COULD THE DEATH OF A BC OR NURSE HAVE BEEN PREVENTED BY USING THE HANDS-FREE TECHNIQUE?
Abstract
In 1991, Bernadette Stringer, a long time BC Nurses’ Union health and safety representative, learned about the death of a 48 year old Victoria, B.C., OR nurse who had sustained a hepatitis C contaminated needlestick. This incident led to a study evaluating the hands-free technique’s ability to decrease the risk of percutaneous injury, glove tear and mucocutaneous contamination during surgery that Ms. Stringer carried out in partial fulfillment of her Ph.D. (granted in 1998, by McGill University’s Joint Departments of Epidemiology, Biostatistics and Occupational Health, in the Faculty ofMedicine). That study’s main findings were published in 2002 in one of the British Medical Journal’s publications, Occupational and Environmental Medicine 2.
The following article will discuss aspects of Bev Holmwood’s case, review the literature on the hands-free technique, and describe a new study that has again evaluated the hands-free technique’s effectiveness.
References
Stringer B. Use of the hands-free technique in
hospital operating rooms - A study of the
effectiveness of a work practice [dissertation].
Montréal (QC): McGill University 1998.
Stringer B, Infante-Rivard C, Hanley J.
“Effectiveness of the hands-free technique in
reducing operating theatre injuries”
Occupational and Environmental Medicine
10 (2002): 703-707.
Gerberding JL, Littell C, Tarkington A,
Brown A, Schecter WP. “Risk of exposure of
surgical personnel to patients’ blood during
surgery at San Francisco General hospital”
New England Journal of Medicine. 322.25
(1990): 1788-93.
Panlilio AL, Foy DR, Edwards JR, Bell DM,
Welch BA, Parrish CM, et al. “Blood contacts
during surgical procedures” Journal of the
American Medical Association. 265.12 (1991):
-1537.
Popejoy SL, Fry DE. “Blood contact and
exposure in the operating room” Surgery
Gynecology and Obstetrics. 172.6 (1991): 480-
Quebbeman EJ, Telford GL, Hubbard S,
Wadsworth K, Hardman B, Goodman H, et al.
“Risk of blood contamination and injury to
operating room personnel” Annals of Surgery.
5 (1991): 614-620.
Tokars JI, Bell DM, Culver DH, Marcus R,
Mendelson MH, Sloap EP, et al. “Percutaneous
injuries during surgical procedures” Journal of
the American Medical Association. 267.21
(1992): 2899-2904.
White MC, Lynch P. “Blood contact and
exposures among operating room personnel: A
multicenter study” American Journal of
Infection Control. 21.5 (1993): 243-248.
Stringer B, Infante-Rivard C, Hanley J.
“Effectiveness of the hands-free technique in
reducing operating theatre injuries”
Occupational and Environmental Medicine
10 (2002): 703-707.
Panlilio AL, Foy DR, Edwards JR, Bell DM,
Welch BA, Parrish CM, et al. “Blood contacts
during surgical procedures” Journal of the
American Medical Association. 265.12 (1991):
-1537.
White MC, Lynch P. “Blood contact and
exposures among operating room personnel: A
multicenter study” American Journal of
Infection Control. 21.5 (1993): 243-248.
Gerberding JL, Littell C, Tarkington A,
Brown A, Schecter WP. “Risk of exposure of
surgical personnel to patients’ blood during
surgery at San Francisco General hospital” New
England Journal of Medicine. 322.25 (1990):
-93.
Panlilio AL, Foy DR, Edwards JR, Bell DM,
Welch BA, Parrish CM, et al. “Blood contacts
during surgical procedures” Journal of the
American Medical Association. 265.12 (1991):
-1537.
Popejoy SL, Fry DE. “Blood contact and
exposure in the operating room” Surgery
Gynecology and Obstetrics. 172.6 (1991): 480-
Quebbeman EJ, Telford GL, Hubbard S,
Wadsworth K, Hardman B, Goodman H, et al.
“Risk of blood contamination and injury to
operating room personnel” Annals of Surgery.
5 (1991): 614-620.
Tokars JI, Bell DM, Culver DH, Marcus R,
Mendelson MH, Sloap EP, et al. “Percutaneous
injuries during surgical procedures” Journal of
the American Medical Association. 267.21
(1992): 2899-2904.
White MC, Lynch P. “Blood contact and
exposures among operating room personnel: A
multicenter study” American Journal of
Infection Control. 21.5 (1993): 243-248.
Stringer B, Infante-Rivard C, Hanley J.
“Effectiveness of the hands-free technique in
reducing operating theatre injuries”
Occupational and Environmental Medicine
10 (2002): 703-707.
Health Canada. “Prevention and control of
occupational infections in healthcare” Canada
Communicable Disease Report 28S1 (2002): 1-
Moloughney BW. “Transmission and
postexposure management of bloodborne virus
infections in the health care setting: Where are
we now?” Canadian Medical Association
Journal 165.4 (2001): 445-451.
Rogers B, Goodno L. “Evaluation of
interventions to prevent needlestick injuries in
health care occupations” American Journal of
Preventive Medicine 18.4 Suppl (2000): 90-98.
Centers for Disease Control and Prevention.
