Perceptions, Attitudes and Barriers to Compliance with American College of Surgeons Operating Room Safety Guidelines

Christina M. Welc DO, Michael Edmond MD, Kara Elam, Kakotan Sanogo, Akbar Nassiry, Wilhelm Zuelzer MD, Therese Duane MD, Michael P. Stevens MD and Gonzalo Bearman MD.

Virginia Commonwealth University. Richmond, VA USA.

Perceptions, Attitudes and Barriers to Compliance with American College of Surgeons Operating Room Safety Guidelines.

Background: The American College of Surgeons (ACS) Statement on Sharps Safety recommends universal adoption of double gloving (DG), the use of a Hands Free Zone (HFZ) and blunt tip suture needles (BTSN) for closure of deep fascia and muscle to prevent needlestick injuries in the OR. 

Objective: To examine perceptions, attitudes and barriers to compliance with the ACS Guidelines for the prevention of needlestick injuries in the OR.

Methods: An anonymous, voluntary survey was distributed to a convenience sample of surgical staff in an academic medical center. Surveys were distributed in the OR as well as at surgical conferences.

Results: 107 surveys were completed. The response rate was 33% (107/324). Of the respondents, 69 (64%) were residents and 31 (29%) were attendings. The remaining were OR nurses 3 (7%), fellows 2 (6%) and other 2 (6%).

ACS Recommendation	Residents N (%)	Attendings N (%)	p-value
Aware of DG guideline	40 (58%)	21 (68%)	0.4451
Agreed/strongly agreed that DG reduces needlestick injuries	43 (62%)	17 (55%)	0.3775
Used DG >75% of cases	25 (36%)	9 (29%)	0.4232
Reported decreased tactile sensation as barrier to DG use	44 (64%)	20 (65%)	0.9110
Aware of the HFZ recommendations	42 (61%)	19 (61%)	0.8945
Agreed/strongly agreed that use of HFZ reduces needlestick injuries	40 (58%)	16 (52%)	0.4518
Used HFZ > 75% of cases	5 (7%)	2 (6%)	1.0000
Reported that HFZ was encouraged by surgical leadership	23 (33%)	6 (19%)	0.1310
Agreed/strongly agreed that HFZ distracts or breaks concentration	10 (14%)	7 (23%)	0.3520
Agreed/strongly agreed that the OR staff was not trained in HFZ	15 (22%)	6 (19%)	0.7336
Aware of BTSN use guideline	33 (48%)	16 (52%)	0.8280
Agreed/strongly agreed that BTSNs reduced percutaneous injuries	32 (46%)	13 (42%)	0.5904
Reported BTSN use > 75% of cases	5 (7%)	3 (10%)	0.7051
Agreed/strongly agreed that BTSN was unavailable in OR	12 (18%)	3 (10%)	0.3758
Agreed/strongly agreed that BTSN use is less effective for tissue closure	17 (25%)	10 (32%)	0.4780

 

Conclusions: Resident and attending surgeons shared similar perspectives and were poorly adherent with ACS guidelines for OR safety.  The majority of surgeons are aware of the ACS guidelines for DG and HFZ. Self reported awareness of BTSN was poor. Obstacles to full employment of ACS guidelines include knowledge and training gaps, lack of effective promotion by the health system and surgical leadership, and availability of BTSN.