Study on needle stick injuries during surgery and blunt needle use for reducing occupational exposure and hygiene benefits

Abstract

BACKGROUND:

The conventional round suture needle poses a significant risk of needle stick injuries among surgical physicians, identified as a global occupational hazard by the World Health Organization, increasing hospital costs and exposure to bloodborne pathogens. While novel blunt suture needles have shown promise in reducing these risks, their adoption is limited domestically, prompting a study to compare their efficacy against traditional sharp needles in reducing needle stick injuries among surgical physicians.

OBJECTIVE:

To investigate suture needle stick injuries among surgical doctors during operations and assess the application effectiveness of a novel blunt suture needle.

METHODS:

A total of 106 surgical department physicians from March 2021 to February 2023 participated in the study. After completing a questionnaire survey on suture needle injuries during surgery, the participants were divided into two groups. Over a 6-month intervention period, the control group used regular round needles while the study group utilized novel blunt suture needles. Subsequently, suture needle injury incidence rates and economic hygiene benefits were compared between the two groups.

RESULTS:

The suture needle injury questionnaire survey showed that over the past 6 months, among 106 surgical department physicians, 20 needle stick injuries occurred, yielding an incidence rate of 18.87%. The highest incidence (65.00%) was during suturing incisions longer than 10 cm, primarily when visibility was poor (70.00%). Surgeons linked most injuries (60.00%) to prolonged surgical duration causing fatigue. Although 85.00% detected injuries within 1 minute, only 40.00% were reported, often due to perceived reporting complexity. Following intervention, the study group had significantly fewer injuries per surgery and lower occupational exposure costs compared to the control group ( 0.05).

CONCLUSION:

Surgical department physicians commonly sustain suture needle injuries while suturing incisions of 5–10 cm length under poor visibility, exacerbated by prolonged surgical duration. Despite detecting most injuries within 1 minute, only 40% are reported. The implementation of novel blunt suture needles significantly decreases injury rates, resulting in reduced occupational exposure costs and favorable safety and economic hygiene outcomes.

1. Introduction

For surgical department physicians, the conventional round suture needle is an indispensable tool for suturing patients’ skin, soft tissues, or organs during surgical procedures. However, due to its sharp and penetrating nature, the conventional round suture needle significantly increases the risk of suture needle stick injuries for operating physicians, whether or not it causes skin damage and bleeding [1]. According to reports from the World Health Organization, suture needle stick injuries are a serious occupational hazard faced by healthcare workers today, with approximately 3 million healthcare workers globally exposed to suture needle stick injuries every day, significantly increasing occupational exposure cost expenditures for hospitals and adding to the economic burden of healthcare systems [2, 3]. Research also indicates that around 30 bloodborne pathogens can be transmitted through suture needle stick injuries in the operating room. Once infections are triggered, it not only causes substantial physical and mental harm to healthcare personnel but also imposes significant pressures, including time and economic burdens, on the individuals exposed and healthcare institutions [4, 5]. Studies have shown that compared to traditional sharp suture needles, the use of novel blunt suture needles in surgical procedures can significantly reduce the occupational exposure risk for surgical department physicians [6, 7]. Currently, novel blunt suture needles are recommended for some surgical suturing procedures in foreign countries. However, their domestic promotion and application are limited, and there is a lack of related research on clinical effectiveness. Therefore, based on the actual situation of surgical suturing in our hospital, this study investigates the occurrence of suture needle stick injuries among surgical department physicians during suturing. A novel blunt suture needle is employed in some surgical procedures, and a comparison is made with traditional sharp suture needles. The aim is to explore the feasibility of promoting the use of novel blunt suture needles to reduce the risk of suture needle stick injuries in occupational exposure and economic hygiene benefits. The results are as follows.

2. Materials and methods

2.1. General information

A total of 106 surgical department physicians from our hospital were selected as research subjects between March 2021 and February 2023. The participants were randomly divided into the control group and the study group, each consisting of 53 cases. The general information of the two groups, including gender, age, years of work, surgical department classification, educational background, etc., were well-balanced ($p>$ 0.05), ensuring comparability (Table 1).

