AORN RECOMENTATION PRACTICES.pdf

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CONTINUING EDUCATION

Implementing AORNRecommended Practicesfor Sharps Safety DONNA A. FORD, MSN, RN-BC, CNOR, CRCST 2.2

www.aorn.org/CE

Continuing Education Contact Hoursindicates that continuing education (CE) contact hours are

available for this activity. Earn the CE contact hours byreading this article, reviewing the purpose/goal and objectives,and completing the online Examination and Learner Evalua-tion at http://www.aorn.org/CE . A score of 70% correct on theexamination is required for credit. Participants receive feedback on incorrect answers. Each applicant who successfullycompletes this program can immediately print a certicate of completion.

Event: #14503Session: #0001Fee: Members $17.60, Nonmembers $35.20

The CE contact hours for this article expire January 31, 2017.Pricing is subject to change.

Purpose/GoalTo provide the learner with knowledge specic to preventingsharps injuries and bloodborne pathogen exposure.

Objectives1. Discuss legislation related to preventing bloodborne

pathogen transmission.2. Discuss causes of percutaneous injury in perioperative

settings.

3. Identify hazards associated with percutaneous injury.4. Identify controls (ie, engineering, work practice, admin-

istrative) that can be used to help prevent sharps injuries.5. Describe actions perioperative RNs can take to assist in

preventing sharps injuries and bloodborne pathogentransmission.

AccreditationAORN is accredited as a provider of continuing nursingeducation by the American Nurses Credentialing CentersCommission on Accreditation.

ApprovalsThis program meets criteria for CNOR and CRNFA recerti-cation, as well as other CE requirements.

AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check withyour state board of nursing for acceptance of this activity for relicensure.

Conict of Interest DisclosuresMs Ford has no declared afliation that could be perceived as

posing potential conict of interest in the publication of thisarticle.The behavioral objectives for this program were created by

Liz Cowperthwaite, senior managing editor, and RebeccaHolm, MSN, RN, CNOR, clinical editor, with consultationfrom Susan Bakewell, MS, RN-BC, director, PerioperativeEducation. Ms Cowperthwaite, Ms Holm, and Ms Bakewellhave no declared afliations that could be perceived as posing potential conicts of interest in the publication of this article.

Sponsorship or Commercial Support No sponsorship or commercial support was received for thisarticle.

DisclaimerAORN recognizes these activities as CE for RNs. This rec-ognition does not imply that AORN or the American NursesCredentialing Center approves or endorses products mentioned in the activity.

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RECOMMENDED PRACTICESImplementing AORN

Recommended Practicesfor Sharps Safety DONNA A. FORD, MSN, RN-BC, CNOR, CRCST 2.2

www.aorn.org/CE

ABSTRACT

Prevention of percutaneous sharps injuries in perioperative settings remains achallenge. Occupational transmission of bloodborne pathogens, not only from pa-tients to health care providers but also from health care providers to patients, is asignicant concern. Legislation and position statements geared toward ensuring thesafety of patients and health care workers have not resulted in signicantly reduced sharps injuries in perioperative settings. Awareness and understanding of the typesof percutaneous injuries that occur in perioperative settings is fundamental todeveloping an effective sharps injury prevention program. The AORN Recom-mended practices for sharps safety clearly delineates evidence-based recommen-dations for sharps injury prevention. Perioperative RNs can lead efforts to change

practice for the safety of patients and perioperative team members by promoting theelimination of sharps hazards; the use of engineering, work practice, and adminis-trative controls; and the proper use of personal protective equipment, includingdouble gloving. AORN J 99 (January 2014) 107-117. AORN, Inc, 2014. http://dx.doi.org/10.1016/j.aorn.2013.11.013

Key words: sharps injuries, sharps injury prevention, engineering controls, work practice controls, administrative controls, blunt-tip needles, neutral zone, double gloving.

