CONTINUING EDUCATION

Implementing AORN
Recommended Practices
for Sharps Safety
DONNA A. FORD, MSN, RN-BC, CNOR, CRCST
2.2
www.aorn.org/CE
Continuing Education Contact Hours
indicates that continuing education (CE) contact hours are
available for this activity. Earn the CE contact hours by
reading 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 the
examination is required for credit. Participants receive feed-
back on incorrect answers. Each applicant who successfully
completes this program can immediately print a certicate of
completion.
Event: #14503
Session: #0001
Fee: Members $17.60, Nonmembers $35.20
The CE contact hours for this article expire January 31, 2017.
Pricing is subject to change.
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, 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 pathogen
transmission.
Accreditation
AORN is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Centers
Commission on Accreditation.
Approvals
This 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 with
your state board of nursing for acceptance of this activity for
relicensure.
Conict of Interest Disclosures
Ms Ford has no declared afliation that could be perceived as
posing potential conict of interest in the publication of this
article.
The behavioral objectives for this program were created by
Liz Cowperthwaite, senior managing editor, and Rebecca
Holm, MSN, RN, CNOR, clinical editor, with consultation
from Susan Bakewell, MS, RN-BC, director, Perioperative
Education. Ms Cowperthwaite, Ms Holm, and Ms Bakewell
have 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 this
article.
Disclaimer
AORN recognizes these activities as CE for RNs. This rec-
ognition does not imply that AORN or the American Nurses
Credentialing Center approves or endorses products mentioned
in the activity.
http://dx.doi.org/10.1016/j.aorn.2013.11.013
106 j AORN Journal January 2014 Vol 99 No 1 AORN, Inc, 2014
RECOMMENDED PRACTICES
Implementing AORN
Recommended Practices
for 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 a
challenge. Occupational transmission of bloodborne pathogens, not only from pa-
tients to health care providers but also from health care providers to patients, is a
signicant concern. Legislation and position statements geared toward ensuring the
safety of patients and health care workers have not resulted in signicantly reduced
sharps injuries in perioperative settings. Awareness and understanding of the types
of percutaneous injuries that occur in perioperative settings is fundamental to
developing 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 the
elimination of sharps hazards; the use of engineering, work practice, and adminis-
trative controls; and the proper use of personal protective equipment, including
double 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 requires
safeguards and practice controls, perioper-
ative team members continue to experience
occupational percutaneous injuries at unacceptable
levels.
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 can
result 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 percutaneous
injuries by helping perioperative nurses identify
potential sharps hazards, implement best practices,
and develop policies and procedures related to safe
http://dx.doi.org/10.1016/j.aorn.2013.11.013
AORN, Inc, 2014 January 2014 Vol 99 No 1 AORN Journal j 107
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 most
signicant recommendations of the Recommended
practices for sharps safety, including those that can
have the largest effect on sharps injury reduction.
More in-depth information and a review of evi-
dence for each recommendation can be found in the
complete recommended practices (RP) document.
5
WHATS NEW
The new Recommended practices for sharps
safety supersedes the AORN guidance state-
ment: Sharps injury prevention in the perioperative
setting,
6
developed in 2005. The intent of the
guidance statement was to assist perioperative
RNs in developing sharps injury prevention pro-
grams and overcoming obstacles to compliance
with the suggested and mandated practices. Federal
regulations and strong research evidence provided
support for a stronger position on sharps safety,
so the RP document was developed to replace
the guidance statement.
Although many of the responsibilities and risk-
reduction strategies from the guidance statement
have been carried over into the RP document, the
new 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 from
regulatory controls, randomized controlled trials,
and Cochrane systematic reviews.
RATIONALE
Approximately 500,000 health care workers each
year experience percutaneous injuries.
3,7
Percuta-
neous injuries are associated with occupational
transmission 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 sharp
or contact with the health care providers blood
through an unnoticed glove perforation. Between
1991 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 occupational
exposure 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 to
the 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 occu-
pational exposure. Costs to the employer include
the postexposure management, the laboratory tests
and follow-up testing, and any necessary prophy-
laxis, as well as loss of productivity of the health
care worker. The annual cost of percutaneous sharps
injuries has been estimated at $65 million.
