Addressing Surgical Site Infection in Cesarean Section Surgery

Maureen Spencer, RN, M.Ed. Infection Control Specialist

Boston, MA www.workingtowardzero.com

maureen@workingtowardzero.com

1

Background: Patient Aspects

Burden of SSIs

Patients with SSIs have a 2-11 times higher risk of death than those without SSI

77% of deaths associated with SSIs are directly related to the SSI

SSIs cost approximately $10 Billion/Yr in the U.S. SSI increases cost > 54% with a resulting (facility) profit

margin decreased to 3.4% from 23%. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, the Hospital Infection Control Practices Advisory

Committee. Guideline for the prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-280

Deverick J. Anderson, MD, MPH, et. al. Supplement Article: SHEA/IDSA Practice Recommendation Strategies to Prevent Surgical Site Infections in Acute Care Hospitals. Infect Control Hosp Epidemiol 2008;29:S51–S61. © 2008 by The Society for Healthcare Epidemiology of America

Joint Commission on Accreditation of Healthcare Organizations. Surveillance, Prevention, and Control of Infection

[Hospital Infection Control Standards, 2005] Joint Commission Perspectives. 2004;24(7). Dimick JB, Weeks WB, Karia RJ, Das S, Campbell Jr DA. Who pays for poor surgical quality? Building

a business case for quality improvement. J Am Coll Surg. 2006;202:933-937. Abstract

3

OB/Gyn Basic Facts

According to the CDC: C-Section is one of the most common surgeries in reproductive age women

• Past Data : 24% of all first births (1 in 4) • C-section rate in 2007 reached 32% in US, a 50%

increase since 1996 2,3

• Repeat C-section rate is estimates at 92%, as VBAC rate decreases3

Ford, J, Grewal,J,Mikolajczyk R et.al., Primary cesarean delivery amoung parous women in the U.S., 1990-2003. Obstet Gynecol. 2008;112 (6):12351241 Centers for Disease Control and Prevention, Department of Health and Human Services. National Vital Statistics Report. Vol 54, No. 4 Joyce AM, Hamilton BE, Sutton PD, et al. Births: Final Data for 2005. National Vital Statisics Report. 2007;56:6

ObGyn Basic Facts

Hysterectomy is the second most frequent surgery performed in reproductive age women

- 600,000 hysterectomies/Yr in the U.S. - 20% for abnormal uterine bleeding - Rate of 5.4/1000 cases

Centers for Disease Control and Prevention, Department

of Health and Human Services. National Vital Statistics Report. Vol 54, No. 4

Falcone, Tommaso. Hysterectomy for benign disease. Obstet Gynecol. March 2008;111:3: 753-760

Background on OB/Gyn Infections Infection is one of the most common complications of cesarean

delivery 1,2

Endomyometritis : From 4% (scheduled C/S, intact) to 75% (prolonged labor,

Ruptured membranes3,5

Wound infection: Occur in 2.5% to 16% of cesareans4

Breakdown of surgical incision, caused by wound infection.6 ~2-9%

Studies/ Evidence:

1. Allen VM, et al. Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term. Obstet Gynecol. 2003;102:477-482. Abstract

2. Chaim W, Bashiri et al. Prevalence and clinical significance of postpartum endometritis and wound infection. Infect Dis Obstet Gynecol. 2000;8:77-82. Abstract

3. Hopkins L, Smaill F. Antibiotic prophylaxis regimens and drugs for cesarean section. Cochrane Database Syst Rev. 2000;(2):CD001136

4. Owen, J, Andrews, WW. Wound complications after cesarean sections. Clin Obstet Gynecol. 1994; 37:842

5. Tita, Alan T. N.;et al. Emerging Cocepts in in antibiotic prophylaxis for cesarean delivery. Obstetrics & Gynecology . 113(3):675-682, March 2009.

6. REID, VC. Vaginal Preparation With Povidone Iodine and Postcesarean Infectious Morbidity: A Randomized Controlled Tria Obstetrics & Gynecology l. January 2001 - Volume 97 - Issue 1 - p 147-152

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C-Section Infections • 15 to 80% of post-C-section

infections, particularly those involving wounds, may actually occur after initial discharge

from the hospital.

• Underestimation of the incidence of post-cesarean infection is

pervasive.