E ven with legislation in place that requiressafeguards and practice controls, perioper-ative team members continue to experienceoccupational percutaneous injuries at unacceptablelevels. 1 Eight years after the passage of the Needle-stick Safety and Prevention Act, 2 Jagger et al 1,3 re- ported that although sharps injuries had decreased 31.6% in nonsurgical settings, they had increased

6.5% in surgical settings. Percutaneous injuries canresult in occupational transmission of hepatitis B,hepatitis C, and HIV. 4

The purpose of the new Recommended prac-tices for sharps safety 5 is to prevent percutaneousinjuries by helping perioperative nurses identify potential sharps hazards, implement best practices,and develop policies and procedures related to safe

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practices and postexposure protocols. AORN rec-ommended practices represent what is considered to be optimal and achievable perioperative nursing practice and are based on the highest level of evi-dence available. This article highlights the mostsignicant recommendations of the Recommended practices for sharps safety, including those that canhave the largest effect on sharps injury reduction.More in-depth information and a review of evi-dence for each recommendation can be found in thecomplete recommended practices (RP) document. 5

WHATS NEWThe new Recommended practices for sharpssafety supersedes the AORN guidance state-

ment: Sharps injury prevention in the perioperativesetting, 6 developed in 2005. The intent of theguidance statement was to assist perioperativeRNs in developing sharps injury prevention pro-grams and overcoming obstacles to compliancewith the suggested and mandated practices. Federalregulations and strong research evidence provided support for a stronger position on sharps safety,so the RP document was developed to replacethe guidance statement.

Although many of the responsibilities and risk-reduction strategies from the guidance statementhave been carried over into the RP document, thenew document provides the format of recommen-dations followed by evidence-based rationales,evidence-rated intervention statements, and sup- porting activity statements. The evidence sup- porting the recommendations is derived fromregulatory controls, randomized controlled trials,and Cochrane systematic reviews.

RATIONALEApproximately 500,000 health care workers eachyear experience percutaneous injuries. 3,7 Percuta-neous injuries are associated with occupationaltransmission of hepatitis B virus, hepatitis C virus,and HIV, which can result in lifelong health con-cerns. 4 Percutaneous injuries also present a risk to patients; a health care provider who is infected with

a bloodborne pathogen and who then receives a percutaneous injury can inadvertently infect a pa-tient through contact with the contaminated sharpor contact with the health care providers blood through an unnoticed glove perforation. Between1991 and 2005, 132 cases of health care provider-to-patient transmission of hepatitis B, hepatitis C,or HIV were documented. 8

Anyone who has experienced an occupationalexposure to bloodborne pathogens knows the emo-tional burden of fear, worry, and concern that fol-lows, which may be far greater than the actual physical injury. The real or potential economic burdens also can cause additional stress. Costs tothe health care worker are any expenses incurred

because of missed work days. Potential economic burdens include the inability to continue working because of an illness that results from the occupational exposure. Costs to the employer includethe postexposure management, the laboratory testsand follow-up testing, and any necessary prophy-laxis, as well as loss of productivity of the healthcare worker. The annual cost of percutaneous sharpsinjuries has been estimated at $65 million. 9 Thecost for a health care facility to manage an occu-

pational exposure can range from $71 to $4,838 per exposure. 10

Two signicant pieces of legislation, the Blood- borne Pathogens Standard 29 CFR x1910.1030 in1992 11 and the Needlestick Safety and PreventionAct in 2000, 2 are aimed at reducing occupationaltransmission of bloodborne pathogens. The purposeof the Bloodborne Pathogens Standard is to limithealth care worker exposure to bloodborne patho-gens and other potentially infectious materials by

requiring implementation of engineering controls(eg, use of safety-engineered devices) and work practice controls (eg, use of a neutral zone for passing sharps). 12 The additional legislation in2000 directed the Occupational Safety and HealthAdministration (OSHA) to make multiple revisionsto the existing Bloodborne Pathogens Standard.The Needlestick Safety and Prevention Act includesrequirements that annual review of exposure control

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plans also should reect changes in technologythat eliminate or reduce exposure to bloodborne pathogens. 2 Because medical technology is con-stantly changing and improving, more devices are becoming available that can help reduce sharpsinjuries. 13

In addition to AORN, a number of professionalassociations have issued statements supportingsharps injury prevention practices. These asso-ciations include the American Academy of Orthopaedic Surgeons, 14 the American Col-lege of Surgeons, 15 the Association of SurgicalTechnologists, 16 and the Council on Surgical and Perioperative Safety. 17 In 2012, the InternationalHealthcare Worker Safety Center at the University

of Virginia, Charlottesville, released a consensusstatement endorsed by 20 organizations citingimproved sharps safety in surgical settings as thehighest priority in reducing percutaneous sharpsinjuries. 18 Three governmental agencies, the USFood and Drug Administration, the NationalInstitute for Occupational Safety and Health,and OSHA, issued a joint safety communicationin May 2012 encouraging the use of blunt-tipsuture needles. 19

