and PGY-1 plastic surgery residents were videotaped performing pediatric inguinal hernia repairs. For each procedure, the resident was the principal operator, with the attending surgeon assisting. Retrospective assessment of safe and unsafe sharps handling was determined based on published guidelines. We assessed safety performance in personal sharps tasks, passage of sharps and verbal notification regarding sharps. Data was analyzed using descriptive statistics.
Data were collected from 18 residents' videos (4 plastic surgery, 14 general surgery). Residents safely performed sharps tasks, passed and verbally notified about sharps an average of 69.2%, 93.2% and 9.9% of the time, respectively. Suture needle manipulation was handled safely 56.2% of the time (mean 4.4 safe v. 4.3 unsafe actions). Surgical residents demonstrated a safe suture tying technique in 91.8% of cases, proper tissue retraction in 85.2% and safe handling of injection needles in 72.2% of cases. When assessing the safety performance of the surgical team, attending surgeons acting as surgical assistants safely passed sharps 80.0% of the time, while scrub nurses demonstrated safe passing at all times. Attending surgeons used verbal notification when passing sharps 22.7% of the time, while scrub nurses verbally notified the team 4.3% of the time.
Junior surgical residents consistently passed sharps safely. Personal sharps tasks were less likely to be performed safely, and only a minority of residents verbally notified the team about sharps placement.

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    ABSTRACT: Sharps injuries are one of the most frequent health-care related accidents. It is estimated globally that 35 million workers are at risk; in Mexico there is no data available for this type of injuries. They are associated with lack of training, instrument and procedure risk, fatigue and stress. The occupational distribution is nurses 45 %, technicians 20 %, doctors 20 % and maintenance workers 5 %. The most commonly associated procedures are injection, venipuncture, suture, and insertion and manipulation of IV catheters. Hepatitis B is the most commonly transmitted agent. Emotional distress is huge as well as the cost of prophylaxis and follow-up. More than half of the injuries are not notified. The most common reasons for not reporting are: the belief that the exposure has low risk of infection, the lack of knowledge of reporting systems and the assumption that it is difficult to notify. Many strategies have been created to reduce the incidence of sharps injuries, such as: identifying the risk of blood exposure, the creation of politics to minimize the risk, the education and training to create a safe workplace, the enhancing of the reporting system, the use of double-gloving and using safety-engineered sharps devices. In many countries these politics have reduced the incidence of sharps injuries as well as the economic burden.
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