Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-24T19:52:27.966Z Has data issue: false hasContentIssue false
  • English
  • Français

Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures

Published online by Cambridge University Press:  09 February 2016

Douglas J. Myers ,
Hester J. Lipscomb ,
Carol Epling ,
Debra Hunt ,
William Richardson ,
Lynn Smith-Lovin  and
John M. Dement
Douglas J. Myers*
Affiliation:
Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina Department of Occupational and Environmental Health Sciences, West Virginia University, Morgantown, West Virginia
Hester J. Lipscomb
Affiliation:
Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
Carol Epling
Affiliation:
Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
Debra Hunt
Affiliation:
Division of Biological Safety, Duke University Medical Center, Durham, North Carolina
William Richardson
Affiliation:
Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
Lynn Smith-Lovin
Affiliation:
Department of Sociology, Duke University, Durham, North Carolina
John M. Dement
Affiliation:
Division of Occupational and Environmental Medicine, Department of Community and Family Medicine, Duke University Medical Center, Durham, North Carolina
*
Address correspondence to Douglas Myers, ScD, Occupational and Environmental Health Sciences Department, West Virginia University, 1 Medical Center Dr, PO Box 6190, Morgantown, WV 26506 (djmyers@hsc.wvu.edu).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures.

DESIGN

A 10-year retrospective cohort study.

SETTING

A single large academic teaching hospital.

PARTICIPANTS

Surgical teams participating in surgical procedures (n=333,073) performed during 2001–2010 and 2,113 reported percutaneous BBFE were analyzed.

METHODS

A social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices.

RESULTS

The team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88–0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85–0.99]) than for exposures involving suture needles (0.96 [0.88–1.04]).

CONCLUSIONS

Greater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.

Infect Control Hosp Epidemiol 2016;37:512–518

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 5 , May 2016 , pp. 512 - 518
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Truckey, F. Anæsthesia and anæsthetics. Am J Nurs 1911;11:803–806.Google Scholar
2. Wilson, RN. Teamwork in the operating room. Hum Organ 1954;12:9–14.Google Scholar
3. Dekker, S. Patient Safety: A Human Factors Approach. Boca Raton: CRC Press; 2011.Google Scholar
4. Flin, RH, O’Connor, P, Crichton, M. Safety at the Sharp End: A Guide to Non-technical Skills. Aldershot, UK: Ashgate; 2008.Google Scholar
5. Gawande, A. The Checklist Manifesto: How to Get Things Right. New York: Metropolitan Books; 2010.Google Scholar
6. Jagger, J, Berguer, R, Phillips, EK, Parker, G, Gomaa, AE. Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation. AORN J 2011;93:322–330.Google Scholar
7. Borgatti, SP, Jones, C. A measure of past collaboration. Connect 1996;19:58–60.Google Scholar
8. Arriaga, AF, Elbardissi, AW, Regenbogen, SE, et al. A policy-based intervention for the reduction of communication breakdowns in inpatient surgical care: results from a Harvard surgical safety collaborative. Ann Surg 2011;253:849–854.Google Scholar
9. Nagpal, K, Vats, A, Ahmed, K, et al. A systematic quantitative assessment of risks associated with poor communication in surgical care. Arch Surg 2010;145:582–588.Google Scholar
10. ElBardissi, AW, Regenbogen, SE, Greenberg, CC, et al. Communication practices on 4 Harvard surgical services: a surgical safety collaborative. Ann Surg 2009;250:861–865.Google Scholar
11. Lingard, L, Regehr, G, Orser, B, et al. Evaluation of a preoperative checklist and team briefing among surgeons, nurses, and anesthesiologists to reduce failures in communication. Arch Surg 2008;143:12–17.Google Scholar
12. Davenport, DL, Henderson, WG, Mosca, CL, Khuri, SF, Mentzer, RM Jr. Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions. J Am Coll Surg 2007;205:778–784.Google Scholar
13. Webster, JL, Cao, CG. Lowering communication barriers in operating room technology. Hum Factors 2006;48:747–758.Google Scholar
14. Lingard, L, Whyte, S, Espin, S, Baker, GR, Orser, B, Doran, D. Towards safer interprofessional communication: constructing a model of “utility” from preoperative team briefings. J Interprof Care 2006;20:471–483.Google Scholar
15. Davies, JM. Team communication in the operating room. Acta Anaesthesiol Scand 2005;49:898–901.Google Scholar
16. Awad, SS, Fagan, SP, Bellows, C, et al. Bridging the communication gap in the operating room with medical team training. Am J Surg 2005;190:770–774.Google Scholar
17. Myers, DJ, Lipscomb, HJ, Epling, C, et al. Surgical procedure characteristics and risk of sharps-related blood and body fluid exposure [published online October 5, 2015]. Infect Control Hosp Epidemiol 2016;37:80–87.Google Scholar
18. Dement, JM, Pompeii, LA, Ostbye, T, et al. An integrated comprehensive occupational surveillance system for health care workers. Am J Ind Med 2004;45:528–538.Google Scholar
19. Loomis, D, Richardson, DB, Elliott, L. Poisson regression analysis of ungrouped data. Occup Environ Med 2005;62:325–329.Google Scholar
20. Myers, DJ, Epling, C, Dement, J, Hunt, D. Risk of sharp device-related blood and body fluid exposure in operating rooms. Infect Control Hosp Epidemiol 2008;29:1139–1148.Google Scholar
21. Tarantola, A, Golliot, F, L’Heriteau, F, et al. Assessment of preventive measures for accidental blood exposure in operating theaters: a survey of 20 hospitals in Northern France. Am J Infect Control 2006;34:376–382.Google Scholar
22. Stata Statistical Software. Release 12 [computer program]. College Station, TX: StataCorp; 2011.Google Scholar
23. Puro, V, De Carli, G, Petrosillo, N, Ippolito, G. Risk of exposure to bloodborne infection for Italian healthcare workers, by job category and work area. Studio Italiano Rischio Occupazionale da HIV Group. Infect Control Hosp Epidemiol 2001;22:206–210.Google Scholar
24. Mullen, B, Copper, C. The relation between group cohesiveness and performance: an integration. Psychol Bull 1994;115:210–227.Google Scholar
25. Makary, MA, Sexton, JB, Freischlag, JA, et al. Operating room teamwork among physicians and nurses: teamwork in the eye of the beholder. J Am Coll Surg 2006;202:746–752.Google Scholar
26. Healey, AN, Undre, S, Sevdalis, N, Koutantji, M, Vincent, CA. The complexity of measuring interprofessional teamwork in the operating theatre. J Interprof Care 2006;20:485–495.Google Scholar
27. Au, E, Gossage, JA, Bailey, SR. The reporting of needlestick injuries sustained in theatre by surgeons: are we under-reporting? J Hosp Infect 2008;70:66–70.Google Scholar
28. Haiduven, DJ, Simpkins, SM, Phillips, ES, Stevens, DA. A survey of percutaneous/ mucocutaneous injury reporting in a public teaching hospital. J Hosp Infect 1999;41:151–154.Google Scholar
29. Voide, C, Darling, KE, Kenfak-Foguena, A, Erard, V, Cavassini, M, Lazor-Blanchet, C. Underreporting of needlestick and sharps injuries among healthcare workers in a Swiss university hospital. Swiss Med Weekly 2012;142:w13523.Google Scholar
30. Makary, MA, Al-Attar, A, Holzmueller, CG, et al. Needlestick injuries among surgeons in training. N Engl J Med 2007;356:2693–2699.Google Scholar