Accrediting bodies (eg, The Joint Commission,the Accreditation Association for AmbulatoryHealth Care) and regulatory organizations (eg,OSHA, the Centers for Medicare & Medicaid Services) may survey for sharps safety duringvisits to health care facilities. Key points in asurvey could include review of the exposurecontrol plan, which must be in compliance withthe federal legislation and should meet the criteriaestablished in the Needlestick Safety and Pre-

vention Act. 13 Surveyors also may look to en-sure that sharps containers are located close tothe point of use and glove boxes and personal protective equipment (PPE) are placed in conve-nient locations. Other potential points in a surveyinclude a review of policies, sharps injury logs,and documentation of safety training. Surveyorsmay observe use of PPE and question personnelabout safety procedures. 20

DISCUSSIONImplementing a sharps injury prevention programcan be a challenging process in any setting. TheRecommended practices for sharps safety pro-vides information that can assist with developinga bloodborne pathogens exposure control plan 11 ;eliminating the hazards; and implementing engi-neering controls, work practice controls, and ad-ministrative controls. 5 Engineering controls are practices that remove the hazard from the work- place, such as the use of safety-engineered de-vices. 11 Work practice controls minimize the risk of exposure to blood and other potentially infec-tious materials by changing the method of per-forming a task. 11,21,22 Administrative controls

include developing policies and procedures and providing education and training on preventionof bloodborne pathogen exposure.

Recommendation IHealth care facilities must have a bloodborne pathogens exposure control plan, as required byOSHA. 11 The exposure control plan is a componentof administrative controls, which are important tothe success of a sharps safety program. The plan

must include an exposure determination for employees who have the potential to be exposed to blood and body uids; a plan to reduce sharps injuries, including prioritized risk-reduction strate-gies; and a process to monitor sharps injury data.The plan must be reviewed and updated at leastannually and any time new practices are imple-mented. Ensuring compliance with the exposurecontrol plan and related policies is important toshow commitment to prevention of sharps injuries.

Administrators and managers, in collaborationwith occupational health and infection prevention practitioners, can develop the exposure control plan. Frontline personnel, including perioperativeRNs and surgeons, should be involved in identi-fying control methods to prevent sharps injuries byusing the hierarchy of controls to prioritize pre-vention interventions ( Figure 1 ).23 At the top of the hierarchy (ie, the most effective strategy) is

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RP IMPLEMENTATION GUIDE: SHARPS SAFETY www.aornjournal.org
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from hand to hand. 14-17,29,32-37 A neutral zone helpsensure that the surgeon and scrub person do nottouch the same sharp instrument at the same time.This technique, also called hands-free technique,is accomplished by designating a neutral zone onthe sterile eld and placing sharp items withinthe zone for transfer between scrubbed personnel. 5

A modied neutral zone may be needed whenthe surgeon is using a microscope; sharps arecarefully placed in the surgeons hand, and thesurgeon returns the sharp to the neutral zone after use. 14,33,38-42

The no-touch technique should be used tominimize manual handling of sharps by gloved hands. For example, when loading a suture in the

needle holder, the scrubbed team member should keep the needle in the suture packet and use thesuture packet to position the needle in the needleholder ( Figure 2 ). The scrubbed team member should then use a one-handed technique to reposi-tion a needle before placing it in a needle box onthe sterile eld.

Additional work control practices include main-taining situational awareness when sharps are inuse, communicating the location of sharps on the

sterile eld, removing needles before tying suture,

and using instruments instead of hands for tissueretraction. Personnel should use caution at all timeswhen handling sharps and should follow safe in- jection practices. 11

To successfully implement work practice con-trols, perioperative team members need to under-stand potential hazards with a current practice, bewilling to change their practice, actually make the practice change, and then consistently perform the practice in the new, safer way. The importance of education in this process cannot be understated.Managers and educators can reinforce the princi- ples of work practice controls and the importanceof communication and situational awareness duringuse of sharps. The educator has a key role in pro-

viding assistance to individual team members and surgical teams implementing work practice controlsand learning new ways to safely perform tasks.Practice with the no-touch technique gives per-sonnel the opportunity to try various ways of manipulating sharps with minimal handling. Role play and simulation activities can help team members determine acceptable ways of implementinguse of a neutral zone for different surgical pro-cedures and different patient positions. Periopera-

tive RNs and other team members can collaboratewith the educator to help personnel develop theseskills.