Table 1.

Comparison of general information between two groups

General information		Control group ($n=$ 53)	Study group ($n=$ 53)	Statistical values	$p$
Age ($\overline{x}\pm s$, year)		40.23 $\pm$ 10.26	40.08 $\pm$ 10.41	$t=$ 0.075	0.941
Years of work (%)	1–5 years (including 5 years)	10 (18.87)	10 (18.87)	${\chi }^2=$ 0.186	0.911
	5–10 years	20 (37.74)	22 (41.51)
	$⩾$ 10 years	23 (43.40)	21 (39.62)
Gender (%)	Male	26 (49.06)	28 (52.83)	${\chi }^2=$ 0.151	0.698
	Female	27 (50.94)	25 (47.17)
Surgical department	Orthopedics	9 (16.98)	10 (18.87)	${\chi }^2=$ 1.036	0.960
classification (%)	Obstetrics and gynecology	8 (15.09)	9 (16.98)
	Cardiothoracic surgery	8 (15.09)	8 (15.09)
	General surgery	12 (22.64)	8 (15.09)
	Urology	10 (18.87)	11 (20.75)
	Neurosurgery	6 (11.32)	7 (13.21)
Educational background(%)	Master and above	15 (28.30)	17 (32.08)	${\chi }^2=$ 0.179	0.672
	Below master	38 (71.70)	36 (67.92)

2.2. Survey content

A total of 106 surgical department physicians were surveyed, and all underwent a questionnaire regarding suture needle stick injuries during surgical suturing. The questionnaire covered five aspects: (1) Occurrences of suture needle stick injuries among surgical department physicians in the past month, including whether suture needle stick injuries occurred, and the length of the incision when suture needle stick injuries occurred. (2) Timing of suture needle stick injuries. (3) Causes for suture needle stick injuries. (4) Time to physicians detection of suture needle stick injuries. (5) Actions taken after suture needle stick injuries, including whether incidents were reported and reasons for non-reporting.

2.3. Intervention methods

After completing the questionnaire survey on suture needle stick injuries during surgery, physicians in the control group continued to use traditional round needles, while the study group used a novel type of blunt suture needle (Ethiguard III). Both groups underwent a 3-month intervention, with strict training on surgical operation application, suture needle stick injury risk management, and reporting during the intervention period. This ensured a 100% reporting rate of suture needle stick injuries among surgical department physicians during surgery.

2.4. Observation indicators

(1) Suture needle stick injury questionnaire survey results, including the occurrence of suture needle stick injuries among surgical department physicians in the past month, timing of suture needle stick injuries, causes for suture needle stick injuries, time to physicians detection of suture needle stick injuries, and actions taken after suture needle stick injuries. (2) Suture needle stick injury occurrences in both groups, including the number of surgeries performed and the number of suture needle stick injuries before and during the intervention. The average number of suture needle stick injuries per surgical procedure was calculated. (3) Economic hygiene benefits. Compare the per capita occupational exposure cost expenditures after interventions in the two groups.

2.5. Statistical analysis

Statistic Package for Social Science (SPSS) 22.0 software (IBM, Armonk, NY, USA) was used for data analysis. Continuous data were expressed as ($\overline{\chi }\pm S$) and analyzed using $t$-tests, while categorical data were expressed as percentages and analyzed using ${\chi }^2$ tests. A significance level of 0.05 was considered statistically significant.

3. Results

3.1. Incidence of suture needle stick injuries

In the past 6 months, a total of 20 suture needle stick injuries occurred among the 106 surgical department physicians, resulting in a suture needle stick injury incidence rate of 18.87%. The highest incidence of suture needle stick injuries occurred when suturing incisions longer than 10 cm (Table 2 and Fig. 1).

Table 2.