Tita, Alan T. N.; Rouse, Dwight J et al. Obstetrics & Gynecology .

113(3): 675-682, March 2009

Wound Infections in Gyn Surgery

• Overall wound infection rate 12%

• 6% detected during the initial hospital stay

• 35.7% required an additional surgical procedure

• 50% of the patients with infection required readmission

Aparna Kamat et al. Wound Infections in Gyn Surgery. Infectious Diseases in Obstetrics and

Gynecology. Volume 8 (2000), Issue 5-6, Pages 230-234

Surgical Wound Classification System

• Class I (Clean): Uninfected field without GI/GU entry.

• Class II (Clean-contaminated): GI/GU surgery. Vaginal Surgery. No evidence active infection

• Class III (contaminated): Major breaks in sterile technique,GI spillage. Incision with acute,nonpurulent inflammation.

• Class IV (Dirty): Perforated viscera or acute clinical infection active.

ACOG Practice Bulletin: Antibiotic prophylaxis for Gyn procedures. Number 104,

May 2009; 1180-1187

SSI In the Ob/Gyn Current Literature

Sullivan SA, Smith T, Chang E. et al. Administration of cefazolin prior to skin incision is superior to cefazolin at cord clamping in preventng postcesarean infectious morbidity: a randomized, controlled trial. AmJ Obstet Gynecol. 2007;197:333-334

Gardella, Carolyn; Goltra, Lynne Bartholomew; Laschansky, Ellen; Drolette, Linda; Magaret, Amalia; Chadwick, H S.; Eschenbach, David. High-Concentration Supplemental Perioperative Oxygen to Reduce the Incidence of Postcesarean Surgical Site Infection: A Randomized Controlled Trial. Obstetrics & Gynecology . 112(3):545-552, September 2008

Walsh, Christine; Scaife, Courtney; Hopf, Harriet . Prevention and management of surgical site infextions in morbidly obese women. Obstetrics & Gynecology . 113(2, Part 1):411-415, February 2009

Tita, Alan T. N.; Rouse, Dwight J.; Blackwell, Sean; Saade, George R.; Spong, Catherine Y.; Andrews, William W. Emerging Cocepts in in antibiotic prophylaxis for cesarean delivery. Obstetrics & Gynecology . 113(3):675-682, March 2009.

Clara Bodelon, PhD, et al. Factors Associated With Peripartum Hysterectomy. JULY 2009 OBSTETRICS & GYNECOLOGY VOL.114, NO. 1,

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SSI In ACOG Literature: Wound Focus

1. Vermillion et al. Wound infection after CS, effect of the subcutaneous tissue. Obstet Gynecology. 2000. Conclusion: increased subcutaneous thickness= more risk SSI 2. Vertical Skin Incision and wound infection in the obese partuient. Obstet Gynecol. 2003 Conclusion: vertical skin worse than low transverse for infection 3. Ramsey et al. Subcutaneous tissue closure with or without drain in the obese patient. Obstet Gynecol. 2005 Conclusion: drain addition no better than suture alone for wound reduction. Drain may increase infection 4. Walsh et al. Prevention and management of SSI in obese patients. Obstet Gynecol. 2009. Conclusion: close subcutaneous skin if more than 2 cm for decreased wound complications

Current techniques – Surgical Site Infections

Two Categories (Cesarean Section) SSI:

• Metritis/Endometritis (Organ SSI)

• Abdominal incision:

- Deep Wound

- Superficial

- The Centers for Disease Control and Prevention/National Nosocomial

Infections Surveillance (NNIS) program (CDC, 1996).

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Current techniques – Surgical Site Infections Cesarean SSI Rate between 5-10%1,2

Independent Risk Factors for SSI: • Prolonged Operating time >38 min

• BMI > 30 • Wound Hematoma

• Lack of Perioperative Antibiotics/Timing

• Use of Skin Staples

1. Olsen MA; Butler AM; Willers DM. Risk factors for surgical site infection after low transverse cesarean section.Infect Contol Hosp Epidemiol.2008;29 (6): 477-84, discussion 485-6.

2. Opoien HK. Post-cesarean surgical site infections according to CDC standards: rates and risk factors. A prospective cohort study.Acta Obstet Gynecol Scanda.2007;86 (9):1097-102.

