Sharps Handling Practices Among Junior Surgical Residents – A Video Analysis
David Tso BSc, Monica Langer MD, Geoffrey Blair MD, Sonia Butterworth MD
Division of Pediatric General Surgery, BC Children’s Hospital
A survey of surgical residents at over 17 medical centers Resident safety performance was assessed in three areas: RESULTS
1. Personal sharps tasks
99% of surgeons in training had sustained a needlestick injury E.g. Suture needle handling
19 surgical residents videoed
by their final year of training (2) 2. Passage of sharps 15 general surgery residents (PGY-2)
53% involved patients with a history of HIV, hepatitis B or C, or E.g. Scalpel , injection needle 4 plastic surgery residents (PGY-1) 100
intravenous-drug use 3. Verbal notification when passing of sharps Initial videos (n=19): 90
E.g. “There’s a needle up.” Sharps tasks performed safely = 66.3%
In differentiating the mechanisms of injuries due to sharps, 80
Bakaeen and colleagues found that Second video was taken of the resident after the technical
Safe passing of sharps = 90.4% 70
69% of OR injuries were inflicted by suture needles performance feedback session and safety performance Verbal notification when passing = 10.1% 60
9% from hollow-bore needles was compared between the two procedures. Unsafe sharps practices mostly with handling of
34% from sharp instruments (3) 50
Video reviewer blinded to resident level & video order 4.7 unsafe actions per surgery 40
Specifically, injuries from sharps can occur when 30
Loading suture needle into driver/repositioning needle All residents demonstrated safe handling of the
with fingers scalpel blade 20
During hand-to-hand passing of sharps No actual injuries to the surgical resident/ team 10
Suturing muscle and fascia when needle manipulated 0
Second video follow-up (n=8) Initial Video (n=8) Final Video (n=8)
Retraction of tissue with hands
Surgeon sews towards own hand or assistant's hand No statistically significant differences between initial
Tying a suture while needle is attached and final procedures with regards to Personal sharps personal passage communication
Suture is left unattended on operative field after use (4) tasks (p=0.17), Passing of sharps instruments
(p=0.14) or Verbal notification (p=0.29) Figure 2. Graph of mean percentage of safe tasks
Figure 1. Examples of safe and unsafe manipulation of the suture needle.
1) Unsafe handling of suture needle using fingers. 2) Safe handling of 4.4 missed opportunities to use of verbal cues to alert performed by surgical residents as seen in the initial
PURPOSE suture needle using forceps. team members when passing sharp instruments and final videos (n=8) taken during an inguinal hernia
To examine sharps handling practices of junior surgical residents
performing an operation
Evaluate whether experience correlates with a decrease in unsafe Sharps Task Safe Unsafe
sharps behavior Personal Sharp Tasks
Suture needle Using forceps to load or Using fingers to load or
Hypothesis: Safety performance is not expected to improve with reposition needle reposition needle Junior surgical residents consistently passed sharp instruments in
operative experience in the absence of formal training on sharps Tying Sutures Needle is on driver Needle is exposed while a safe manner
practices during tying, and is tying suture Tasks relating to manipulation of sharps were less likely to be
Initial video Standard
protected performed safely
Tissue Retraction Using instrument to Using hand/fingers to Description Safety (mean) Deviation
Minority of residents verbally notified team members when passing
retract wound edge retract wound edge, Safe 4.3 2.7
METHODS when using sharps when suturing towards sharp instruments
Suture needle manipulation Unsafe 4.7 4.0
Junior surgical residents: hand/fingers Review of technical performance of the surgical procedure did not
PGY-2 general surgery & PGY-1 plastic surgery residents % Safe 53.7% 33.8% significantly improve safe sharps handling practices
Injection Needle Injecting away from Injecting towards
2 month rotation in pediatric general pediatric surgery at BC Handling hand/fingers, no 2- hand/fingers, 2 handed Safe 3.5 1.5
handed needle re- needle capping
Tying sutures Explicit instruction and feedback on sharps handling should
Children’s Hospital in Vancouver, British Columbia Unsafe 0.5 1.0
capping become an integral part of surgical residency programs and
% Safe 86.9% 25.6%
Videotaped performing pediatric indirect inguinal hernia repairs: surgical culture (4-7)
Sharps Placement on Placing sharps back Sharps left on operative Safe 1.8 0.8
Junior surgical residents as principle operator, attending Operative Field onto a neutral hands field unattended Tissue retraction
free zone while not in use Unsafe 0.5 0.8
% Safe 83.3% 28.3% REFERENCES
Technical feedback was given by the attending surgeon on Passing of Sharps
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Table 1: Definitions of safe and unsafe sharps tasks used to assess safety 2004 Sep;199(3):462-467.