Incidence of suture needle stick injuries in the past 6 months ($n$, %)

Length of surgical	Suture needle stick injuries (cases)	Incidence rate (%)
1–5 cm	3	2.83
5–10 cm	4	3.78
$>$ 10 cm	13	12.26
Total	20	18.87

Figure 1.

Incidence of suture needle stick injuries for different incision lengths.

3.2. Timing of suture needle stick

The highest incidence of suture needle stick injuries in the last suture session occurred when the primary surgeon or the first assistant performed a suture under poor visibility conditions (Table 3 and Fig. 2).

Table 3.

Timing of suture needle stick injuries and their proportions

Timing of suture needle stick injuries	Suture needle stick injuries (cases)	Incidence rate (%)
Intraoperative receipt or return of sutures by the surgeon or first assistant	3	2.83
When the lead surgeon or first assistant operates in conjunction with a dock	3	2.83
When the primary surgeon or the first assistant performs a suture with poor visibility	14	13.21
Total	20	18.87

Figure 2.

Timing of suture needle stick injuries and their proportions.

3.3. Causes of suture needle stick injuries

Among the causes of suture needle stick injuries, surgeons believed that the proportion of of suture needle stick injuries related to prolonged surgical duration causing mental and physical exhaustion was the highest (Table 4 and Fig. 3).

Table 4.

Causes of suture needle stick injuries and their proportions

Causes of suture needle stick injuries	Suture needle stick injuries (cases)	Incidence rate (%)
High level of stress during surgery	5	4.72
Use of suture needles in emergency surgery	3	2.83
Physical and mental exhaustion due to prolonged surgery	12	11.32
Total	20	18.87

Figure 3.

Causes of suture needle stick injuries and their proportions.

3.4. Time to physician detection of suture needle stick injuries

When suture needle stick injuries occurred, the highest proportion of physicians detected the injuries within 1 minute (Table 5 and Fig. 4).

Table 5.

Time to physician detection of suture needle stick injuries and their proportions

Time to physician detection of suture needle stick injuries	Suture needle stick injuries (cases)	Incidence rate (%)
Detected within 1 min	17	16.04
Detected within 30 min	2	1.89
Detected after the surgery	1	0.94
Total	20	18.87

Figure 4.

Time to physician detection of suture needle stick injuries and their proportions.

3.5. Actions taken after suture needle stick injuries

After suture needle stick injuries occurred, only 40.00% were reported, and among the reasons for non-reporting, the highest proportion was attributed to the perceived complexity of the reporting process (Table 6).

Table 6.

Actions taken after suture needle stick injuries

Actions taken after suture needle stick injuries	Suture needle stick injuries (cases)	Incidence rate (%)
Reporting	8	40.00
Reasons for non-reporting	12	60.00
Suture needle injury with small wound	3	25.00
Complexity of the reporting process	6	50.00
Patient without bloodborne infectious disease	3	25.00

3.6. Incidence of suture needle stick injuries in both groups

The average number of suture needle stick injuries per surgical procedure in the study group compared to the control group showed no significant difference before intervention ($p>$ 0.05). However, after intervention, the average number of suture needle stick injuries per surgical procedure in the study group was significantly lower than that in the control group ( 0.05) (Table 7 and Fig. 5).

Table 7.

Incidence of suture needle stick injuries in both groups ($\overline{\chi }\pm S$, cases)

Group	Cases	Pre-intervention	Post-intervention	$t$	$p$
Control group	53	0.12 $\pm$ 0.03	0.10 $\pm$ 0.03	3.590	0.001
Study group	53	0.13 $\pm$ 0.04	0.02 $\pm$ 0.01	20.318	0.000
$t$		1.523	19.267
$p$		0.131	0.000

Figure 5.

Number of occurrence of suture needle stick injuries (^∗∗∗p< 0.001).

3.7. Economic hygiene benefits comparison

Compared to the control group, there was no significant difference in per capita occupational exposure cost expenditures before intervention in the study group ($p>$ 0.05). However, after the intervention, the per capita occupational exposure cost expenditures in the study group were significantly lower than those in the control group ( 0.05) (Table 8).