9
The
cost 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 in
1992
11
and the Needlestick Safety and Prevention
Act in 2000,
2
are aimed at reducing occupational
transmission of bloodborne pathogens. The purpose
of the Bloodborne Pathogens Standard is to limit
health 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 in
2000 directed the Occupational Safety and Health
Administration (OSHA) to make multiple revisions
to the existing Bloodborne Pathogens Standard.
The Needlestick Safety and Prevention Act includes
requirements that annual review of exposure control
108 j AORN Journal
January 2014 Vol 99 No 1 FORD
plans also should reect changes in technology
that 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 sharps
injuries.
13
In addition to AORN, a number of professional
associations have issued statements supporting
sharps injury prevention practices. These asso-
ciations include the American Academy of
Orthopaedic Surgeons,
14
the American Col-
lege of Surgeons,
15
the Association of Surgical
Technologists,
16
and the Council on Surgical and
Perioperative Safety.
17
In 2012, the International
Healthcare Worker Safety Center at the University
of Virginia, Charlottesville, released a consensus
statement endorsed by 20 organizations citing
improved sharps safety in surgical settings as the
highest priority in reducing percutaneous sharps
injuries.
18
Three governmental agencies, the US
Food and Drug Administration, the National
Institute for Occupational Safety and Health,
and OSHA, issued a joint safety communication
in May 2012 encouraging the use of blunt-tip
suture needles.
19
Accrediting bodies (eg, The Joint Commission,
the Accreditation Association for Ambulatory
Health Care) and regulatory organizations (eg,
OSHA, the Centers for Medicare & Medicaid
Services) may survey for sharps safety during
visits to health care facilities. Key points in a
survey could include review of the exposure
control plan, which must be in compliance with
the federal legislation and should meet the criteria
established in the Needlestick Safety and Pre-
vention Act.
13
Surveyors also may look to en-
sure that sharps containers are located close to
the point of use and glove boxes and personal
protective equipment (PPE) are placed in conve-
nient locations. Other potential points in a survey
include a review of policies, sharps injury logs,
and documentation of safety training. Surveyors
may observe use of PPE and question personnel
about safety procedures.
20
DISCUSSION
Implementing a sharps injury prevention program
can be a challenging process in any setting. The
Recommended practices for sharps safety pro-
vides information that can assist with developing
a 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 prevention
of bloodborne pathogen exposure.
Recommendation I
Health care facilities must have a bloodborne
pathogens exposure control plan, as required by
OSHA.
11
The exposure control plan is a component
of administrative controls, which are important to
the success of a sharps safety program. The plan
must include an exposure determination for em-
ployees who have the potential to be exposed to
blood and body uids; a plan to reduce sharps in-
juries, including prioritized risk-reduction strate-
gies; and a process to monitor sharps injury data.
The plan must be reviewed and updated at least
annually and any time new practices are imple-
mented. Ensuring compliance with the exposure
control plan and related policies is important to
show commitment to prevention of sharps injuries.
Administrators and managers, in collaboration
with occupational health and infection prevention
practitioners, can develop the exposure control
plan. Frontline personnel, including perioperative
RNs and surgeons, should be involved in identi-
fying control methods to prevent sharps injuries by
using 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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eliminating the hazard by completely removing it
from use. Eliminating the hazard (eg, a sharp item
or instrument) involves identifying alternative ways
to perform the necessary task without using sharps,
such as by using a tissue adhesive and adhesive
strips or a skin stapler to close a skin incision.
A systematic review of 14 randomized controlled
trials that evaluated surgical wound healing when
tissue adhesives were used for skin closure showed
there was no signicant difference in infection
rates, patient and user satisfaction, or cost between
use of sutures and use of adhesives.
24
Therefore,
when clinically indicated, it could be appropriate
to use adhesives in place of suture to help prevent
needlestick injuries.
The highest priority should be eliminating the
device that has the potential to cause the most
injuries.
5
If eliminating use of the device is not
feasible, controls at lower levels of the hierarchy
should be considered, such as using engineering
controls, work practice controls, administrative
controls, and PPE.
23
Recommendation II
When elimination of sharps is not feasible, peri-
operative team members must use sharps with
safety-engineered devices that isolate or remove
the risk of bloodborne pathogen exposure.
11
Sharps
with engineered sharps injury protection have a
built-in safety feature and include blunt-tip suture
needles,
4,15,17,25-28
safety scalpels,
11
and safety-
engineered syringes and needles.
11,23
Alternative
wound closure devices and needleless systems
are effective in preventing percutaneous injuries
11
and include fascial closure devices, tissue sta-
plers, tissue adhesives, and adhesive skin closure
strips.