3. Tita, Alan T. N.; Rouse, Dwight J.; Blackwell, Sean; Saade, George R.; Spong, Catherine Y.; Andrews, William W. Emerging Cocepts in in antibiotic prophylaxis for cesarean delivery. Obstetrics & Gynecology . 113(3):675-682, March 2009.

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Staples vs. Suture at Cesarean

• 30th Annual Meeting: Society MFM February 1- 6, 2010 Chicago, IL

• C/S Cohort • Prospective RCT, N= 416 • Staples (197) vs 4-0 monocryl (219) • Wound separation: staples (17%), suture (5%) • COMPOSITE wound complication rate: Staple (22%), suture (9%)

Suzanne Basha, Meredith Rochon, Joanne Quinones, Kara Coassolo, Orion Rust, John Smulian. A randomized controlled trial of wound complication rates of subcuticular suture vs staples for skin closure at cesarean delivery American Journal of Obstetrics and Gynecology, Volume 201, Issue 6, Supplement 1, December 2009, Page S4

Staples and SSI: Orthopedics

• BMJ March 2010

Meta-analysis to compare the clinical outcomes after ortho

surgery using wound closure with staples vs sutures • 6 publications ( 683 wounds )

332 patients =sutures 351= staples.

• Compared with suture closure, staple closure associated with more 3X risk of superficial wound infection after ortho surgery (RR, 3.83; 95% CI, 1.38 - 10.68; P = .01).

• hip surgery: risk for development of a wound infection 4 times

greater with staples vs sutures (RR, 4.79, 95% CI, 1.24 - 18.47; P = .02). B I Singh, C Mcgarvey. BMJ. March 2010;340:c403 Stplaes and Orthopedic Skin infections.

Tools for SSI Reduction – Antibiotic prophylaxis (timing) 1,2

– Scrubbing

– Gowning, Gloving

– Prevention of hypothermia

– Antimicrobial skin prep

– Aseptic technique

– Plus Antibacterial Sutures

– DERMABOND* Topical Skin Adhesive

1. Tita, Alan T. N.; Rouse, Dwight J.; Blackwell, Sean; Saade, George R.; Spong, Catherine Y.; Andrews, William W. Emerging Cocepts in in antibiotic prophylaxis for cesarean delivery. Obstetrics & Gynecology . 113(3):675-682, March 2009.

2. Owens, Stephanie M.; Brozanski, Beverly S.; Meyn, Leslie A.; Wiesenfeld, Harold C. Antibiotiic prophlyaxis at cesartean before skin incision. Obstetrics & Gynecology . 114(3):573-579, September 2009.

Antibacterial Sutures

PLUS Antibacterial Sutures: Kill bacteria and inhibit colonization of the suture1

Proven in vitro to create a zone of inhibition around the suture against the most common surgical site pathogens2

Staphylococcus aureus

Staphylococcus epidermidis

Methicillin-resistant Staphylococcus aureus (MRSA)

Methicillin-resistant Staphylococcus epidermidis (MRSE)

In vivo testing shows MONOCRYL* Plus Antibacterial (poliglecaprone 25) Suture and PDS* Plus Antibacterial (Polydioxanone) Suture kill bacteria and inhibit colonization of the suture3:

E. coli

Klebsiella pneumoniae

1. Storch ML, Rothenburger SJ, Jacinto G Experimental Efficacy Study of Coated VICRYL plus Antibacterial Suture in Guinea Pigs Challenged with Staphylococcus aureus. Surg Infect J. 2004;5 :281-288.

2. Rothenburger S, Spangler D, Bhende S, Burkley D In Vitro Antimicrobial Evaluation of Coated VICRYL* Plus Antibacterial Suture (Coated Polyglactin 910 with Triclosan) using Zone of Inhibition Assays. Surg Infect J. 2002;3: S79-S87.

