Percutaneous injuries during surgical procedures.
OBJECTIVE
To study the numbers and circumstances of percutaneous injuries (eg, needle sticks, cuts) that occur during surgical procedures. Surgical personnel risk infection with blood-borne pathogens from percutaneous injuries; some injuries might also place patients at risk by exposing them to a health care worker's blood.


METHODS
Observers present at 1382 surgical procedures recorded information about the procedure, the personnel present, and percutaneous injuries that occurred.


METHODS
Four US teaching hospitals during 1990.


METHODS
Operating room personnel in five surgical specialties.


METHODS
Numbers and circumstances of percutaneous injuries among surgical personnel and instances in which surgical instruments that had injured a worker recontacted the patient's surgical wound.


RESULTS
Ninety-nine injuries occurred during 95 (6.9%) of the 1382 procedures. Seventy-six injuries (77%) were caused by suture needles and affected the nondominant hand (62 injuries [63%]), especially the distal forefinger. The risk of injury adjusted for confounding variables by logistic regression was higher during vaginal hysterectomy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.5) and lower during certain orthopedic procedures (OR, 0.2; CI, 0.1 to 0.7) than during 11 other types of procedures (reference group; OR, 1.0). Use of fingers rather than an instrument to hold the tissue being sutured was associated with 35 injuries (35%). Eighty-eight injuries (89%) were sustained by resident or attending surgeons; in 28 (32%) of the 88 injuries in surgeons, the sharp object that caused the injury recontacted the patient.


CONCLUSIONS
Percutaneous injuries occur regularly during surgery, placing surgical personnel and, to a lesser extent, patients at risk for infection with blood-borne pathogens. Many such injuries may be preventable with changes in devices, techniques, or protective equipment; all such measures require careful evaluation to determine their efficacy in reducing injury and their effect on patient care.
Tokars
J I
JI
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga 30333.
Bell
D M
DM
Culver
D H
DH
Marcus
R
R
Mendelson
M H
MH
Sloan
E P
EP
Farber
B F
BF
Fligner
D
D
Chamberland
M E
ME
McKibben
P S
PS
D000062:Accidents, Occupational / Q000706:statistics & numerical data; D002641:Chicago; D013502:General Surgery; D006230:Hand Injuries / Q000209:etiology; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D016602:Needlestick Injuries / Q000453:epidemiology / Q000209:etiology*; D009519:New York City; D015588:Observer Variation; D009873:Operating Rooms; D012044:Regression Analysis; D012307:Risk Factors; D012867:Skin / Q000293:injuries*; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000706:statistics & numerical data