Surgical Procedure Characteristics and Risk of Sharps-Related Blood and Body Fluid Exposure

Abstract

OBJECTIVETo use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms.DESIGNA 10-year retrospective cohort design.SETTINGA single large academic teaching hospital.PARTICIPANTSAll surgical procedures (n=333,073) performed in 2001–2010 as well as 2,113 reported BBF exposures were analyzed.METHODSCrude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors.RESULTSThe 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 (17.7 exposures per 1,000 procedures with 501–1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to <6 hours, 27.1 exposures per 1,000 procedures lasting ≥6 hours). Regression results showed associations were generally stronger for suture needle–related exposures.CONCLUSIONSResults largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types.Infect. Control Hosp. Epidemiol. 2015;37(1):80–87

Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures

“…17 The results indicated that these associations vary somewhat by device type (exposures involving suture needles vs those involving all other devices). Table 2 includes 3 sets of Poisson regression modeling results that are identical except that the first set models all percutaneous BBFE, the second models those involving suture needles, and the third models exposures involving all other devices.…”

“…Procedure characteristics were reported previously. 17 Figure 1 shows the distribution of team stability index scores for all surgical procedures; Figure 2 shows the distributions by surgical service. The stability index mean (SD) was 0.35 (0.13) (N = 317,416).…”

“…19 Previous analyses of these data revealed some different patterns in risk for exposures involving suture needles and those involving other devices. 17 To explore the possibility that the role of familiarity among team members might also vary by device type, additional analyses were conducted stratifying by surgical device category. This distinction is of potential statistical relevance because approximately half of all percutaneous BBFE in the OR involve suture needles.…”

“…However, in previous publications our group noted that efforts to improve reporting at this institution were implemented during the study period. 17,20 Though others have reported that coworkers witnessing needlestick injuries is a powerful determinant of reporting events, 30 it is conceivable that team members who have developed informal interpersonal relationships could be more likely to avoid formal procedures and be less likely to report percutaneous BBFE.…”

“…The association between these procedure properties and risk of percutaneous BBFE were reported previously. 17 The Index of Past Collaboration A variable unique to this percutaneous BBFE study is a measure of the extent to which surgical team members, working any given procedure in the study period, have worked together on surgical procedures in the previous 6 months. This measure, the index of past collaboration developed by Borgatti and Jones, 7 represents the opportunity all members of a surgical procedure have had (during the specified window) to develop familiarity with other members.…”