29-31
Strong evidence supports the use of blunt-tip
suture needles for muscle and fascia closure. In
a Cochrane review of 10 randomized controlled
trials, researchers found that using blunt-tip suture
needles instead of sharp-tip suture needles re-
duced the incidence of glove perforation by 54%,
thereby reducing the risk of infectious disease
transmission.
25
Managers can identify devices with engineering
controls through contact with vendors, attending
vendor displays at conferences, and professional
networking. A multidisciplinary committee in-
cluding direct users should be part of the process
for selecting and evaluating safety-engineered de-
vices.
2
Educators can plan a product fair to help
personnel identify safety-engineered devices and
other sharps safety products to select for an eval-
uation. Perioperative RNs can encourage team
members to provide objective evaluations of safety-
engineered devices. After products are selected, the
educator may want to set up a sharps safety skills
fair to allow personnel and surgeons an opportunity
to have hands-on practice with the trial devices.
Recommendation III
Hand-to-hand passing of sharps, such as needles,
blades, and sharp instruments, accounts for the
majority of percutaneous injuries.
3
Perioperative
personnel must use work practice controls when
handling any type of disposable or reusable sharp.
Work practice controls change the way a task
is performed when sharp devices are used. For
example, surgical team members should use a
neutral zone for passing any sharp device (eg,
blade, instrument, needle) rather than passing items
Figure 1. The hierarchy of controls. Illustration
reprinted with permission from AORN, Inc, Denver,
CO. All rights reserved.
110 j AORN Journal
January 2014 Vol 99 No 1 FORD
from hand to hand.
14-17,29,32-37
A neutral zone helps
ensure that the surgeon and scrub person do not
touch the same sharp instrument at the same time.
This technique, also called hands-free technique,
is accomplished by designating a neutral zone on
the sterile eld and placing sharp items within
the zone for transfer between scrubbed personnel.
5
A modied neutral zone may be needed when
the surgeon is using a microscope; sharps are
carefully placed in the surgeons hand, and the
surgeon returns the sharp to the neutral zone after
use.
14,33,38-42
The no-touch technique should be used to
minimize 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 the
suture packet to position the needle in the needle
holder (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 on
the sterile eld.
Additional work control practices include main-
taining situational awareness when sharps are in
use, communicating the location of sharps on the
sterile eld, removing needles before tying suture,
and using instruments instead of hands for tissue
retraction. Personnel should use caution at all times
when 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, be
willing 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 importance
of communication and situational awareness during
use of sharps. The educator has a key role in pro-
viding assistance to individual team members and
surgical teams implementing work practice controls
and 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 mem-
bers determine acceptable ways of implementing
use of a neutral zone for different surgical pro-
cedures and different patient positions. Periopera-
tive RNs and other team members can collaborate
with the educator to help personnel develop these
skills.
Recommendation IV
Proper use of PPE is required by the OSHA
Bloodborne 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 ex-
posure, breaks in sterile technique, and surgical site
infection.
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 gloves
are perforated, the volume of blood on a solid sharp
device can be reduced by as much as 95% compared
with perforation of a single glove.
45-47
Figure 2. Use of the no-touch technique.
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Often, glove perforations are not detected by the
user. Use of a perforation indicator system (ie, a
colored glove under a standard glove) is recom-
mended for personnel wearing double gloves,
because perforations are easier to see and allow
detection more frequently (Figure 3).
43
Gloves
should be monitored for punctures as a way to help
ensure barrier protection against transmission of
microorganisms and bloodborne pathogens to the
surgical eld. Virus-inhibiting gloves, which re-
duce the amount of virus transmitted if a glove
becomes perforated, may be worn, especially dur-
ing procedures for which there is a higher risk of
glove perforation.
48-50
Perioperative RNs should model the use of
standard precautions; wear appropriate PPE, in-
cluding protective eyewear, mask, and gloves; and
encourage other team members to wear PPE and
bloodborne pathogen protection. The RN circulator
also can help monitor scrubbed team members
gloves for signs of perforation.
43
Recommendation V
Safe handling of sharps includes ensuring that sharps
are contained in a safe manner and using proper
disposal practices. Sharps injuries can be sustained
because sharps are left on the oor or a table or are
protruding from a trash bag or disposal container.
