Hands-free Technique Research Articles

Hands-free technique in the operating room: reduction in body fluid exposure and the value of a training video.

This study sought to determine if (1) using a hands-free technique (HFT)--whereby no two surgical team members touch the same sharp item simultaneously--> or = 75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to > or = 75%, immediately and over time. During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when > or = 75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2. A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for > or = 75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of > or = 75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later. The use of HFT and the HFT video were both found to be effective.

Sharps Injury Reporting Amongst Surgeons

The aim of this study was to evaluate the level of sharps injury reporting amongst surgeons. A total of 164 surgeons completed a questionnaire on the reporting of sharps injuries, on the reasons for not reporting and their practise of universal precautions. Out of 164 surgeons, only 25.8% had reported all their injuries, 22.5% had reported some and 51.7% had reported none. The top three reasons for not reporting their injuries included perception of low risk of transmission, not being concerned and no time. Of the respondents, 15.9% practised all three universal precautions of double-gloving, face shields and hands-free technique. We showed that despite local trust adherence to Department of Health policy, sharps injury reporting rates are inadequate. Further investment into healthcare worker education as well as a facilitation of the process of reporting may be necessary to improve reporting rates.

Accidental exposures to blood and body fluid in the operation room and the issue of underreporting

A retrospective review of all exposure injuries affecting members of the operative care line at a single university hospital between January 2000 and December 2007 was performed. A questionnaire survey on current status of adherence to barrier precautions was also completed by 164 staff members. Of 136 exposure injuries, 87 (64.0%) were in surgeons, and 49 (36.0%) were in scrub nurses. Surgeons were most commonly injured during suturing (49, 56%), followed by "handing over sharps" (7, 8%), whereas scrub nurses were most commonly injured during "counting and sorting of sharps" (15, 41%), followed by "handing over sharps," and "splash." The questionnaire survey revealed that compliance with goggles, face shields, and double gloving was poor, and only 9% of respondents routinely used the hands-free technique. Only 22% of staff who had experienced exposure injuries reported every incident. Because circumstances of exposure injuries in operating rooms differ by profession, appropriate preventive measures should address individual situations. To reduce exposure injuries in the operating room, further efforts are required including education, mentoring, and competency training for operation personnel.

Use of hands-free technique among operating room nurses in the Republic of Korea

The recently introduced concept of hands-free technique (HFT) currently has no recommendations or formal educational program for use in the Republic of Korea. This study evaluated the level of HFT use and investigated factors related to HFT use among Korean operating room nurses. Data were obtained through a self-administered questionnaire from 158 operating room nurses in 7 general hospitals in Busan, Republic of Korea, in April and May 2006. The questionnaire elicited information on demographics, exposure to education on HFT, attitude toward the need for HFT, concerns about exposure to bloodborne pathogens, and experience with HTF use. Multilevel multiple logistic regression analysis with generalized estimating equations was used, and adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. We found that 56% of the participants had used HFT, and 50% had received education on HFT. The use of HFT had a significant association with both education on HFT (OR = 12.02; 95% CI = 7.50 to 19.25) and attitude toward the need for HFT (OR = 4.22; 95% CI = 2.43 to 7.35). Increasing education about HFT could be the most important approach to increasing the use of HFT among Korean operating room nurses. Thus, routine teaching about HFT should be provided to these nurses.

Use of Hands-Free Technique among Operating Room Nurses, Republic of Korea

Use of Hands-Free Technique among Operating Room Nurses, Republic of Korea

USING GOAL SETTING, TASK CLARIFICATION, AND FEEDBACK TO INCREASE THE USE OF THE HANDS‐FREE TECHNIQUE BY HOSPITAL OPERATING ROOM STAFF

We evaluated the effects of a behavioral treatment on the safe passing of sharp instruments using the hands-free technique among hospital operating room personnel during surgical procedures. Treatment consisted of participative goal setting, task clarification, and feedback. The average percentage of sharp instruments passed safely increased from 32% to 64% and 31% to 70% between baseline and treatment phases in the inpatient and outpatient surgery units, respectively. Five-month follow-up data suggested maintenance of treatment effects. These findings suggest the utility of organizational behavior management strategies in reducing risky behavior in hospital settings.

