Percutaneous injuries during surgical procedures

JAMA. 1992 Jun 3;267(21):2899-904.


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.

MeSH terms

  • Accidents, Occupational / statistics & numerical data
  • Chicago
  • General Surgery
  • Hand Injuries / etiology
  • Hospitals, Teaching
  • Humans
  • Logistic Models
  • Needlestick Injuries / epidemiology
  • Needlestick Injuries / etiology*
  • New York City
  • Observer Variation
  • Operating Rooms*
  • Regression Analysis
  • Risk Factors
  • Skin / injuries*
  • Surgical Procedures, Operative / adverse effects*
  • Surgical Procedures, Operative / statistics & numerical data