51
Sharps containers should be puncture and leak re-
sistant and large enough to hold the types of sharps
that will need to be placed in them.
52
The container
should be recognizable, visible, and placed in prox-
imity to the point of use.
52
After the container has
reached a visible ll level, the container should be
replaced.
11
Personnel should use counting devices
to contain needles and sharps on the sterile eld.
11
Perioperative RNs can advocate for others
through careful use of sharps disposal containers,
such as by placing containers close to the point of
use, using care when putting sharps into the con-
tainer, and ensuring the containers are not overlled.
Careful identication and separation of contami-
nated disposable and reusable sharps is important
to protect personnel in the decontamination area
from injury. Reusable sharps should be clearly se-
gregated on the case cart for easy identication.
11
Recommendation VI
Perioperative RNs should maintain an awareness
of personal and professional responsibilities for
sharps injury prevention and serve as role models
for other team members. This includes observing
all local, state, and federal regulations pertaining to
handling of sharps and prevention of bloodborne
pathogens. Perioperative RNs can protect them-
selves by wearing appropriate PPE, getting immu-
nized against hepatitis B virus, using sharps devices
with safety features provided by the health care
facility, and complying with other policies and
procedures designed to protect against disease
transmission. If a perioperative RN sustains a
sharps injury, he or she should immediately report
the injury and receive prophylactic treatment for
bloodborne pathogen exposure. If a team member
experiences a sharps injury, the perioperative RN
can assist the team member with the reporting pro-
cess. Perioperative RNs can be leaders in the sharps
injury prevention process by being a champion of
sharps safety.
Figure 3. Glove perforation of an outer glove with
an inner indicator system glove. Reprinted with
permission from Recommended practices for sterile
technique. In: Perioperative Standards and Recom-
mended Practices. Denver, CO: AORN, Inc; 2013:98.
112 j AORN Journal
January 2014 Vol 99 No 1 FORD
The Final Four
The nal four recommendations in each AORN RP
document discuss education/competency, docu-
mentation, policies and procedures, and quality
assurance/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 applicable
to 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 position
descriptions.
Documentation is used as a method to monitor
compliance with regulations, measure performance
with sharps safety measures, maintain employee
records of education and competency verication,
and track occupational exposures. Implementing
new or updated recom-
mended practices may war-
rant a review or revision of
the relevant documentation
being used in the facility.
Policies and procedures
should be developed, re-
viewed periodically, revised
as necessary, and readily
available in the practice
setting. New or updated
recommended practices
may present an opportunity
for collaborative efforts
among nurses and personnel
from other departments
in the facility to develop
organization-wide policies
and procedures that support
the recommended practices.
The AORN Policy and
Procedure Templates, 3rd edition,
54
provides a
collection of 30 sample policies and customizable
templates based on AORNs Perioperative Stan-
dards and Recommended Practices.
55
Quality
assessment and improvement activities assist in
evaluating the quality of patient care, the presence
of environmental safety hazards, and the formula-
tion of plans for taking corrective actions. For details
on the nal four practice recommendations that are
specic to the RP document discussed in this article,
please refer to the full text of the RP document.
AMBULATORY PATIENT SCENARIO
It is a busy day in a freestanding ambulatory sur-
gery center (ASC). The surgical team is nishing a
left knee arthroscopy on a 20-year-old male patient,
the third patient of six that day in the orthopedic
OR. The instrument table is moved away, and the
scrubbed team members remove the drapes. As the
RN circulator places a single hollow-bore needle
into the sharps container, the patient begins to wake
and move around. As the RN looks back to assist the
patient, she is stuck in the right index nger by a
Educational Resources
n AORN Video Library: Hand Hygiene, Gowning & Gloving
Practices in the Perioperative Setting [DVD]. http://cine-med.com/
index.php?navaorn&catall.
n AORN Video Library: Prevention of Transmissible Infections in
the Perioperative Practice Setting [DVD]. http://cine-med.com/
index.php?navaorn&catall.
n AORN Video Library: Risk Management for the Perioperative
Nurse [DVD]. http://cine-med.com/index.php?navaorn&
catall.
n Recommended practices for prevention of transmissible in-
fections in the perioperative practice setting. In: Perioperative
Standards 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.
AORN Journal j 113
RP IMPLEMENTATION GUIDE: SHARPS SAFETY www.aornjournal.org
small-gauge K-wire that was removed from the rst
patient of the day and is sticking out of the opening
in the sharps container.