Workplace Safety Climate and Incivility Among British Columbia and Ontario Operating Room Nurses: A Preliminary Investigation

Poor safety climate and incivility have been linked to worse work organization-related practices and high accident rates. This study investigates the influence of safety climate and incivility on the use of a recommended operating room (OR) practice, the hands-free technique (HFT), among OR nurses in four hospitals in Ontario and British Columbia. Of the 87 nurses who completed self-administered questionnaires, 82% perceived safety climate as “not good” and 49% reported supervisor incivility. Incivility correlated with worse safety climate on the communication/conflict subscale. Better safety climate on the management support subscale and less supervisor incivility predicted HFT use.

Using Goal Setting, Task Clarification, and Feedback to Increase the Use of the Hands-Free Technique by Hospital Operating Room Staff

Using Goal Setting, Task Clarification, and Feedback to Increase the Use of the Hands-Free Technique by Hospital Operating Room Staff

Using Goal Setting, Task Clarification, and Feedback to Increase the Use of the Hands-Free Technique by Hospital Operating Room Staff

Using Goal Setting, Task Clarification, and Feedback to Increase the Use of the Hands-Free Technique by Hospital Operating Room Staff

Hands-Free Technique: Preventing Occupational Exposure during Surgery

Occupational exposure to blood borne pathogens has led to HBV, HCV and HIV infections among surgeons, nurses and other operating room (OR) personnel and, to a lesser degree, patients (Ross et al 2000, The incident investigation teams and others 1997). Of seven OR studies in which an observer or circulating nurse recorded exposures, there was a percuataneous injury in 1.7-15% of all surgeries, and a mucocutaneous contamination in 6.2-50% of all surgeries. (Gerberding et al 1990, Panlilio et al 1991, Popejoy & Fry 1991, Quebbeman et al 1991, Tokars et al 1992, Lynch & White 1993, Stringer, Infante-Rivard & Hanley 2002). Surgeons and residents usually sustained the greatest number of percutaneous and other exposures during surgery.

Perioperative Use of the Hands-Free Technique: A Semistructured Interview Study

OCCUPATIONALLY CONTRACTED bloodborne infections are preventable, but the use of many protective measures remains limited. THERE IS GROWING EVIDENCE that the use of the hands-free technique (HFT) to pass sharp items during surgical procedures is effective in protecting against sharps injury and bloody contamination. RESEARCHERS CONDUCTED in-depth telephone interviews to explore 20 health care providers' knowledge and use of the HFT. MOST OF THE INTERVIEWEES did not regularly use the HFT, and some were resistant to its use.

Evaluation of techniques for treating the bleeding wound

Background: Despite the fact that the urgent control of active bleeding from external body surfaces demands a basic procedure, it is puzzling that this topic has received little if any attention in modern medical research. Elastic adhesive dressing (ELAD) has been proposed for dressing the bleeding wound. Methods and materials: Three techniques were compared over a simulated wound in a human model. Pressures generated between the chosen dressing surface and the underlying mock wound’s cutaneous surface, time consumption, convenience, satisfaction and pain were tested for each technique. Results: Sixty-eight experiments were performed over nine separate anatomical sites. Average pressures for field dressing, ELAD and manual compression were 33, 88 and 180 mmHg, respectively; these differences in pressure were statistically significant. Manual pressure was equally inconvenient for both patient and caregiver. The more proximal and wider anatomical regions were more difficult and time consuming to compress. The caregivers graded ELAD the highest level of convenience and general satisfaction. Conclusions: Field bandage testing reflected its inadequacy in controlling bleeding from most body regions. The results suggest that ELAD may be the hands-free technique of choice. We hope that this article will stimulate further research and elicit evidence on precisely which technique is most suitable for various anatomical location.

Effectiveness of the hands-free technique in reducing operating theatre injuries

Background: Operating theatre personnel are at increased risk for transmission of blood borne pathogens when passing sharp instruments. The hands-free technique, whereby a tray or other means are used to...

Biological indicators; sterile storage; hands-free technique; instrument counts; ceramic tile in the OR

Biological indicators; sterile storage; hands-free technique; instrument counts; ceramic tile in the OR