Preventing Blood and Body Fluid Exposures During Surgical Procedures

Details

• Personal Author:
  Dement, John M. ; Epling C ; Hunt D ; Lipscomb HJ ; Myers DJ ; Richardson W ; Smith-Lovin L
• Description:
  The rate of percutaneous blood and body fluid (BBF) exposures in the operating room (OR) remains high despite various attempts to reduce the rate of these outcomes. This study included and assessment of surgical procedure characteristics that modify the risk of BBF exposures and evaluation of efforts to reduce the risk of BBF exposures in the OR. The intervention included an institutional policy requiring the implementation of a hands-free neutral passing zone to avoid hand to hand passing of surgical instruments during procedures, the promotion of blunt suture needles use for certain suturing tasks, and the promotion of double gloving. All intervention measures were implemented between July 2005 and January 2007. We explored the role of teamwork as it relates to safety in the operating theater. We used a social network measure of "past collaboration" found in the sociological literature, but never before used to study safety in the operating room, to produce a quantitative score for each team assembled for each surgical procedure. We explored whether teams who have worked together more in the past experienced lower rates of BBF exposures, possibly through greater familiarity among team members. To achieve these aims, we gathered several administrative datasets spanning a ten year period (2001-2010) at a single large teaching hospital. Individual-level data were linked via employee identifiers; patient identifiers were used to link injury events to surgical procedures during which they occurred. These data included 2,113 BBF exposure events and 333,073 surgical procedures. Poisson regression was used to analyze the data. Separate models were produced for BBF exposures due to suture needles and those due to all other surgical instruments. The overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss, number of personnel working in the surgical field during the procedure, and procedure duration. Regression results showed associations were generally stronger for suture needle-related exposures. There was no detectable effect of the intervention measures; rates of BBF exposures rose steadily across the entire study period. Results show a small but statistically significant (a<0.05) reduction in risk of BBF exposures for teams that had higher past collaboration index scores. This association was also strongest for BBF exposures involving devices other than suture needles. The main conclusions of this study are 1) more intense efforts or different measures and strategies than those used at this study site will likely be required to improve safety in the OR, 2) future studies should explore why risk factors for suture needles and other devices may differ and 3) additional research should be done to verify the novel findings that suggest greater familiarity among surgical team members improves safety in the OR. The measure of past collaboration used here may be used to explore the role of team stability for other outcomes, such as patient safety outcomes, or in other work settings where teamwork may conceivably affect safety, such as among firefighters or miners. [Description provided by NIOSH]
• Subjects:
  Blood Body Fluids Occupational Health Safety
• Keywords:
  Body Fluids Disease Prevention Exposure Assessment Intervention Effectiveness Operating Rooms Surgery
• Series:
  Grant Final Reports
• Publisher:
  National Institute for Occupational Safety and Health
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Final Grant Report
• Place as Subject:
  North Carolina ; OSHA Region 3 ; OSHA Region 4 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  OEP - Office of Extramural Programs
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-56
• NIOSHTIC Number:
  nn:20055353
• NTIS Accession Number:
  PB2019-100833
• Citation:
  Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, K01-OH-009657, 2014 Nov; :1-56
• Contact Point Address:
  Douglas Myers, ScD, MA, Assistant Professor, Department of Occupational and Environmental Health Sciences, West Virginia University, P.O. Box 9190, Morgantown, WV 26506
• Email:
  djmyers@hsc.wvu.edu
• Federal Fiscal Year:
  2015
• NORA Priority Area:
  Healthcare and Social Assistance
• Performing Organization:
  West Virginia University
• Peer Reviewed:
  False
• Start Date:
  20090901
• Source Full Name:
  National Institute for Occupational Safety and Health
• End Date:
  20140831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:92a4464b41af4e7f24c9fdd608f427d0c6f3bfab04ca71a82036cdb3ac5db22235eb36ba0bf73fe403138496c86760db6655058b6a9c3ae9b70b34166da130c8
• Download URL:
  https://stacks.cdc.gov/view/cdc/218844/cdc_218844_DS1.pdf
• File Type:
  [PDF - 2.95 MB ]