After the patient is settled, the RN treats the
minor percutaneous injury. Knowing that she should
report the exposure, she considers the challenges.
The rst patient of the day had undergone a pro-
cedure under a block anesthesia and moderate se-
dation and might already have been discharged
from the ASC; thus, obtaining a blood sample for
testing from the suspected source patient might not
be possible. If obtained, the blood sample would
have to be sent to a hospital laboratory in the vi-
cinity for processing. Also, the ASC contracts with
a hospital for occupational health services, so the
postexposure evaluation would be more difcult
and time consuming, requiring follow-up appoint-
ments at another facility. Because there are still
three more patients scheduled in her OR, the RN
knows it will be difcult to get away before the
schedule is completed, and she needs to hurry
home at the end of her shift to drive her daughter
to soccer practice.
The RN also considers reasons she might not be
at risk for bloodborne pathogen exposure. She re-
ceived the hepatitis B vaccination, and because the
percutaneous injury was caused by a K-wire and not
a hollow-bore, blood-lled needle, she believes she
is at lower risk for acquiring hepatitis B, hepatitis
C, or HIV. Based on the patients age and medical
history, the RN makes the assessment that he was
probably at low risk for hepatitis C infection.
Despite these considerations, the RN knows it is
in her best interest to report the exposure as soon
as possible. In addition to concerns about her own
health, she is concerned about the health implications
for others in her family and possibly her patients as
well. Between scheduled surgeries, she contacts the
charge nurse and reports the exposure. The charge
nurse arranges relief for the RN so she can complete
the employee incident form and contacts the occu-
pational health nurse to report the exposure. The
suspected source patient has already been discharged
from the ASC, so the exposure is treated as an
unknown source exposure. Fortunately, her re-
sults are negative after one full year of testing.
HOSPITAL PATIENT
SCENARIO
A 66-year-old woman with a
metastatic colon carcinoma
is undergoing an open left
hepatic lobectomy. The pa-
tient is obese and diabetic.
A certied surgical technol-
ogist (CST) in orientation
to the specialty is being
trained by another CST, so
both CSTs are scrubbed in.
During the procedure, the
patient has several periods
of hemodynamic instability
caused by bleeding. Thee
surgeon nishes repairing a
bleeding vessel and quickly
hands the cut suture with
needle back to the CST in
Resources for Implementation
n AORN Syntegrity Framework. AORN, Inc. http://www.aorn
.org/syntegrity.
n ORNurseLink
TM
. http://ornurselink.aorn.org.
n Perioperative Job Descriptions and Competency Evaluation
Tools [CD-ROM]. Denver, CO: AORN, Inc; 2012. http://
www.aorn.org/JobDescriptions.
n Policy and Procedure Templates [CD-ROM]. 3rd ed. Denver,
CO: AORN, Inc; 2013. http://www.aorn.org/Books_and_Publi
cations/AORN_Publications/Policy_and_Procedure_Templates
.aspx.
n The Roadmap to ASC Compliance [CD-ROM]. Denver, CO:
AORN, Inc; 2012. http://www.aorn.org/Education/Ambulatory/
Ambulatory_Surgery_Center_Resources.aspx.
Editors note: Syntegrity is a registered trademark and
ORNurseLink is a trademark of AORN, Inc, Denver, CO.
Web site access veried November 1, 2013.
114 j AORN Journal
January 2014 Vol 99 No 1 FORD
training. As the CST grasps the suture from the
surgeons hand, the needle perforates both layers
of the CSTs double gloves. The contaminated
needle is handed off to the RN circulator and the
experienced CST takes over until the patients
bleeding is controlled, allowing the CST in train-
ing to break scrub, treat the injury, and contact
the occupational health nurse on-call to report
the exposure. The postexposure evaluation is per-
formed, and blood is drawn from the patient. The
source 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 sharps
safety program had been established at this hospital
in the early 1990s and modications were made
annually, this and other percutaneous injury oc-
currences spur a renewed effort by the hospital
safety committee to bring sharps injury prevention
to the forefront. Educators plan a safety fair that is
held during a staff development session to show
various ways to minimize the risk of sharps in-
juries. 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 development
session in which they review the pertinent legisla-
tion, position statements from professional associ-
ations, and evidence-based recommendations. In
addition, the CST and another staff member who
had experienced recent percutaneous exposures
consent to tell the stories of their experiences.
