Canadian Medical Association Journal 1995; 153: 139 [letter]
The article "Reported use of strategies by surgeons to prevent transmission of bloodborne diseases" (Can Med Assoc J 1995; 152: 1089-1095 [abstract]), by Dr. James G. Wright, Nancy L. Young and Derek Stephens, and newspaper reports of HIV seroconversion due to a scalpel injury in an Italian surgeon (the first such case documented) illustrate the need for research on ways to prevent transmission of bloodborne diseases during surgery.
In the survey by Wright and colleagues, 92% of respondents reported a willingness to change the way they performed surgery to prevent transmission of bloodborne diseases, and 55% believed that there was too little research into ways of reducing the risk. Yet only 3.2% of respondents used the "no-touch" technique (also called the "hands-free" technique) and only 3.8% passed sharps in a basin.
As a third-year doctoral student in the Department of Occupational Health, Faculty of Medicine, McGill University, Montreal, I have developed a protocol to study the hands-free technique. This technique is defined as the indirect transfer of instruments between the surgeon or surgeons and other scrubbed personnel, during which neither person touches the same sharp item at the same time. This may involve placing sharps in a designated neutral zone -- a section of the surgical field or a container -- where they can be retrieved.
The hands-free technique has been recommended by the Royal College of Surgery, the Academy of Orthopaedic Surgeons, the Association of Operating Room Nurses and the US Centers for Disease Control and Prevention. Only one previous study assessed the technique, along with several other factors, and the findings were inconclusive.
Hence, although it is recommended, the hands-free technique has not yet been adequately subjected to the questions used to judge injury-control measures: Is the technique used? Is it used properly? Does it reduce injury when properly used?
Although use of the hands-free technique is related to only a portion of high-risk behaviour during surgery, the only way to evaluate injury reduction is to choose a few discrete practices, assess their use and compare accident levels before and after the introduction of the practices.
However, I have encountered difficulty in implementing my study because I cannot find a hospital in which at least 20% of surgical procedures are conducted with the use of the hands-free technique. The study would take 4 to 6 months in a moderately busy hospital and would involve gathering information from approximately 3000 procedures.
If any reader knows of a hospital that may meet the criteria for this study, please contact me through the Department of Occupational Health, Faculty of Medicine, McGill University, fax 514 398-7435.
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