Table 8.

Comparison of economic hygiene benefits in two groups ($\overline{\chi }\pm S$, yuan)

Group	Cases	Pre-intervention	Post-intervention	$t$	$p$
Control group	53	1665.12 $\pm$ 10.10	1500.20 $\pm$ 10.01	83.632	0.000
Study group	53	1664.13 $\pm$ 10.15	1376.93 $\pm$ 8.02	160.097	0.000
$t$		0.499	69.303
$p$		0.619	0.000

4. Discussion

Surgical department physicians frequently come into contact with and use suture needles during procedures, and the risk of suture needle stick injuries is high due to various internal and external factors. Suture needle stick injuries have become a significant safety concern for surgical department physicians. To reduce the risk of suture needle stick injuries, numerous studies have been conducted, with a focus on suture needle management systems and operating room procedural standards. However, there has been limited research on the suture needles themselves. Currently, research suggests that clearly identifying the risk factors that contribute to suture needle stick injuries and taking effective measures to mitigate them can significantly reduce the incidence of such injuries [8, 9]. Additionally, studies indicate that replacing traditional round suture needles with novel blunt suture needles, without increasing the difficulty of suturing operations, can effectively enhance the safety of suturing procedures [10].

In this study, a questionnaire survey on suture needle stick injuries among surgical department physicians revealed the following findings: (1) The incidence of suture needle stick injuries was highest when suturing incisions longer than 10 cm. This could be attributed to the shorter suturing time and fewer suturing needle insertions when the incision is less than 10 cm, reducing the risk of suture needle stick injuries. In contrast, longer incisions ($>$ 10 cm) significantly affect the visibility during suturing, increasing the difficulty of the procedure and the likelihood of suture needle stick injuries [11, 12]. In such cases, experienced physicians should be assigned to suture longer incisions, and collaboration with other healthcare staff is crucial to providing a clear operational view and reducing the risk of suture needle stick injuries. (2) The primary timing for the most recent suture needle stick injury during suturing was: 1) when the primary surgeon or assistant received or returned the suturing needle during the procedure; 2) when the primary surgeon or assistant coordinated and aligned the suturing needle during surgery; 3) when the primary surgeon or assistant performed suturing under poor visibility conditions [13, 14]. The incidence of suture needle stick injuries during suturing operations under poor visibility conditions was as high as 70.00% (14/20). When visibility is poor, physicians cannot effectively observe the puncture of the suturing needle, relying solely on clinical experience, significantly increasing the risk of suture needle stick injuries. In response to this situation, healthcare staff should exercise caution during the exchange of suturing needles, and rinsing the incision or using magnifying instruments during suturing can provide a clearer view, reducing the incidence of suture needle stick injuries. (3) The main causes for suture needle stick injuries included: 1) high levels of mental stress during the surgical process; 2) the use of suturing needles in emergency surgeries; 3) prolonged surgical duration leading to mental and physical exhaustion [15, 16]. Surgeons believed that prolonged surgical duration resulting in mental and physical exhaustion was the primary cause of suture needle stick injuries, accounting for a significant proportion of 60.00% (12/20). The analysis suggests that surgical department physicians often need to perform surgeries for extended periods, which significantly consumes their physical and mental energy. Suturing is a delicate operation, and when physicians are fatigued, suture needle stick injuries are more likely to occur. To address this, continuous improvement of the surgical skills of operating room physicians and the accumulation of suturing experience are essential to face various surgeries with a calm mindset. Additionally, optimizing the allocation of surgical personnel can reduce the burden on the primary surgeon and allow them to perform suturing operations comfortably, lowering the incidence of suture needle stick injuries. (4) The highest proportion of physicians detected suture needle stick injuries within 1 minute of occurrence. This is likely due to the sharpness of traditional round suturing needles, which can cause noticeable pain upon skin penetration. Thus, physicians are quick to perceive suture needle stick injuries when they occur [17, 18]. (5) After suture needle stick injuries occurred, only 40.00% were reported. Reasons for non-reporting included the small size of the suture needle stick injury, cumbersome reporting processes, and the absence of bloodborne infectious diseases in patients. Among the reasons, the most significant proportion was attributed to the perceived complexity of the reporting process (50.00%). In the future, efforts should be made to streamline the reporting process for needlestick injuries, enhance physicians’ personal awareness of suture needle stick injury protection and reporting, with the aim of increasing the reporting rate, and reducing the risk of large-scale healthcare-associated infections [19, 20].

