Percutaneous Sharps Injuries and the Benefit of Safety Engineered Devices in Ophthalmology Operating Rooms: A Literature Review

Authors: Khaldon Abbas, Stuti M. Tanya, Bonnie He, Edsel Ing.

Author Disclosure Block: K. Abbas: None. S.M. Tanya: None. B. He: None. E. Ing: None.

Abstract Body:

Purpose: The hazard associated with percutaneous sharps injuries (PSI) has encouraged behaviour change and the use of safety-engineered surgical sharps. The purpose of this study was to provide a comprehensive review of PSI and the benefit of safety-engineered scalpels and devices in ophthalmology operating rooms (OpRs).

Study Design: Comprehensive literature review

Methods: A comprehensive literature search was performed using PubMed, EMBASE, and grey literature databases from inception to September 2021. Search terms included “sharps injury” AND “ophthalmology” OR “seroconversion” OR “operating room” OR “infectious diseases”, “scalpel” OR “sharps” AND “safety” OR “cost analysis”, and “single-use scalpel”. All English-language articles examining sharps injuries in healthcare settings were included.

Results: Forty-seven articles were included in our analysis. Within ophthalmology practices, PSI were most common in OpRs (60.8%), nurses sustained most injuries (36.0%) followed by surgeons (26.0%), and the median rate of PSI was reported at approximately 1.3 per 1000 surgical procedures per year. In one study, fellows-in-training sustained most injuries (24.0%) followed by nurses (23.0%). Most injuries occurred during procedures (31.3%) and sharps disposal/cleaning (29.4%). Within all hospital OpRs, the most frequent sources of injury were suturing needles (43.4%) followed by scalpels (17.0%). Safety scalpels with retractable sheaths, the combination of a scalpel blade remover and hands-free passing technique, and scalpel blade removers can be effective in reducing scalpel injuries by 52.5%, 44.5%, and 32.8%, respectively. Infectious disease is a significant concern following PSI; approximately 40.0% of patients undergoing surgery have a potentially transmissible illness. According to EPINet reports from 2010-2020, an average of 90.4% of sharps were contaminated before injury. Common infections include hepatitis B, hepatitis C, and human immunodeficiency virus with transmission risk from PSI estimated to be 1:3, 1:30, and 1:300, respectively. Anxiety and depression are reported in 67.8% of healthcare workers suffering PSI. After PSI, the odds ratio of post-traumatic stress disorder is increased by 4.28 times. The costs of PSI include infection testing and treatment, emergency room visits, staff absence and replacement, and counselling—averaging US$747 per injury. PSI are underreported at a rate estimated to be between 26% and 90%; therefore, the true rate associated with injury may be underestimated. 

Conclusions: PSIs are common, underreported, tend to be contaminated, and cause physical and psychological distress to healthcare workers. Safety-engineered devices and techniques have the potential for improved safety and may correlate with cost-benefit. Further studies are needed to elucidate the effectiveness of safety-engineered devices to prevent PSI in ophthalmology OpRs.