Recommendation IV Proper use of PPE is required by the OSHABloodborne Pathogens Standard. 11 For example,strong evidence exists to support the practice of double gloving to reduce the risk of glove perfora-tion and percutaneous exposure. 43 In one study, the

overall perforation rate of gloves was 15.8%, which presents concerns about bloodborne pathogen exposure, breaks in sterile technique, and surgical siteinfection. 44 When two pairs of gloves are worn and a perforation occurs, often only the outer glove is perforated. 43 Research has shown that if both glovesare perforated, the volume of blood on a solid sharpdevice can be reduced by as much as 95% compared with perforation of a single glove. 45-47Figure 2. Use of the no-touch technique.

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The Final FourThe nal four recommendations in each AORN RPdocument discuss education/competency, docu-mentation, policies and procedures, and qualityassurance/performance improvement, as appli-cable. These four topics are integral to the imple-mentation of AORN practice recommendations.Personnel should receive initial and ongoing edu-cation and competency verication as applicableto their roles. Implementing new and updated rec-ommended practices affords an excellent opportu-nity to create or update competency materials and verication tools. AORNs perioperative compe-tencies team has developed the AORN Periopera-tive Job Descriptions and Competency Evaluation

Tools 53 to assist perioperative personnel in devel-oping competency evaluation tools and positiondescriptions.

Documentation is used as a method to monitor compliance with regulations, measure performancewith sharps safety measures, maintain employeerecords of education and competency verication,and track occupational exposures. Implementingnew or updated recom-mended practices may war-

rant a review or revision of the relevant documentation being used in the facility.

Policies and proceduresshould be developed, re-viewed periodically, revised as necessary, and readilyavailable in the practicesetting. New or updated recommended practices

may present an opportunityfor collaborative effortsamong nurses and personnelfrom other departmentsin the facility to developorganization-wide policiesand procedures that supportthe recommended practices.The AORN Policy and

Procedure Templates, 3rd edition, 54 provides acollection of 30 sample policies and customizabletemplates based on AORNs Perioperative Stan-dards and Recommended Practices. 55 Qualityassessment and improvement activities assist inevaluating the quality of patient care, the presenceof environmental safety hazards, and the formula-tion of plans for taking corrective actions. For detailson the nal four practice recommendations that arespecic to the RP document discussed in this article, please refer to the full text of the RP document.

AMBULATORY PATIENT SCENARIOIt is a busy day in a freestanding ambulatory sur-gery center (ASC). The surgical team is nishing aleft knee arthroscopy on a 20-year-old male patient,the third patient of six that day in the orthopedicOR. The instrument table is moved away, and thescrubbed team members remove the drapes. As theRN circulator places a single hollow-bore needleinto the sharps container, the patient begins to wakeand move around. As the RN looks back to assist the patient, she is stuck in the right index nger by a

Educational Resourcesn AORN Video Library: Hand Hygiene, Gowning & Gloving

Practices in the Perioperative Setting [DVD]. http://cine-med.com/ index.php?nav aorn&cat all .

n AORN Video Library: Prevention of Transmissible Infections inthe Perioperative Practice Setting [DVD]. http://cine-med.com/ index.php?nav aorn&cat all .

n AORN Video Library: Risk Management for the Perioperative Nurse [DVD]. http://cine-med.com/index.php?nav aorn&cat all .

n Recommended practices for prevention of transmissible in-fections in the perioperative practice setting. In : PerioperativeStandards and Recommended Practices . Denver, CO: AORN,Inc; 2013:331-363.

n Sharps Safety Tool Kit. AORN, Inc. https://www.aorn.org/ Clinical_Practice/ToolKits/Tool_Kits.aspx .

Web site access veried November 1, 2013.

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training. As the CST grasps the suture from thesurgeons hand, the needle perforates both layersof the CSTs double gloves. The contaminated needle is handed off to the RN circulator and theexperienced CST takes over until the patients bleeding is controlled, allowing the CST in train-ing to break scrub, treat the injury, and contactthe occupational health nurse on-call to reportthe exposure. The postexposure evaluation is per-formed, and blood is drawn from the patient. Thesource patient is at low risk for bloodborne patho-gens and, by being double gloved, the CST took precautions to help prevent or reduce the risk of bloodborne pathogen exposure. Her tests are ne-gative for disease exposure.

