July 2013 Vol 98 No 1 • AORN Connections | C5http://dx.doi.org/10.1016/S0001-2092(13)00626-1© AORN, Inc, 2013

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The new “Recommended practices for sharps safety”1 was released electronically in June 2013 and will be available in the

2014 edition of Perioperative Standards and Recommended Practices.2 The new recommended practices (RP) are an expansion of AORN’s “Guidance statement: sharps injury prevention in the perioperative setting,”3 and include best practices for preventing sharps injuries and reducing bloodborne pathogen exposure to perioperative patients and personnel. Following the requirements outlined in the Occupational Safety and Health Administration’s (OSHA) Bloodborne Pathogens Standard,4 the RP is based on a hierarchy of controls that include hazard elimination measures (e.g., exposure control plan); engineering controls (e.g., blunt suture needles, safety scalpels); work practice controls (e.g., neutral zone, no-touch technique); administrative controls (e.g., post-exposure evaluation and follow-up); and personal protective equipment (PPE). The recommendations for each topic reflect AORN’s critical evidence review, appraisal, and rating process.

Hazard elimination The Sharps Safety RP states that health care

facilities must establish a written bloodborne pathogens exposure plan, which should be reviewed and updated at least annually.1 The plan should include a profile of how sharps injuries occur, the occupational group sustaining the most injuries, the location of the injuries, the sharps devices involved, the procedures that most commonly contribute to sharps injuries, and sharps injury reduction devices in use. As part of the exposure control plan, health care organizations should also establish a process for selecting and evaluating sharps safety devices. The process for evaluating sharps safety devices should be decided on by a multidisciplinary team that includes frontline workers.

Engineering controls The RP states that perioperative personnel

must use sharps with safety-engineered devices, in accordance with the Needlestick Safety and Prevention Act of 2000 that mandates that

employers provide safety-engineered devices in health care settings.1 The RP highlights strong evidence supporting the use of safety-engineered devices, including a retrospective review of 161 injuries that indicated that 65 percent of the injuries could have been prevented by using a device with safety-engineered features.5

The RP advocates the use of two main engineering controls: blunt suture needles and safety scalpels. According to the RP, blunt suture needles should be used unless clinically contraindicated, because they may prevent percutaneous injuries.1 The RP contains information from a Cochrane review that evaluated blunt versus sharp needles for preventing percutaneous exposure incidents in surgical staff members and found that using blunt needles reduced glove perforation risk by 54 percent.6 In addition, the RP promotes the use of safety scalpels when clinically feasible and cites research that indicates scalpel injuries are the second most common injury in the perioperative setting.1 The RP lists several types of safety scalpel devices that may be used in the perioperative setting: single-use scalpel handles and blades that do not require disassembly, retracting scalpel blades, shielded or sheathed scalpel blades, rounded tip scalpel blades, and scalpel blade removal devices. Alternative wound closure devices (e.g., fascial closure devices, tissue staplers, tissue adhesives, adhesive skin closure strips) are also recommended for use when clinically indicated.

Work practice controlsThe RP instructs perioperative personnel to

use work practice controls when handling sharp devices (e.g., scalpels, hypodermic needles, suture needles).1 It recommends that used sharps on the sterile field be kept in a puncture-resistant container to help ensure their containment and needle containers be securely closed before disposal. In addition, the RP advocates the use of a neutral zone or hands-free technique for passing sharp instruments, blades, and needles.1 The RP lists specific instructions for the use of a neutral zone, including identifying the neutral zone in the preoperative briefing, giving verbal notification when a sharp is in the neutral zone, and placing

New recommended practices for sharps safety releasedLeslie KnudsonManaging Editor

C6 | AORN C

one sharp at a time in the neutral zone. The use of alternative cutting devices (e.g., electrosurgery) is also recommended when clinically indicated.

Administrative controlsThe RP highlights the perioperative RN’s

responsibility to evaluate his or her practice against professional practice standards, rules, and local, state, and federal regulations.1 In addition to individual responsibility, the RP states that health care organizations are responsible for providing initial and ongoing education and competency validation of perioperative team members’ knowledge of sharps safety principles and their performance related to sharps safety processes. The RP also provides specific recommendations for documentation related to sharps safety, the development of policies and procedures for sharps safety processes and practices, and quality improvement activities for monitoring and improving the prevention of sharps injuries.

Personal protective equipment The RP states that perioperative personnel

must use PPE, which is also required by OSHA where there is a risk of occupational exposure to blood, body fluids, or other potentially infectious materials.1 The RP supports double gloving during surgical and other invasive procedures that have the potential for exposure to blood, body fluids, or other infectious materials. A significant amount of research is cited in the RP that indicates double gloving reduces the risk of glove perforation and percutaneous injury and minimizes bloodborne pathogen exposure. The RP also supports the use of perforation indicator systems when double gloves are worn and advises perioperative personnel to monitor gloves for punctures. “I think PPE is one of the easiest things that anyone in the OR can do to reduce their risk,” said Mary Ogg, MSN, RN, CNOR, lead author of the RP and perioperative nursing specialist at AORN. “You can wear double gloves without having to get buy-in from other team members.”

ConclusionAn estimated 384,325 hospital health care

workers sustain a percutaneous injury each year.7 Because percutaneous injuries are associated with the transmission of hepatitis B, hepatitis C, HIV, and other pathogens, it is critical for perioperative personnel to follow recommended practices for preventing sharps injuries and reducing bloodborne pathogen exposure to patients and

health care workers. “This particular RP has very strong evidence to support it,” said Ogg. “It is an OSHA regulation that says we have to do it, so it’s against the law not to do it; but we have Cochrane reviews and very strong studies that show if you do these measures, you can reduce sharps injuries.”

Additional ResourcesThe Recommended Practices for Sharps Safety

webinar, which covers the AORN evidence rating process and discusses how perioperative personnel can implement evidence-based practices, can be viewed at http://www.aorn.org/Events/Webinars/Previously_Recorded_Webinars.aspx. The Sharps Safety Tool Kit offers resources to help perioperative professionals reduce the risk of sharps injuries in the OR and can be accessed at http://www.aorn.org/Secondary.aspx?id=20852.

References1. Recommended practices for sharps safety.

In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014. In press.

2. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2014. In press.

3. AORN guidance statement: sharps injury prevention in the perioperative setting. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:573-577.

4. OSHA’s Bloodborne Pathogens Standard. Occupational Safety and Health Administration. http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf. Accessed June 11, 2013.

5. Waclawski ER. Evaluation of potential reduction in blood and body fluid exposures by use of alternative instruments. Occup Med (Lond). 2004;54(8):567-569.

6. Parantainen A, Verbeek JH, Lavoie MC, Pahwa M. Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff. Cochrane Database Syst Rev. 2011;11:CD009170.

7. Panlilio AL, Orelien JG, Srivastava PU, et al. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infect Control Hosp Epidemiol. 2004;25(7):556-562.

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