In this study, the results indicate that the average number of suture needle stick injuries per surgical procedure in the study group is lower than that in the control group after the intervention. Additionally, the per capita occupational exposure cost expenditures after the intervention in the study group are lower than those in the control group. This confirms that the use of the novel type of blunt suture needle is effective in reducing both the average number of needle stick injuries per surgery and per capita occupational exposure cost expenditures. The analysis attributes this outcome to the use of blunt suture needles in the intervention group, specifically the Ethiguard III. This safety-engineered suturing needle is designed for the operating room and employs a grinding process to increase the needle tip diameter from 0 mm to 0.12 mm. It reduces the puncture force from 150–200 gf to 350–450 gf, achieving a balance between effective puncturing and injury prevention. This novel type of suture needle, when used, creates a depression that obstructs puncturing during operations on surgical gloves, skin, and muscle tissue. Healthcare personnel have sufficient reaction time to retract their hands, thereby reducing the risk of suture needle stick injuries during surgery. It is particularly effective in avoiding needle stick injuries when the primary surgeon or assistant is performing suturing operations in poor visibility conditions. Even if a needle stick injury occurs, it can effectively reduce the severity of the damage, ensuring both safety and cost-effectiveness in usage [21]. Furthermore, research suggests that the Ethiguard III, a novel type of safety-engineered needle, exhibits only slightly weaker puncturing capabilities on surgical gloves and skin/muscle tissue compared to regular round-pointed suture needles. The operational difficulty for surgeons in suturing incisions does not significantly increase, allowing for effective and smooth needle penetration during suturing procedures without the need for multiple entries and exits. This underscores its effectiveness and supports its potential for clinical application and widespread use [22]. In this study, we investigated the number of cases, the time and the causes of suture needle injury before intervention, the doctors’ awareness of the occurrence of suture needle injury, and the post-treatment of suture needle injury, the results show that the new type of blunt suture needle can reduce the incidence of needle puncture injury, and the incidence of needle puncture injury is higher than that of the new type of needle. However, there are some problems in this study, such as single choice, small number of respondents, short survey time and short use time of new blunt suture needle. Therefore, it is necessary to improve the contents of questionnaire, enlarge the number of patients, extend the length of investigation and use the new type of blunt suture needle in order to obtain more accurate results, it can provide reliable theoretical support for clinical popularization of new blunt suture needle.

5. Conclusion

In summary, prior to the intervention, suture needle stick injuries among surgical department physicians were primarily associated with suturing incisions of 5–10 cm in length and occurred most frequently when operating under poor visibility conditions. Surgical department physicians identified prolonged surgical duration leading to mental and physical exhaustion as the main cause of suture needle stick injuries. Additionally, the majority of physicians were able to perceive suture needle stick injuries within 1 minute of their occurrence. However, only 40% of physicians chose to report such incidents post-surgery, with the most common reason for non-reporting being the perceived complexity of the reporting process. The utilization of the novel blunt suture needle effectively reduced the incidence of suture needle stick injuries among surgical department physicians during suturing procedures, lowering per capita occupational exposure cost expenditures. This ensures both safety and economic hygiene benefits in usage.

Ethical approval

This study was approved by the ethics committee of Haikou Affiliated Hospital of Central South University Xiangya School of Medicine. Signed written informed consents were obtained from the patients and/or guardians.

Funding

This work was supported by Hainan Provincial Natural Science Foundation of China (NO. 821RC1143).

Conflict of interest

The authors have no potential conflicts of interest to report relevant to this article.