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Jerome I. Tokars, MD, MPH; David M. Bell, MD; David H. Culver, PhD; Ruthanne Marcus, MPH; Meryl H. Mendelson, MD; Edward P. Sloan, MD, MPH; Bruce F. Farber, MD; Denise Fligner, MD; Mary E. Chamberland, MD, MPH; Penny S. McKibben; William J. Martone, MD, MSc

JAMA. 1992;267(21):2899-2904.

Abstract
Objective.
—To study the numbers and circumstances of percutaneous injuries (eg, needle sticks, cuts) that occur during surgical procedures. Surgical personnel risk infection with blood-borne pathogens from percutaneous injuries; some injuries might also place patients at risk by exposing them to a health care worker's blood.

Design.
—Observers present at 1382 surgical procedures recorded information about the procedure, the personnel present, and percutaneous injuries that occurred.

Setting.
—Four US teaching hospitals during 1990.

Participants.
—Operating room personnel in five surgical specialties.

Main Outcome Measures.
—Numbers and circumstances of percutaneous injuries among surgical personnel and instances in which surgical instruments that had injured a worker recontacted the patient's surgical wound.

Results.
—Ninety-nine injuries occurred during 95 (6.9%) of the 1382 procedures. Seventy-six injuries (77%) were caused by suture needles and affected the nondominant hand (62 injuries [63%]), especially the distal forefinger. The risk of injury adjusted for confounding variables by logistic regression was higher during vaginal hysterectomy (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.6 to 7.5) and lower during certain orthopedic procedures (OR, 0.2; CI, 0.1 to 0.7) than during 11 other types of procedures (reference group; OR, 1.0). Use of fingers rather than an instrument to hold the tissue being sutured was associated with 35 injuries (35%). Eighty-eight injuries (89%) were sustained by resident or attending surgeons; in 28 (32%) of the 88 injuries in surgeons, the sharp object that caused the injury recontacted the patient.

Conclusion.
—Percutaneous injuries occur regularly during surgery, placing surgical personnel and, to a lesser extent, patients at risk for infection with blood-borne pathogens. Many such injuries may be preventable with changes in devices, techniques, or protective equipment; all such measures require careful evaluation to determine their efficacy in reducing injury and their effect on patient care.

(JAMA. 1992;267:2899-2904)

Author Affiliations
From the Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Atlanta, Ga (Drs Tokars, Bell, Culver, Chamberland, and Martone and Mss Marcus and McKibben); the Division of Infectious Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY (Dr Mendelson); the Department of Emergency Medicine, Cook County Hospital, Chicago, Ill (Dr Sloan); the Division of Infectious Diseases, Department of Medicine, North Shore University Hospital, Cornell University Medical College, Manhasset, NY (Dr Farber); and the Department of Emergency Medicine, Christ Hospital and Medical Center, Oak Lawn, Ill (Dr Fligner).

Footnotes
Reprint requests to Hospital Infections Program, Centers for Disease Control, Mailstop A-07, Atlanta, GA 30333 (Dr Tokars).

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