Although an exposure control plan and sharpssafety program had been established at this hospitalin the early 1990s and modications were madeannually, this and other percutaneous injury oc-currences spur a renewed effort by the hospitalsafety committee to bring sharps injury preventionto the forefront. Educators plan a safety fair that isheld during a staff development session to showvarious ways to minimize the risk of sharps injuries. Safety committee members present on the

topics of double gloving, using a neutral zone, and handling sharps safely, as well as provide occupa-tional exposure data. Later in the year, members of the safety committee present a staff developmentsession in which they review the pertinent legisla-tion, position statements from professional associ-ations, and evidence-based recommendations. Inaddition, the CST and another staff member whohad experienced recent percutaneous exposuresconsent to tell the stories of their experiences.

This combination of topics helps reinforce thecurrent legislative requirements, what can be doneto minimize the risk of sharps injuries, and whatcan happen when someone experiences an occupational exposure from a sharps injury.

CONCLUSIONThe AORN Recommended practices for sharpssafety is a thorough review of every aspect of

sharps injury prevention and associated evidence- based recommendations. Key takeaways includethe following:

n Sharps injury prevention is a concern and a re-sponsibility of all members of the perioperativeteam.

n Knowing the causes and types of injuries thatoccur in the practice setting is a critical com- ponent of developing a sharps injury prevention program.

n Prioritizing risk-reduction strategies involvesgiving the highest priority to the device thatcan have the greatest effect on sharps injuryreduction.

n Eliminating the hazard (eg, removing the sharpobject from use) and using safety-engineered devices are the most effective ways to preventsharps injuries.

n Sharps injuries occur most frequently whensharps are passed hand to hand, so scrubbed team members should use a neutral zone.

n Double gloving minimizes the risk of bloodborne pathogen exposure.

Perioperative RNs should be aware of methods

to prevent sharps injuries and occupational trans-mission of bloodborne pathogens. The Recom-mended practices for sharps safety delineateshow perioperative personnel should practice with-in the recommendations. Perioperative nursesshould review the RP document with colleaguesand serve as a resource and role model for safesharps practices.

Acknowledgment: The author thanks Mary J. Ogg, MSN, RN, CNOR, perioperative nursing specialist at AORN, Inc, for her assistance with writing thismanuscript.

