Revised statement on sharps safety
The following statement was revised by the American College of Surgeons (ACS) Committee on Perioperative
Care and was reviewed and approved by the ACS Board of Regents at its June 2016 meeting.
Sharps injuries and surgical glove tears continue to expose surgeons and operating room (OR)
personnel to the risk of infection. Patients’ blood
makes contact with the skin or mucous membranes of OR personnel in as many as 50 percent
of operations, with cuts or needlesticks occurring in as many as 15 percent of operations. Surgeons and first assistants are at highest risk for injury, sustaining up to 59 percent of the injuries in
the OR. Scrub personnel have the second highest
frequency of injuries in the OR ( 19 percent), followed by anesthesiologists ( 6 percent), and circulating nurses ( 6 percent). Of the estimated 384,000
needlestick injuries that occur in hospitals each
year, 23 percent occur in surgical settings.
Published literature indicates that while needlestick injury rates have been decreasing among
nonsurgical health care providers, they have not
declined among health care professionals who work
in surgical settings. According to a 2010 article
published in the Journal of the American College of Surgeons and citing data from a 1998 study, more than
half of needlestick injuries involving suture needles occur during the suturing of fascia or muscle.
For surgeons, suture needles are the most frequent
source of sharps injuries.
The ACS supports work practices that are
designed to eliminate, protect, or standardize the
use of sharp instruments in the OR. The ACS also
recommends the use of structured evaluations
and user-based criteria that include performance
standards, task analysis, simulation, and training
programs for devices intended to reduce sharps injuries in the OR.
A team approach is critical to reduce the risk of
blood-borne infections resulting from sharps injuries in the OR. Hospitals and health care facilities
should make sharps injury reduction techniques
and instruments available to surgeons and OR
OR work practices
Glove barrier failure is common, with reported perforation rates as high as 61 percent for surgeons and 40
percent for scrub personnel. Double gloving reduces
the risk of exposure to patient blood by as much as 87
percent when the outer glove is punctured. However,
double gloving has certain disadvantages, such as
decreased tactile sensation. In certain types of operations (such as neurosurgery procedures), where
delicate manipulation of instruments and tissues is
required, double gloving may impair the surgeon’s
ability to optimally perform the procedures. Despite a
large body of data documenting the benefits of double
gloving, this technique has not received wide acceptance among surgeons. In many cases, a period of
adaptation and “retraining” appears to be necessary
before practitioners feel comfortable with the technique. Specially designed undergloves are available
to make the process of double gloving more acceptable to surgeons.
Therefore the ACS recommends:
• The universal adoption of the double glove (or under-glove) technique to reduce exposure to body fluids
resulting from glove tears and sharps injuries. In certain delicate operations, and in situations where it may
compromise the safe conduct of the operation or safety
of the patient, the surgeon may decide to forgo this
Blunt tip suture needles
Suture needle injuries pose the greatest risk of sharps
injury to the surgeon and scrub personnel. The effectiveness of the use of blunt-tip suture needles in
reducing sharps injuries is supported by a number of
randomized studies and case series that demonstrate a
decrease in the rate of glove puncture from 38 percent
down to 6 percent—and down to zero in some cases—
following the adoption of blunt-tip suture needles.