The operating room (OR) is arguably the most dangerous location in the healthcare delivery system. Mark Davis discusses what patients can do to make their surgeries safer.
By Mark Davis M.D. (author “Irresponsible: What Surgeons Won’t Tell You and How to Protect Yourself”)
Sooner or later, everyone will face surgery, their own or that of a loved one.
The operating room (OR) is arguably the most dangerous location in the healthcare delivery system. A prime example is the little publicized man-made epidemic of sharps injuries. According to the Centers for Disease Control and Prevention (CDC), U.S. surgeons and their assistants are injured approximately 1000 times a day by suture needles, scalpel blades and other sharp objects.
Sharps injuries expose care providers to the blood of patients who are frequently infected with HIV, hepatitis C and hepatitis B, which can result in providers becoming infected. Surgeons, more so than other surgical team members, often do not report their sharps injuries, thereby depriving themselves of the opportunity for testing, post-exposure prophylaxis and treatment.
This creates a danger for future patients of unknowingly infected surgeons. When infected surgeons continue to experience sharps injuries, and the surgeon’s bleeding injured hand comes in contact with patients’ internal tissues (defined by the CDC as a re-contact), the surgeon’s infection may be transmitted to patients.
Unless someone has worked in the OR, it is highly unlikely that he or she is aware of the risk associated with sharps injuries and exposure to bloodborne pathogens. The epidemic of sharps injuries converges with the HIV and hepatitis C epidemics to make the OR a uniquely dangerous place for patients and care providers alike.
Sharps injuries are frequent but preventable. Safety engineered devices such as blunt tipped suture needles (BSN) have been shown to significantly reduce the incidence of suture needle sticks, by far the most common type of sharps injury. BSN have been available for almost two decades. The American College of Surgeons and six other surgical organizations recommend that BSN be used for closing the muscle and fascia layers of all incisions. Despite efforts by surgical facilities to educate surgeons and encourage them to use safer technology, only 5 percent of suture needles used are the safer blunt tipped variety. Another useful safety-engineered device, the safety scalpel, is utilized even less often than BSN.
Surgeons’ resistance to change translates to costly expenditures that could be avoided. Significant costs include laboratory testing of patients and care providers, counseling, post-exposure drug prophylaxis to prevent HIV infection and treatment for hepatitis C, not to mention the human suffering associated with having to be tested and potentially acquiring a deadly disease.
What can patients do to protect against this threat and ensure a safe passage during their surgical procedure? When patients are referred to a surgeon, I recommend that they ask on first meeting the surgeon whether or not he or she uses blunt tipped suture needles, safety scalpels, and other safe techniques.
Surgeons and physicians respond to consumer scrutiny and pressure, as evidenced by the well known finding that care providers are more likely to wash their hands when entering a patient’s room if they are aware the patient is watching. Transparency and the educated/empowered healthcare consumer can help ensure the safety of their own surgical procedure and ultimately, it can be hoped, help drive the widespread adoption of best safe practices in the delivery of surgical care.
- Panlilio AL, Orelien JG, Srivastava PU, Jagger J, Cohn RD, Cardo DM; The NaSH Surveillance Group (CDC); The EPINet Data Sharing Network. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infection Control and Hospital Epidemiology. 2004;25(7):556-562.