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http://www.gpo.gov/fdsys/pkg/PLAW-106publ430/html/PLAW-106publ430.htmhttp://www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol6/pdf/CFR-2011-title29-vol6-sec1910-1030.pdfhttp://www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol6/pdf/CFR-2011-title29-vol6-sec1910-1030.pdfhttp://www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol6/pdf/CFR-2011-title29-vol6-sec1910-1030.pdfhttp://www.jointcommission.org/assets/1/18/SEA_22.pdfhttp://www.jointcommission.org/assets/1/18/SEA_22.pdfhttp://www.aaos.org/about/papers/advistmt/1018.asphttp://www.aaos.org/about/papers/advistmt/1018.asphttp://www.facs.org/fellows_info/statements/st-58.htmlhttp://www.facs.org/fellows_info/statements/st-58.htmlhttp://www.ast.org/pdf/Standards_of_Practice/RSOP_Sharps_Safety_Neutral_Zone.pdfhttp://www.ast.org/pdf/Standards_of_Practice/RSOP_Sharps_Safety_Neutral_Zone.pdfhttp://cspsteam.org/sharpssafety/sharpssafety.htmlhttp://cspsteam.org/sharpssafety/sharpssafety.htmlhttp://healthsystem.virginia.edu/pub/epinet/ConsensusStatementOnSharpsInjuryPrevention.pdfhttp://healthsystem.virginia.edu/pub/epinet/ConsensusStatementOnSharpsInjuryPrevention.pdfhttp://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM306035.pdfhttp://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM306035.pdfhttp://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM306035.pdfhttp://www.ormanager.com/wp-content/uploads/pdf/ORMVol28No2ASCSharpsSafety.pdfhttp://www.ormanager.com/wp-content/uploads/pdf/ORMVol28No2ASCSharpsSafety.pdfhttp://www.ormanager.com/wp-content/uploads/pdf/ORMVol28No2ASCSharpsSafety.pdfhttp://www.healthsystem.virginia.edu/pub/epinet/epinet-2007-rates.pdfhttp://www.healthsystem.virginia.edu/pub/epinet/epinet-2007-rates.pdfhttp://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdfhttp://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdfhttp://www.cdc.gov/niosh/docs/2008-101/pdfs/2008-101.pdfhttp://www.cdc.gov/niosh/docs/2008-101/pdfs/2008-101.pdfhttp://www.cdc.gov/niosh/docs/2008-101/pdfs/2008-101.pdfhttp://www.cdc.gov/niosh/docs/2008-101/pdfs/2008-101.pdfhttp://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdfhttp://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdfhttp://www.healthsystem.virginia.edu/pub/epinet/epinet-2007-rates.pdfhttp://www.healthsystem.virginia.edu/pub/epinet/epinet-2007-rates.pdfhttp://www.ormanager.com/wp-content/uploads/pdf/ORMVol28No2ASCSharpsSafety.pdfhttp://www.ormanager.com/wp-content/uploads/pdf/ORMVol28No2ASCSharpsSafety.pdfhttp://www.ormanager.com/wp-content/uploads/pdf/ORMVol28No2ASCSharpsSafety.pdfhttp://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM306035.pdfhttp://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM306035.pdfhttp://www.fda.gov/downloads/MedicalDevices/Safety/AlertsandNotices/UCM306035.pdfhttp://healthsystem.virginia.edu/pub/epinet/ConsensusStatementOnSharpsInjuryPrevention.pdfhttp://healthsystem.virginia.edu/pub/epinet/ConsensusStatementOnSharpsInjuryPrevention.pdfhttp://cspsteam.org/sharpssafety/sharpssafety.htmlhttp://cspsteam.org/sharpssafety/sharpssafety.htmlhttp://www.ast.org/pdf/Standards_of_Practice/RSOP_Sharps_Safety_Neutral_Zone.pdfhttp://www.ast.org/pdf/Standards_of_Practice/RSOP_Sharps_Safety_Neutral_Zone.pdfhttp://www.facs.org/fellows_info/statements/st-58.htmlhttp://www.facs.org/fellows_info/statements/st-58.htmlhttp://www.aaos.org/about/papers/advistmt/1018.asphttp://www.aaos.org/about/papers/advistmt/1018.asphttp://www.jointcommission.org/assets/1/18/SEA_22.pdfhttp://www.jointcommission.org/assets/1/18/SEA_22.pdfhttp://www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol6/pdf/CFR-2011-title29-vol6-sec1910-1030.pdfhttp://www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol6/pdf/CFR-2011-title29-vol6-sec1910-1030.pdfhttp://www.gpo.gov/fdsys/pkg/CFR-2011-title29-vol6/pdf/CFR-2011-title29-vol6-sec1910-1030.pdfhttp://www.gpo.gov/fdsys/pkg/PLAW-106publ430/html/PLAW-106publ430.htm


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31. Bhattacharyya M, Bradley H. Intraoperative handling and wound healing of arthroscopic portal wounds: a clinicalstudy comparing nylon suture with would closure strips. J Perioper Pract. 2008;18(5):194-196, 198.

32. Hidalgo JA, MacArthur RD, Crane LR. An overview of HIV infection and AIDS: etiology, pathogenesis, diag-nosis, epidemiology, and occupational exposure. SeminThoracic Cardiovasc Surg. 2000;12(2):130-139.

33. Folin A, Nyberg B, Nordstr om G. Reducing blood exposures during orthopedic surgical procedures. AORN J.2000;71(3):573-582.

34. Jeong IS, Park S. Use of hands-free technique amongoperating room nurses in the Republic of Korea. Am J Infect Control. 2009;37(2):131-135.

35. Stringer B, Haines AT, Goldsmith CH, Berguer R,Blythe J. Is use of the hands-free technique during sur-gery, a safe work practice, associated with safetyclimate? Am J Infect Control. 2009;37(9):766-772.

36. Stringer B, Haines T. The hands-free technique: aneffective and easily implemented work practice. Perioper Nurs Clin. 2010;5(1):45-58.

37. Stringer B, Haines T, Goldsmith CH, et al. Hands-freetechnique in the operating room: reduction in body uid exposure and the value of a training video. Public Health Rep. 2009;124(Suppl 1):169-179.

38. Bessinger CD Jr. Preventing transmission of human im-munodeciency virus during operations. Surg Gynecol Obstet. 1988;167(4):287-289.

39. Stringer B, Infante-Rivard C, Hanley JA. Effective-ness of the hands-free technique in reducing operatingtheater injuries. Occup Environ Med. 2002;59(10):703-707.

40. Cunningham TR, Austin J. Using goal setting, task,clarication, and feedback to increase the use of hands-free technique by hospital operating room staff. J Appl Behav Anal. 2007;40(4):673-677.