3. Data on file, ETHICON Inc.

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* Trademark

IRGACARE® MP (Triclosan) Properties

• IRGACARE MP

– 2,4,4′-tri-chloro-2′-hydroxydiphenyl ether

– High-purity material that meets USP specifications for triclosan, with minimal residue content

• IRGACARE MP is safe

– Biocompatible, nontoxic

– Consumer products • Mouthwash, toothpaste, soaps,

cosmetics

• IRGACARE MP is effective

– Active against methicillin-sensitive and methicillin-resistant S aureus and S epidermidis (most common for device infections)

– Active against Escherichia coli and Klebsiella pneumoniae

• IRGACARE MP is compatible with suture processing

– Maintains excellent suture properties

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USP=United States Pharmacopeia.

Zurita R et al. Macromol Biosci. 2006;6:58-69.

Ming Xet al. Surg Infect (Larchmt). 2007;8:201-207.

Ming X et al. Surg Infect (Larchmt). 2008;9:451-457.

Barbolt TA. Surg Infect (Larchmt). 2002;3(suppl 1):S45-S53.

“…all surgical wounds become contaminated to some degree – the primary determinant whether the contamination is established as a clinical infection is host (a competent) defense…”

Belda et al., JAMA 2005;294:2035-2042

J Am Coll Surg 2006;203:481-489

Mean Microbial Recovery from Standard Polyglactin 910 Sutures (V) and Triclosan-Coated Polyglactin 910

Braided Sutures (VT)

0

25

50

75

100

125

150

175

200

225

250

275

300

Exposure Time 2 Minutes

S. aureus (MRSA)

E. coli

V

VT

p<0.01 102 105 102 105 102 105

N=10

Me

an c

olo

ny

form

ing

un

its

(c

fu)/

cm s

utu

re

S. epidermidis RP62A

Edmiston et al, J Am Coll Surg 2006;203:481-489

Impact of 20% Bovine Serum Albumin (BSA) on Mean Microbial Recovery from Standard Polyglactin 910 Sutures and

Triclosan-Coated Polyglactin 910 Braided Sutures (VT)

0

100

200

300

400

Mea

n c

olo

ny

form

ing

un

its

(c

fu)/

cm s

utu

re

S. aureus (105) MRSA

Escherichia coli (105)

V + 20% BSA

V

VT

VT + 20% BSA

N=10

V + 20% BSA

Edmiston et al, J Am Coll Surg 2006;203:481-489

p<0.01

Suture with Staphylococcus colonies

Air settling plates in the operating room at the last hour of a total joint case

Potential for Contamination of Sutures at End of Case

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New England Baptist Hospital

Antibacterial Suture Staph aureus Culture Plate Study

• A pure culture - 0.5 MacFarland Broth - of Staph aureus was prepared on a plate

• A coated antibacterial suture was aseptically cut and planted and incubated for 24 hrs

• Photo #1 shows zone of inhibition at day 5

• Photo # 2 shows zone of inhibition at day 10

• Plate on right is a non-coated suture. Staph aureus growth right over it

5 day zone of inhibition

10 day zone of inhibition

PLUS Antibacterial Sutures: Published Data/ Evidence Based Recommendations

Gomez-Alonso A, Garcia-Criado F J, Garcia-Sanchez J E, et al. Study of the efficacy of

Coated VICRYL Plus Antibacterial Suture (coated Polglactin 910 suture with Triclosan) in two animal models of general surgery. J Infect 2007;54:82-8.

Ford HR, et al. Intraoperative handling and wound healing: controlled clinical trial comparing coated VICRYL plus antibacterial suture (coated polyglactin 910 suture with triclosan) with coated VICRYL suture (coated polyglactin 910 suture). Surgical Infections. 6(3):313-21, 2005.

Edmiston CE, et al. Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination? Journal of the American College of Surgeons. 203(4):481-9, 2006 Oct .

Barbolt T. Chemistry and safety of Triclosan, and its use as an antimicrobial coating on Coated Vicryl Plus antibacterial suture. Surg Infect (Larchmt) 2002;3:S45-53.

Slater-Radosti C, Van Aller G, Greenwood R, et al. Biochemical and genetic characterization of the action of triclosan on Staphylococcus aureus. J Antimicrob Chemother 2001; 48:1-6.

Storch M, Rothenburger S, Jacinto G. Experimental efficacy study of coated VICRYL Plus antibacterial suture in guinea pigs challenged with Staphylococcus aureus. Surg Infect (Larchmt) 2004;5(3):281-8.

