CHICAGO Most of the estimated 1,000 suture needle sticks endured by surgeons and surgical residents in the United States each day can be prevented by protecting the needle point within the needle driver, according to Dr. Joy Kunishige.
"Before the needle and needle driver are either handed off to the assistant or returned to the surgical tray, pivot the needle 90 degrees toward the instrument joint," said Dr. Kunishige, a dermatology resident at the University of Texas M.D. Anderson Cancer Center in Houston.
"Next, close the needle driver on the body near, but not on, the shank of the needle," she said. "The needle point should be directed toward and almost touching the driver, thereby disarming the needle point."
To avoid dulling the needle, do not grasp the point by the needle driver, Dr. Kunishige said during a poster presentation at the annual meeting of the American Society for Dermatologic Surgery.
"These precautions are especially important in Mohs surgery because you're using the same tray and the same instruments throughout the procedure," she said in an interview. "If your procedure involves three layers, you're going to use the instrument three times plus once more for reconstruction, so the sharps is being constantly moved around, potentially exposing several people to the risk of a needle stick."
A simple and inexpensive solution for disarming a needle that is being temporarily put aside is to use a brightly colored piece of foam, such as that available at arts and crafts stores. "We keep the foam piece in the upper right-hand corner of the field and just stick our needle into that," Dr. Kunishige said.
The worst mistake is to leave an exposed needle on a patient's chest where it can fall when the patient moves. "Placing a tray on a patient's chest can be a mine field," she said.
Even when a needle stick does not cause infection, follow-up testing can cost up to $3,000, she added.
"If you make these little precautions habitual, you'll greatly reduce the risk of needle sticks in your workplace," Dr. Kunishige concluded.
The needle should be grasped in the needle driver as shown in the image above to avoid exposing the point. Courtesy Dr. Joy Kunishige