This combination of topics helps reinforce the
current legislative requirements, what can be done
to minimize the risk of sharps injuries, and what
can happen when someone experiences an occu-
pational exposure from a sharps injury.
CONCLUSION
The AORN Recommended practices for sharps
safety is a thorough review of every aspect of
sharps injury prevention and associated evidence-
based recommendations. Key takeaways include
the following:
n Sharps injury prevention is a concern and a re-
sponsibility of all members of the perioperative
team.
n Knowing the causes and types of injuries that
occur in the practice setting is a critical com-
ponent of developing a sharps injury prevention
program.
n Prioritizing risk-reduction strategies involves
giving the highest priority to the device that
can have the greatest effect on sharps injury
reduction.
n Eliminating the hazard (eg, removing the sharp
object from use) and using safety-engineered
devices are the most effective ways to prevent
sharps injuries.
n Sharps injuries occur most frequently when
sharps are passed hand to hand, so scrubbed
team members should use a neutral zone.
n Double gloving minimizes the risk of blood-
borne 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 delineates
how perioperative personnel should practice with-
in the recommendations. Perioperative nurses
should review the RP document with colleagues
and serve as a resource and role model for safe
sharps practices.
Acknowledgment: The author thanks Mary J. Ogg,
MSN, RN, CNOR, perioperative nursing specialist
at AORN, Inc, for her assistance with writing this
manuscript.
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Donna A. Ford, MSN, RN-BC, CNOR, CRCST,
is a nursing education specialist, Division of
Surgical Services, Department of Nursing, Mayo
Clinic, 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 upon
which 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 practices
document.
AORN Journal j 117
RP IMPLEMENTATION GUIDE: SHARPS SAFETY www.aornjournal.org
EXAMINATION
CONTINUING EDUCATION
2.2
www.aorn.org/CE
Implementing AORN Recommended
Practices 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 online
Examination and Learner Evaluation at http://www.aorn.org/CE.
QUESTIONS
1. After passage of the Needlestick Safety and Preven-
tion Act, sharps injuries __________ in nonsurgical
settings and __________ in surgical settings.
a. decreased, decreased
b. decreased, increased
c. increased, decreased
d. increased, increased
2. An exposure control plan must include
1. 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 3
c. 1, 2, and 3 d. 1, 2, 3, and 4
3. The highest level of the hierarchy of controls to
help prevent sharps injuries is to
a. 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 suture
needles instead of sharp-tip suture needles reduced
the incidence of glove perforation by
a. 10%. b. 32%.
c. 54%. d. 75%.
118 j AORN Journal January 2014 Vol 99 No 1 AORN, Inc, 2014
5. The majority of percutaneous injuries are caused by
a. 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 surgeon
and scrub person do not touch the same instru-
ment at the same time.
a. true b. false
7. Communicating the location of sharps on the
sterile eld is
a. an administrative control.
b. an engineering control.
c. a work practice control.
8. Personnel may choose to wear virus-inhibiting
gloves during procedures in which there is a
higher risk of glove perforation.
a. true b. false
9. A sharps container should be
1. 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 4
c. 1, 3, and 4 d. 1, 2, 3, and 4
10. Perioperative RNs can demonstrate personal and
professional responsibility in preventing sharps
injuries and bloodborne pathogen transmission by
1. 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 4
c. 2, 3, and 4 d. 1, 2, 3, and 4
AORN Journal j 119
CE EXAMINATION www.aornjournal.org
LEARNER EVALUATION
CONTINUING EDUCATION PROGRAM
2.2
www.aorn.org/CE
Implementing AORN Recommended
Practices for Sharps Safety
T
his evaluation is used to determine the extent
to which this continuing education program met
your learning needs. The evaluation is printed
here for your convenience. To receive continuing
education credit, you must complete the online
Examination and Learner Evaluation at http://www
.aorn.org/CE. Rate the items as described below.
OBJECTIVES
To what extent were the following objectives of this
continuing 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 prevent
sharps injuries.
Low 1. 2. 3. 4. 5. High
5. Describe actions perioperative RNs can take to assist
in 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 this
article 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 acceptance
of the need for change.
4. I will implement change and evaluate the
effect of the change at regular intervals until
the 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 verify
the time you needed to complete the 2.2 con-
tinuing education contact hour (132-minute)
program: _________________________________
120 j AORN Journal January 2014 Vol 99 No 1 AORN, Inc, 2014