Katz S, Izhar M, Mirelman D. Bacterial adherence to surgical sutures. Ann Surg 1981;194:35-41.

Costerton JW, Lewandowski Z, Caldwell DE, Korber DR, Lappin-Scott HM. Microbial biofilms. Ann Rev Microbiol 1995;49:711-45.

Brown MRW, Gilbert P. Sensitivity of biofilms to antimicrobial agents. J Appl Bacteriol 1993;74:S87-97.

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DERMABOND® Topical Skin Adhesive

• The Final Layer of Protection

25

Skin Closure Techniques

• DERMABOND® Topical Skin Adhesive – Works like glue to hold edges of skin together

– Areas do not have to be kept dry during healing

– Bandages are often not required

– Forms a strong, flexible bond fast

– The adhesive "sheds" from the skin naturally as the wound heals

– No sutures to remove

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Skin Closure Techniques • FDA Approves Use of DERMABOND Adhesive to Seal Out

Infection-Causing Bacteria; First Wound-Closure Technology Approved to Protect Wounds & Incisions From Common Microbes.

PR Newswire| January 16, 2002 | Copyright

“ETHICON Products announced today that DERMABOND* Topical Skin Adhesive (2-octyl cyanoacrylate) can act as a barrier against bacterial microbes. The microbial barrier provided by DERMABOND Adhesive seals out the most common infection-causing bacteria, including certain staph, pseudomonas and E. coli. “…..

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DERMABOND® Topical Skin Adhesive

8-carbon side-chain Plasticizers for flexible bond and high wound-

closure strength High viscosity = greater application control May be used without dressings*

Patient may shower immediately Clinically proven to close long incisions2

Gentler on the skin3,4

1. DERMABOND® Adhesive Instructions For Use. Somerville, NJ: ETHICON, INC; 2003 2. Blondeel P, et al. Closure of long surgical incisions with a new formulation of Octyl cyanoacrylate tissue

adhesive vs. commercially available methods. AJS. In press. 3. Quinn,J. A Randomized trial comparing Octyl cyanoacrylate tissue adhesive and sutures in the

management of lacerations.JAMA. 1997 May 21(19):1527-30. 4. Toriumi DM, O’Grady K, Desai D, Bagal A. Use of Octyl-2-cyanoacrylate for skin closure in facial plastic

surgery. Plast Reconstr Surg. 1998;102:2209-2219.

Topical Skin Adhesive: Octyl versus Butyl

1. Perry LC. An evaluation of acute incisional strength with tramumaseal surgical tissue adhesive wound closure. Findings by: Dimensional Analysis Systems, Inc., Leonia, NJ. 1995

2. Singer, Adam J. In Vivo study of wound bursting strength and compliance of topical skin adhesives. Acad Emerg Med. Dec 2008. 15(12): 1290-1294

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OB/Gyn Surgeries

• DERMABOND® Topical Skin Adhesive can be used for topical skin closure in: - Cesarean section - Total abdominal hysterectomy - Tuboplasty - Minimally invasive procedures

DERMABOND® Topical Skin Adhesive

• DERMABOND® Adhesive is clinically proven to close skin effectively in long incisions up to 69 cm1,2 making it appropriate for C-sections and abdominal hysterectomies

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1. Blondeel P, et al. Closure of long surgical incisions with a new formulation of Octyl cyanoacrylate tissue adhesive vs. commercially available methods. AJS. In press.

2. Quinn,J. A Randomized trial comparing Octyl cyanoacrylate tissue adhesive and sutures in the management of lacerations.JAMA. 1997 May 21(19):1559-60.

Incisional Adhesive Skin Closure

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(With Subcuticular Stitch) Abdomino-plasty

(Without Subcuticular stitch) (Neck) Thyroidectomy

Courtesy: Plastic Surgery, ENT Methodist Medical Center Dallas

Benefits for surgeons, nurses, patients, and hospitals

Physician, Hospital -centered Benefits

• Proven microbial barrier for lasting protection

• 7 days of wound healing strength in 3 minutes for strong

closure and peace of mind

• No time spent removing staples or sutures

• Reduces needle stick exposure

• Increases patient satisfaction

• Reduced Hospitalization Costs

Nurse, Patient -centered Benefits

•Reduces number of suture set ups

•Ease of Post Op wound checks

•Reduces number of wound dressings

•Shower immediately

•Excellent Cosmesis

Incisional Adhesive on Total Knee Incision

Adhesive and Antimicrobial Dressing

Healed Dermabond incision

Total hip incision with dermabond and AMD

Rotator Cuffs and Total Shoulders

•Rotator cuff and total shoulders

• incisional adhesive (Dermabond)