41. Eggleston MK Jr, Wax JR, Philput C, Eggleston MH,Weiss MI. Use of surgical pass trays to reduce intra-operative glove perforations. J Matern Fetal Med. 1997;6(4):245-247.

42. Stringer B, Haines T, Goldsmith CH, Blythe J, Harris KA.Perioperative use of the hands-free technique: a semi-structured interview study. AORN J. 2006;84(2):233-248.

43. Tanner J, Parkinson H. Double gloving to reduce surgicalcross-infection. Cochrane Database Syst Rev. 2002;(3):CD0003087.

44. Ersozlu S, Sahin O, Ozgur AF, Akkaya T,TuncayC. Glove punctures in major and minor orthopaedic surgery withdouble gloving. Acta Orthop Belg. 2007;73(6):760-764.

45. Berguer R, Heller PJ. Preventing sharps injuries in theoperating room. J Am Coll Surg. 2004;199(3):462-467.

46. Aarnio P, Laine T. Glove perforation rate in vascular surgery d a comparison between single and doublegloving. Vasa. 2001;30(2):122-124.

47. Laine T, Aarnio P. How often does glove perforationoccur in surgery? Comparison between single glovesand a double gloving system. Am J Surg. 2001;181(6):564-566.

48. Caillot JL, Voiglio EJ. First clinical study of a new virus-inhibiting protective glove. Swiss Med Wkly. 2008;138(1-2):18-22.

49. Krikorian R, Lozach-Perlant A, Ferrier-Rembert A, et al.Standardization of needlestick injury and evaluation of a novel virus-inhibiting protective glove. J Hosp Infect.2007;66(4):339-345.

50. Bricout F, Moraillon A, Sonntag P, Hoerner P,Blackwelder W, Plotkin S. Virus-inhibiting surgicalgloves to reduce the risk of infection by enveloped virus. J Med Virol. 2003;69(4):538-545.

51. Grimmond T, Bylund S, Anglea C, et al. Sharps injury

reduction using a sharps container with enhanced en-gineering: a 28 hospital nonrandomized interventionand cohort sturdy. Am J Infect Control. 2010;38(10):799-805.

52. Selecting, evaluating, and using sharps disposal containers. NIOSH publication no. 97-111. 1988. National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/ pdfs/97-111.pdf . Accessed November 1, 2013.

53. Perioperative Job Descriptions and Competency Evalu-ation Tools [CD-ROM]. Denver, CO: AORN, Inc; 2012.

54. Policy and Procedure Templates . 3rd ed. [CD-ROM].Denver, CO: AORN, Inc. 2013.

55. Perioperative Standards and Recommended Practices .Denver, CO: AORN, Inc; 2013.

Donna A. Ford, MSN, RN-BC, CNOR, CRCST,is a nursing education specialist, Division of Surgical Services, Department of Nursing, MayoClinic, and an assistant professor of nursing,Mayo Clinic College of Medicine, Rochester,MN. Ms Ford has no declared afliation that could be perceived as posing a potential conict of interest in the publication of this article.

This RP Implementation Guide is intended to be an adjunct to the complete recommended practices document uponwhich it is based and is not intended to be a replacement for that document. Individuals who are developing and updating organizational policies and procedures should review and reference the full recommended practicesdocument.

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EXAMINATIONCONTINUING EDUCATION 2.2

www.aorn.org/CEImplementing AORN RecommendedPractices for Sharps Safety

PURPOSE/GOAL

To provide the learner with knowledge specic to preventing sharps injuries and bloodborne pathogen exposure.

OBJECTIVES

1. Discuss legislation related to preventing bloodborne pathogen transmission.2. Discuss causes of percutaneous injury in perioperative settings.3. Identify hazards associated with percutaneous injury.4. Identify controls (ie, engineering, work practice, administrative) that can be used

to help prevent sharps injuries.5. Describe actions perioperative RNs can take to assist in preventing sharps injuries

and bloodborne pathogen transmission.

The Examination and Learner Evaluation are printed here for your conven-ience. To receive continuing education credit, you must complete the onlineExamination and Learner Evaluation at http://www.aorn.org/CE .