“Evaluation of Safety devices for preventing
percutaneous injuries among health-care
workers during phlebotomy procedures -
Minneapolis-St. Paul, new York City, and San
Francisco, 1993-1995” Morbidity and
Mortality Weekly Report. 46.02 (1997): 21-25.
Laine T, Aarnio P. Am J Surg. How often
does glove perforation occur in surgery?
Comparison between single gloves and a
double-gloving system. American Journal of
Surgery 2001 181.6 (2001): 564-566.
Mast ST, Woolwine JD, Gerberding JL.
“Efficacy of gloves in reducing blood volumes
transferred during simulated needlestick injury”
Journal of Infectious Diseases. 168.6 (1993):
-1592.
Centers for Disease Control and Prevention.
“Evaluation of Blunt Suture Needles in
Preventing Percutaneous Injuries Among
Health-Care Workers During Gynecologic
Surgical Procedures - New York City, March
-June 1994” Morbidity and Mortality
Weekly Report. 46.02 (1997): 25-29.
Mingoli A, Sapienza P, Sgarzini G, et al.
Influence of blunt needles on surgical glove
perforation and safety for the surgeon.
American Journal of Surgery 172.5 (1996): 512-
Operating Room Nurses Association of
Canada. Recommended Standards, Guidelines,
and Position Statements for Perioperative
Registered Nursing Practice. Module 3, 5.49
(2005), pp 24.
Association of Perioperative Registered
Nurses (AORN). “Recommended practices for
standard and transmission-based precautions in
the peri-operative practice setting”. Standards,
Recommended Practices and Guidelines.
(Denver: AORN Inc. 2001) .
American College of Surgeons (ACS):
Principles and Practice. (New York: Web MD
.
The American Academy of Orthopedic
Surgeons (AAOS), Taskforce on AIDS and
Orthopedic Surgery. Recommendations for the
Prevention of Human Immunodeficiency Virus
(HIV) Transmission in the Practice of
Orthopedic Surgery. (Park Ridge: AAOS 1989).
Royal College of Surgeons of Edinburgh. A
Statement to Fellows on AIDS and HIV
Infection. (Edinburgh: RCS Edinburgh 1990).
Occupational Safety and Health
Administration (OSHA). Occupational
Exposure to Blood-borne Pathogens.
(Washington, D.C.: US Department of Labor
,Where a search using the term hands-free
technique leads to: etool at:
http://www.osha.gov/SLTC/etools/hospital/
surgical/surgical.html. Accessed January 12,
Workers Safety Insurance Board (WSIB),
Solutions for Change 2003 Grants Competition.
“A Study of the Hands-Free Technique’s
Effectiveness in Reducing Operating Room
Percutaneous Injuries and Contaminations and
the Effectiveness of an Educational Video”.
Available at: http://www.wsib.on.ca/wsib/
wsibsite.nsf/public/researchprojectsfunded2003
#knowledgetransfer. Accessed January 12,
Tokars JI, Bell DM, Culver DH, Marcus R,
Mendelson MH, Sloap EP, et al. “Percutaneous
injuries during surgical procedures” Journal of
the American Medical Association. 267.21
(1992): 2899-2904.
Eggleston MK, Wax JR, Philput C,
Eggleston MH, Weiss MI. “Use of surgical pass
trays to reduce intraoperative glove
perforations” Journal of Maternal and Fetal
Medicine. 6.4 (1997): 245-247.
Stringer B, Infante-Rivard C, Hanley J.
“Effectiveness of the hands-free technique in
reducing operating theatre injuries”
Occupational and Environmental Medicine
10 (2002): 703-707.
Ibid.
Eggleston MK, Wax JR, Philput C,
Eggleston MH, Weiss MI. “Use of surgical pass
trays to reduce intraoperative glove
perforations” Journal of Maternal and Fetal
Medicine. 6.4 (1997): 245-247.
Tokars JI, Bell DM, Culver DH, Marcus R,
Mendelson MH, Sloap EP, et al. “Percutaneous
injuries during surgical procedures” Journal of
the American Medical Association. 267.21
(1992): 2899-2904.
Clancy TR. Medication error prevention.
Progress of initiatives (review). JONA’S
Healthcare Law, Ethics and Regulation 6.1
(2004): 3-12.
Grote G, Zala-Mezo E. The effects of
different forms of coordination in coping with
work load: cockpit versus operating theatre.
Swiss Federal Institute of Technology, Zurich
March 2004.
Workers Safety Insurance Board (WSIB),
Solutions for Change 2003 Grants Competition.
“A Study of the Hands-Free Technique’s
Effectiveness in Reducing Operating Room
Percutaneous Injuries and Contaminations and
the Effectiveness of an Educational Video”.
Available at: http://www.wsib.on.ca/wsib/
wsibsite.nsf/public/researchprojectsfunded2003
#knowledgetransfer. Accessed January 12,
Stringer B, Haines T, Blythe J, Goldsmith C,
Harris K. “Why surgeons and nurses do and
don’t use the hands-free technique, a work
practice for passing sharp items safely during
surgery: A semi-structured interview study”
AORN Journal. 84.2 (2006); 233-248.
Pueschel, M. “VA Invention Reduces OR
Scalpel Injuries” U.S. Medicine Information
Central. July 2004, Available at: http://www.
usmedicine.com/article.cfm?articleID=896&iss
ueID=64. Accessed Janurary 12, 2007.