• AMD gauze (not really necessary)

• Transparent Dressing until discharge

•No staples

•Since implementation, no infections in > 300 total shoulders

Steri-strips over Dermabond

DB: Evidence Based Recommendations

The Efficacy of cyanoacrlylate derived surgical adhesive for use repair of lacs during competitive The American Journal of Emergency Medicine, Volume 18, Issue 3, May 2000, Pages 261-263 Andrew D. Perron, Joseph A. Garcia, E. Parker Hays, Robert Schafermeyer

Ocylt-Cyanoacyrlate tissue adhesive vs suture wound repair in a contaiminated wound model. Surgery, Volume 122, Issue 1, July 1997, Pages 69-72 Jim Quinn, Jennifer Maw, Karam Ramotar, Georg Wenckebach, George Wells

Octyl-2-Cyanoacrylate Adhesive for Skin Closure and Prevention of Infection in

Plastic Surgery Alessandro Silvestri , et. al Aestheic Plastic Surgery (Online)Issue Vol 30 (6) Dec 2006

Tissue Adhesive vs suture wound repair at 1 yr: RCT correlating early, 3 month and 1 yr

cosmetic outcomes, Annals of Emergency Medicine, Volume 32, Issue 6, December 1998, Pages 645-649

James Quinn, George Wells, Terri Sutcliffe, Mario Jarmuske, Jennifer Maw, Ian Stiell, Peter Johns

Closure of long surgical incisions using new formulation of octylcyanoacyrlate tissue

adhesive vx commercially available methods, The American Journal of Surgery, Volume 188, Issue 3, September 2004, Pages 307-313 Phillip N. V. Blondeel, John W. Murphy, Denis Debrosse, James C. Nix III, Larry E. Puls, Nicholas Theodore, Paul Coulthard

CONTRAINDICATIONS

• Do not use on any wound with evidence of active infection, gangrene, or wounds of decubitus etiology.

• Do not use on mucosal surfaces or across mucocutaneous junctions (e.g., oral cavity, lips), or on skin which may be regularly exposed to body fluids or with dense natural hair, (e.g., scalp).

• Do not use on patients with a known hypersensitivity to cyanoacrylate or formaldehyde.

38

Needlestick Safety and Prevention Act

• Signed by Congress of the United States of America on Nov.6, 2000

• Sec.3. Bloodborne pathogens standard1

– (4) In addition to the existing requirements concerning exposure control plans,

the review and update of such plans shall be required to also:

• (A) Reflect changes in technology that eliminate or reduce exposure to

bloodborne pathogens

• (B) Document annually consideration and implementation of appropriate

commercially available and effective safer medical devices designed to

eliminate or minimize occupational exposure.

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1. Needlestick Safety and Prevention Act --H.R.5178—(Law 106 430

Nov 6, 2000) One Hundred Sixth Congress of the United States of

America

Safety and Health Information Bulletin1 (03-23-2007)

• Developed by:

– OSHA (Occupational Safety and Health Administration), Department of Labor

– NIOSH (National Institute for Occupational Safety and Health)

– CDC (Centers for Disease Control and Prevention), Department of Health and Human Services.

• Background:

– ACS and AORN both endorsed the statement—”all published studies to date have demonstrated that the use of blunt suture needles can substantially reduce or eliminate needle stick injuries from surgical needles”

• Conclusion:

– Employer must use safer devices to replace corresponding conventional sharp-tip suture needles in their workplaces when clinically appropriate

– Where an employer has determined that the use of available safer devices is not feasible, the clinical justification for this determination must be documented in the facility’s Exposure Control Plan

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(To be Cont’d)

1. Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuries to Surgical

Personnel. SHIB 03–23–2007 • DHHS (NIOSH) Publication No. 2008–101

Safety and Health Information Bulletin1 (03-23-2007)

• Blunt-tip suture needles are identified by OSHA as an example to reduce percutaneous

injuries.

