Hands-Free Technique in the Operating Room: Reduction in Body Fluid Exposure and the Value of a Training Video

Abstract

SYNOPSISObjectives. This study sought to determine if (1) using a hands-free technique (HFT)-whereby no two surgical team members touch the same sharp item simultaneously-$75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to $75%, immediately and over time.Methods. During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when $75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2.Results. A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for $75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of $75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later.Conclusion. The use of HFT and the HFT video were both found to be effective.

Risk of bloodborne pathogen exposure among Zambian healthcare workers

“…Utilizing sutures with blunted tips for suturing internal muscle and fascia and using suture alternatives such as adhesives and staples for skin closure can reduce the risk of injury for the surgical team. The frequency of injuries that occur during the passing of sharp devices from one person to another can be reduced by the implementation of a ''neutral zone'' in which instruments are placed and from which they are retrieved, such as a container or tray, instead of passing instruments hand-to-hand [22][23][24]. This work practice costs little or nothing except the time involved for training and requires only a commitment to changing practice patterns.…”

Surgeons’ and residents’ double-gloving practices at 2 teaching hospitals in Ontario

“…9 Factors influencing the likelihood of exposure include the type, length and emergency status of the surgery; the amount of blood loss; and the number of personnel present throughout the procedure. 10,11 Surgeons and surgical residents are usually at higher risk for PIs than other operating room personnel. [12][13][14][15][16] Makary and colleagues 17 found that by their final year of training, 99% of surgical residents had had a needle-stick injury.…”

Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: What is the evidence?

“…Their first study, a case-control study of more than 10 000 surgeries in which HFT was used 75% or more of the time, reported that the incident (i.e., percutaneous injury, glove tear, contaminations) rates, which were adjusted for emergency status, time of day or nurses' perceptions of OR noise, were 35% lower (odds ratio 0.65, 95% CI 0.43-0.97) when the HFT was used. 10 In a second observational study of 3700 operations over a 6-month period at a large, urban hospital, use of the HFT reduced percutaneous injury rates by 59% (95% CI 23%-72%) after adjusting for type and duration of surgery, emergency status, noisiness, time of day and number of staff present in the OR. 11 Tokars and colleagues 15 prospectively observed nearly 1400 surgeries and evaluated the percutaneous injury risk associated with 10different practices, including the HFT.…”

“…The total number of exposures after implementation was significantly reduced (compared with preimplementation controls) for scrub nurses, and there was a trend toward reduction for first assistants, but the number of exposures was not reduced for surgeons. Two studies by Stringer and colleagues 10,11 evaluated the effect of HFT (defined as having been implemented when at least 75% of all transfers were hands-free) on percutaneous injury rates among OR staff. Their first study, a case-control study of more than 10 000 surgeries in which HFT was used 75% or more of the time, reported that the incident (i.e., percutaneous injury, glove tear, contaminations) rates, which were adjusted for emergency status, time of day or nurses' perceptions of OR noise, were 35% lower (odds ratio 0.65, 95% CI 0.43-0.97) when the HFT was used.…”