Archive June 2018 XIX, No. 6

The Ergonomics of Sharps Safety

Small adjustments to posture and positioning in the OR cut down on injuries from suture needles and scalpels.

Pramila Kalaga

Pramila Kalaga, MS, CPE

BIO

DON'T LET YOUR GUARD DOWN
DON'T LET YOUR GUARD DOWN ' When you're distracted, it's easy to take your eyes off a moving suture needle or to put your hands in the wrong place at the wrong time.

What do you do when your OR team follows sharps safety rules, yet still gets stuck by suture needles and sliced by scalpels? That was the frustrating conundrum facing the administrators at a metro hospital in Council Bluffs, Iowa. Despite their best efforts, they saw no obvious patterns related to sharps-related injuries in terms of who was getting injured and what procedures were involved.

That was where I came in. As an ergonomist, I brought a different perspective to the challenge. After all, these injuries were happening to people who were experts in dealing with sharp instruments and needles. It wasn't that they didn't know how to handle a needle or how to use neutral zones when passing sharp instruments to each other. There had to be some other considerations that people weren't taking fully into account. When I began my observations, 2 things that are obvious to you jumped out at me:

  • The OR staff was dealing with a very small operative field.
  • A lot of hands and powerful instruments were moving in and out of that small space.

I remember thinking that if this had been an industrial setting (where a lot of my ergonomics training took place), and I saw sharp, powerful instruments in a small space close to people's hands, we'd install machine guards, insist people wear cut-resistant gloves and probably implement other safety measures as well.

In fact, cut-resistant gloves were the first thing I recommended. No good. They turned out to be too thick and heavy, and the staff said they compromised manual dexterity and tactile feedback. We also thought about trying to develop a shield to protect people's hands. But that, too, was a non-starter. They didn't want anything else clogging up the operative field.

Incidentally, double-gloving with standard surgical gloves did help prevent skin from being pierced by needlestick pokes in incidents that we classified as near-misses. And they didn't inhibit tactile feedback or dexterity. Many needlestick injuries were superficial, so double-gloving, which is among AORN's guidelines for needlestick-injury prevention, was one of the measures we adopted as a best practice. We should always be on the lookout for innovations and safer designs in terms of needles and sharps. But we needed to dig deeper to get to the root of the problem.

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