41

Evidence of Effectiveness of Blunt-Tip Suture Needles

1. Use of Blunt-Tip Suture Needlesto Decrease Percutaneous Injuriesto Surgical Personnel. SHIB

03–23–2007 • DHHS (NIOSH) Publication No. 2008–101

In 1997, Mendelson and colleagues reported that, after the introduction of blunt tip needles in 3 hospitals, the use

of blunt-tip suture needles rose to nearly 50% and the rate of percutaneous injuries was reduced by over 75%

Suture Needle Injuries

42

From: Jagger J, Bentley M, Tereskerz P. A study of patterns and prevention of blood exposures in OR personnel.

AORN Journal 1998; 67(5):979-996

Used to suture muscle or fascia

59%

Used to suture skin or other

tissue41%

Potentially Preventable Suture Needle Injuries

Preventable with the use of blunt suture needles

Many are preventable by substituting

alternative methods of skin closure

6 hospitals, 15 months, 197 suture needle injuries

Information from Jane Perry, Janine Jagger. A Surgeon, a Suture

Needle—and Hepatitis C. Vol.5, no. 6, 2001

Suture Needle Injuries

Surveillance data from 87 US Hospitals

Injuries increased 6.5% in surgical settings

Injuries were due to:

Suture needles (43.4%)

Scalpels (17%)

Syringes (12%)

Recent Literature on blunt needles

• Preventing Needlestick Injuries in Obstetrics and Gynecology : How Can We Improve the Use of Blunt Tip Needles in Practice?

• CATANZARITE Val ; BYRD Kevin ; MCNAMARA Mike ; BOMBARD Allan • Surgical needlestick injuries are common in obstetrics and gynecology and can cause

transmission of viral diseases including hepatitis and acquired immunodeficiency syndrome (AIDS). Strategies to reduce the rate of needlestick injuries include using instruments rather than fingers to retract tissue and grasp needles, double gloving, using surgical staplers for skin closure, and substituting blunt tip surgical needles for sharp tip needles where applicable. Studies have shown the use of blunt tip surgical needles to be remarkably effective in reducing needlestick injuries. Despite recommendations by the American College of Surgeons that blunt tip surgical needles be used routinely, at least for fascial closure, and by the Occupational Safety and Health Administration and the National Institute for Occupational Health and Safety that these devices be used whenever medically appropriate, use in obstetrics and gynecology appears to be limited. Potential barriers to use include availability, the "feel" of the needle as it penetrates tissue, and habit. We suggest that blunt tip surgical needles have the potential to replace traditional needles for many obstetric and gynecologic applications. If their use is to become more widespread, we must focus on availability, evaluation for specific applications, and physician education.

Obstetrics and gynecology 2007, vol. 110, no6, pp. 1399-1403

Recent Literature on Blunt Needles

• Winchell, Sara J.; Perlow, Jordan H. Blunt Suture Needle Use in Laceration and Episiotomy Repair at Vaginal Delivery.Obstetrics & Gynecology . 107(4):29S, April 2006.

• Catanzarite, Val; Byrd, Kevin; McNamara, Mike; Bombard, Allan. Preventing Needlestick Injuries in Obstetrics and Gynecology: How Can We Improve the Use of Blunt Tip Needles in Practice? Obstetrics & Gynecology . 110(6):1399-1403, December 2007.

• Mornar, S. et al. Blunt suture needle use in laceration and episiotomy repair at vaginal delivery . Am J Obstet Gynecol. 198 (5):e14-e15, May 2008

• Sullivan, Scott; Williamson, Bridget; Wilson, Lisa K.; Korte, Jeffrey E.; Soper, David. Blunt Needles for the Reduction of Needlestick Injuries During Cesarean Delivery: A Randomized Controlled Trial. Obstetrics & Gynecology . 114(2, Part 1):211-216, August 2009.

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Summary

• Ob/Gyns are responsible for the two most common surgeries in reproductive age women.

• Plus Antibacterial Suture kill bacteria and inhibit colonization of the suture1

• Blunt Needles aid in prevention of needle-stick injuries and protect the patient and clinical staff

• Closure with topical liquid adhesive may decrease risks of dermal infection, and improve patient satisfaction

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