QUESTIONS

1. After passage of the Needlestick Safety and Preven-tion Act, sharps injuries __________ in nonsurgicalsettings and __________ in surgical settings.a. decreased, decreased

b. decreased, increased c. increased, decreased d. increased, increased

2. An exposure control plan must include1. a plan to reduce sharps injuries.2. a process to monitor sharps injury data.3. an exposure determination for employees who

may be exposed to blood and body uids.4. prioritized risk-reduction strategies.

a. 1 and 4 b. 2 and 3c. 1, 2, and 3 d. 1, 2, 3, and 4

3. The highest level of the hierarchy of controls tohelp prevent sharps injuries is toa. develop policies and procedures.

b. eliminate the hazard.c. implement work practice controls.d. use a safety-engineered device.

4. In a Cochrane review of 10 randomized controlled trials, researchers found that using blunt-tip sutureneedles instead of sharp-tip suture needles reduced the incidence of glove perforation bya. 10%. b. 32%.c. 54%. d. 75%.

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5. The majority of percutaneous injuries are caused bya. failure to double glove.b. hand-to-hand passing of sharps.c. using sharp-tip rather than blunt-tip needles.d. using safety-engineered devices.

6. Use of a neutral zone helps ensure the surgeonand scrub person do not touch the same instru-ment at the same time.a. true b. false

7. Communicating the location of sharps on thesterile eld isa. an administrative control.b. an engineering control.c. a work practice control.

8. Personnel may choose to wear virus-inhibitinggloves during procedures in which there is ahigher risk of glove perforation.a. true b. false

9. A sharps container should be1. large enough to hold the types of sharps that

will need to be placed in them.2. placed far from the point of use to prevent

accidental contact with the container.3. puncture and leak resistant.4. replaced when it reaches a visible ll level.

a. 1 and 3 b. 2 and 4c. 1, 3, and 4 d. 1, 2, 3, and 4

10. Perioperative RNs can demonstrate personal and professional responsibility in preventing sharpsinjuries and bloodborne pathogen transmission by1. getting immunized against hepatitis B virus.2. immediately reporting a percutaneous injury.3. observing local, state, and federal regulations

pertaining to handling of sharps.4. receiving prophylactic treatment for blood-

borne pathogen exposure when necessary.a. 1 and 2 b. 3 and 4c. 2, 3, and 4 d. 1, 2, 3, and 4

AORN Journal j 119

CE EXAMINATION www.aornjournal.org


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LEARNER EVALUATIONCONTINUING EDUCATION PROGRAM 2.2

www.aorn.org/CEImplementing AORN RecommendedPractices for Sharps Safety

T his evaluation is used to determine the extentto which this continuing education program metyour learning needs. The evaluation is printed here for your convenience. To receive continuingeducation credit, you must complete the onlineExamination and Learner Evaluation at http://www .aorn.org/CE . Rate the items as described below.

OBJECTIVESTo what extent were the following objectives of thiscontinuing education program achieved?

1. Discuss legislation related to preventing bloodborne pathogen transmission. Low 1. 2. 3. 4. 5. High

2. Discuss causes of percutaneous injury in periopera-tive settings. Low 1. 2. 3. 4. 5. High

3. Identify hazards associated with percutaneous injury. Low 1. 2. 3. 4. 5. High

4. Identify controls (ie, engineering, work practice,administrative) that can be used to help preventsharps injuries. Low 1. 2. 3. 4. 5. High

5. Describe actions perioperative RNs can take to assistin preventing sharps injuries and bloodborne path-ogen transmission. Low 1. 2. 3. 4. 5. High

CONTENT

6. To what extent did this article increase your knowledge of the subject matter? Low 1. 2. 3. 4. 5. High

7. To what extent were your individual objectives met? Low 1. 2. 3. 4. 5. High

8. Will you be able to use the information from thisarticle in your work setting? 1. Yes 2. No

9. Will you change your practice as a result of reading this article? (If yes, answer question#9A. If no, answer question #9B.)

9A. How will you change your practice? (Select all that apply)1. I will provide education to my team regarding

why change is needed.2. I will work with management to change/

implement a policy and procedure.3. I will plan an informational meeting with

physicians to seek their input and acceptanceof the need for change.

4. I will implement change and evaluate theeffect of the change at regular intervals untilthe change is incorporated as best practice.

5. Other: _______________________________ 9B. If you will not change your practice as a result

of reading this article, why? (Select all that apply)1. The content of the article is not relevant to my

practice.2. I do not have enough time to teach others about

the purpose of the needed change.3. I do not have management support to make a

change.4. Other: ________________________________

10. Our accrediting body requires that we verifythe time you needed to complete the 2.2 con-tinuing education contact hour (132-minute) program: _________________________________
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