spective to the challenge. After all, these injuries were happening to peo-
ple who were experts in dealing with sharp instruments and needles. It
wasn't that they didn't know how to handle a needle or how to use neu-
tral zones when passing sharp instruments to each other. There had to
be some other considerations that people weren't taking fully into
account. When I began my observations, 2 things that are obvious to you
jumped out at me:
• The OR staff was dealing with a very small operative field.
• A lot of hands and powerful instruments were moving in and out
of that small space.
I remember thinking that if this had been an industrial setting
(where a lot of my ergonomics training took place), and I saw sharp,
powerful instruments in a small space close to people's hands, we'd
install machine guards, insist people wear cut-resistant gloves and
probably implement other safety measures as well.
In fact, cut-resistant gloves were the first thing I recommended. No
good. They turned out to be too thick and heavy, and the staff said
they compromised manual dexterity and tactile feedback. We also
thought about trying to develop a shield to protect people's hands. But
that, too, was a non-starter. They didn't want anything else clogging
up the operative field.
Incidentally, double-gloving with standard surgical gloves did help pre-
vent skin from being pierced by needlestick pokes in incidents that we
classified as near-misses. And they didn't inhibit tactile feedback or dex-
terity. Many needlestick injuries were superficial, so double-gloving,
which is among AORN's guidelines for needlestick-injury prevention,
was one of the measures we adopted as a best practice. We should
always be on the lookout for innovations and safer designs in terms of
needles and sharps. But we needed to dig deeper to get to the root of the
problem.
9 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U N E 2 0 1 8
