Effectiveness of the hands-free technique in reducing operating theatre injuries.
BACKGROUND
Operating theatre personnel are at increased risk for transmission of blood borne pathogens when passing sharp instruments. The hands-free technique, whereby a tray or other means are used to eliminate simultaneous handling of sharp instruments, has been recommended.


OBJECTIVE
To prospectively evaluate the effectiveness of the hands-free technique in reducing the incidence of percutaneous injuries, contaminations, and glove tears arising from handling sharp instruments.


METHODS
For each of 3765 operations carried out in main and surgical day care operating theatres in a large urban hospital, over six months, circulating nurses recorded the proportion of use of the hands-free technique during each operation, as well as other features of the operation. The hands-free technique, considered to be used when 75% or more of the passes in an operation were done in this way, was used in 42% of operations. The relative rate of incidents (percutaneous injuries, contaminations, and glove tears) in operations where the hands-free technique was used and not used, with adjustment via multiple logistic regression for the different risk profiles of the two sets of operations, was calculated.


RESULTS
A total of 143 incidents (40 percutaneous injuries, 51 contaminations, and 52 glove tears) were reported. In operations with greater than 100 ml blood loss, the incident rate was 4% (18/486) when the hands-free technique was used and 10% (90/880) when it was not, approximately 60% less. When adjusted for differences in type and duration of surgery, emergency status, noisiness, time of day, and number present for 75% of the operation, the reduction in the rate was 59% (95% CI 23% to 72%). In operations with less than 100 ml blood loss, the corresponding rates were 1.4% (15/1051) when the hands-free technique was used and 1.5% (19/1259) when it was not used. Adjustment for differences in risk factors did not alter the difference.


CONCLUSIONS
Although not effective in all operations, use of the hands-free technique was effective in operations with more substantial blood loss.
D000062:Accidents, Occupational / Q000517:prevention & control*; D016063:Blood Loss, Surgical; D004868:Equipment Failure; D005932:Gloves, Surgical; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional / Q000517:prevention & control*; D008505:Medical Staff, Hospital; D016602:Needlestick Injuries / Q000517:prevention & control*; D016273:Occupational Exposure; D009873:Operating Rooms; D011446:Prospective Studies; D012307:Risk Factors; D017751:Safety Management / Q000379:methods*; D013525:Surgical Instruments; D014481:United States