This document was developed by the Occupational Safety and Health Administration (OSHA), Department of Labor, and the National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention, Department of Health and Human Services. OSHA’s mission is to assure the safety and health of America’s workers by setting and enforcing standards; providing training, outreach, and education; establishing partnerships; and encouraging continual improvement in workplace safety and health. NIOSH is the federal agency responsible for conducting research and making recommendations for the prevention of workplace injuries and diseases.

This Safety and Health Information Bulletin is not a standard or regulation, and it creates no new legal obligations. The Bulletin is advisory in nature, informational in content, and is intended to assist employers in providing a safe and healthful workplace. Pursuant to the Occupational Safety and Health Act, employers must comply with hazard-specific safety and health standards promulgated by OSHA or by a state with an OSHA-approved state plan. In addition, pursuant to Section 5(a)(1), the General Duty Clause of the Act, employers must provide their employees with a workplace free from recognized hazards likely to cause death or serious physical harm. Employers can be cited for violating the General Duty Clause if there is a recognized hazard and they do not take reasonable steps to prevent or abate the hazard. However, failure to implement any recommendations in this Safety and Health Information Bulletin is not, in itself, a violation of the General Duty Clause. Citations can only be based on standards, regulations, and the General Duty Clause.

Preface

The Occupational Safety and Health Administration's (OSHA's) Bloodborne Pathogens standard (29 CFR* 1910.1030) protects employees against occupational exposure to bloodborne pathogens. Bloodborne pathogens are pathogenic microorganisms that may be present in human blood and cause human disease. These pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Occupational exposure to bloodborne pathogens may occur when workers receive a penetrating injury to their skin (percutaneous injury). Surgical personnel are at risk of occupational exposure to bloodborne pathogens from injuries caused by sharp surgical instruments. Such personnel include surgeons, nurses, surgical technicians, anesthesiologists, and other health care personnel both inside and outside the operating suite.

*Code of Federal regulations. See CFR in references

Purpose

The purpose of this Safety and Health Information Bulletin is:

1. To describe the hazard of sharp-tip suture needles as a source of percutaneous injuries to surgical personnel;
2. To present evidence of the effectiveness 2. of blunt-tip suture needles in decreasing percutaneous injuries to surgical personnel, particularly when used to suture muscle and fascia; and
3. To emphasize OSHA’s requirement and 3. NIOSH’s recommendation to use safer medical devices—in this case, blunt-tip suture needles—where clinically appropriate.

Background

Sharp-tip suture needles are the leading source of percutaneous injuries to surgical personnel, causing 51% to 77% of these incidents.^1,2,3 Sharp-tip suture needles not only injure surgical staff, but also present a risk to patients from potential exposure to injured staff’s blood. Suture needle injuries can occur when surgical personnel:

• Load or reposition the needle into the needle holder;
• Pass the needle hand-to-hand between team members;
• Sew toward the surgeon or assistant while the surgeon or assistant holds back other tissue;
• Tie the tissue with the needle still attached,
• Leave the needle on the operative field,
• Place needles in an over-filled sharps container; or
• Place needles in a poorly located sharps container.⁴

Suture needle injuries frequently occur during suturing of muscle and fascia.² In 2005, the American College of Surgeons (ACS) issued a statement supporting universal adoption of blunt-tip suture needles for suturing fascia and encouraging further investigation of their appropriate use in other surgical applications. The ACS stated that "all published studies to date have demonstrated that the use of blunt suture needles can substantially reduce or eliminate needle-stick injuries from surgical needles."⁵ The Association of Perioperative Registered Nurses (AORN) endorsed this ACS statement in support of blunt-tip suture needle use where effective and clinically appropriate.⁶ The ACS and AORN are two of the seven member organizations of the Council on Surgical and Perioperative Safety, all of which have endorsed this statement. The other five member organizations are: the American Association of Nurse Anesthetists, the American Association of Surgical Physician Assistants, the American Society of Anesthesiologists, the American Society of PeriAnesthesia Nurses, and the Association of Surgical Technologists.

Engineering Controls

Engineering controls are defined in OSHA’s Bloodborne Pathogens standard as controls that isolate or remove the bloodborne pathogens hazard from the workplace [29 CFR 1910.1030(b)].⁹ The standard states, "Engineering and work practice controls shall be used to eliminate or minimize employee exposure" [29 CFR 1910.1030(d)(2)(i)]. This means that if an effective and clinically appropriate safety-engineered sharp exists, an employer must evaluate and implement it. However, if using a safer device compromises either patient safety or medical integrity its use would not be required.

Blunt–tip suture needles are identified by OSHA as an example of an engineering control to reduce percutaneous injuries (CPL 02-02-069, XIII D.2) (Citation Guidelines). As an alternative to sharp-tip suture needles, blunt-tip suture needles can be used to suture less-dense tissue such as muscle and fascia. Since as many as 59% of suture needle injuries occur during suturing of muscle and fascia,¹ the replacement of conventional sharp-tip suture needles with blunt-tip suture needles for these surgical tasks will reduce injury rates to surgical personnel. Conventional sharp-tip suture needles may be needed to suture skin, bowel, and blood vessels, although suture-less techniques for these procedures are available for use at the discretion of the surgeon. Several case studies suggest, but do not conclusively demonstrate, that blunt suture needles may also be used for suturing bowel and skin.⁷