Perioperative Use of the Hands - Free Technique :

Perioperative personnel who are involved in surgical procedures are exposed to a significant amount of blood and bloody fluids, which may be infected with hepatitis C, hepatitis B, or HIV. Surgical procedures require the use of many sharp instruments, so OR personnel are at an increased risk of sustaining percutaneous injuries, glove tears, and skin and mucous membrane contamination. Many surgical practices and barriers have been proposed to lessen surgical risk of bloodborne pathogen transmission, but little evidence for their effectiveness exists because most have not been properly evaluated. There is good evidence, however, that using redesigned syringes with retractable needles, using blunt-tipped suture needles to close tissue layers below the skin, and wearing two pairs of gloves during surgery can reduce the risk of percutaneous injury. There is also limited evidence that the handsfree technique (HFT) reduces a health care provider’s risk of sharps injury and exposure to bloody fluids. When the HFT is used, instead of sharp items being passed directly between surgeons, residents, nurses, and other OR personnel, they are laid down in a designated “neutral” or “safe” zone and then retrieved as required (Table 1). This applies to passing scalpels and suture needles, other routinely identified sharp items, and items such as trocars, wires, and sharp bone fragments. Safe or neutral zones can consist of a section of the surgical field, a Mayo stand, a table, or a basin, depending on the size, type, and number of sharp items required during a surgical procedure. Surgeons and nurses in the United States are gaining experience in implementing the HFT under the Occupational Safety and Health Administration’s (OSHA’s) standard titled Occupational Exposure to Bloodborne Pathogens; Needlestick and Other Sharps Injuries, which has been in place since 1991 and was further strengthened in 2001. Implementing the HFT may reduce the risk of transmission of bloodborne pathogens, so OSHA has begun inspecting hospitals to assess whether the HFT is used routinely to pass sharp items during surgery. The ability to implement the HFT in sections of the surgical field or potentially to use receptacles already present during surgery is a feature that makes use of the HFT particularly attractive. The primary purpose of the study reported below (ie, one phase of a threephase study) was to explore the attitudes