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James G. Wright, MD, MPH, FRCSC; Allison J. McGeer, MD, FRCPC; Douglas Chyatte, MD; David F. Ransohoff, MD

JAMA. 1991;266(12):1668-1671.

Abstract
Objective.
—The development of strategies to prevent exposure to blood for operating room personnel has been hampered by a lack of knowledge about the specific mechanisms of exposure. The purpose of this study was to classify the mechanisms of glove tears and sharp injuries in the operating room.

Design.
—During a 3-month period, a nurse interviewed operating room personnel immediately after a glove tear or sharp injury had occurred.

Setting.
—Yale-New Haven (Conn) Hospital is a tertiary care teaching hospital.

Results.
—There were 249 glove tears and 70 sharp injuries. Visible skin contact with the patient's blood occurred in 156 glove tears (63%). The mechanism causing the tear could be identified in only 81 (33%). For 230 glove tears (92%), personnel were wearing single gloves. Of 70 sharp injuries, 47 (67%) were caused by needles and usually occurred during suturing. The following three mechanisms accounted for 40 sharp injuries (57%): (1) hands injured while stationary and holding an instrument, 11 (16%)—a position of risk not previously identified; (2) hands injured while retracting tissue, 12 (17%); and (3) injuries caused by sharp instruments not being used, 17 (24%). Instrument passage caused only four sharp injuries (6%).

Conclusions.
—The majority of glove tears have an unknown mechanism, and alteration in the manufacture or number of gloves worn may be helpful in reducing cutaneous blood exposures. The identification of specific mechanisms of sharp injuries should lead to effective strategies to prevent exposure to the human immunodeficiency virus and other blood-borne pathogens in the operating room.

(JAMA. 1991;266:1668-1671)

Author Affiliations
From the Departments of Surgery (Dr Chyatte), Epidemiology and Infection Control (Dr McGeer), Medicine, and Epidemiology (Drs Wright and Ransohoff), Yale University School of Medicine, New Haven, Conn.

Footnotes
Dr McGeer is now with the Department of Microbiology, Princess Margaret Hospital, Toronto, Ontario; Dr Wright is now with the Division of Orthopaedics and Clinical Epidemiology Unit, Hospital for Sick Children, Toronto, Ontario; and Dr Ransohoff is now with the Robert Wood Johnson Clinical Scholars Program, University of North Carolina, Chapel Hill.

Dr Wright was a postdoctoral fellow in the Robert Wood Johnson Clinical Scholars Program; this research was used as a portion of the requirement for a master's of public health thesis, Yale University School of Medicine. Dr McGeer was the recipient of an Ontario Ministry of Health fellowship.

Reprint requests to Division of Orthopaedics, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1x8 (Dr Wright).

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