Introduction

The rate of ‘sharp injuries' occurring in the operating room has been reported to be as high as 7% of all procedures performed, with injuries from the suture needle itself accounting for some three-quarters of these sharp injuries (₁). This paper describes a safe and simple technique for holding the suture when the needle is not in use that could reduce this chance of inadvertent needle stick injury.

Method

It is recommended that after finishing suturing, rather than hold the needle as is the normal custom, that the suture should be held just behind the needle.

Figure 1

Figure 1: Holding the suture vs. the needle

The needle is now loose and poses very little risk of needle stick injury, however, the combination of suture and needle holder is still together for suture ergonomics and ease of continued use. (Figure 2)

Figure 2

Figure 2: Needle safe yet controlled

Discussion

A technique is presented designed to prevent the risk of needle stick injury posed by needles held within a needle holder but not in active use. This method represents the most common mechanism of intraoperative inadvertent injury.

Most surgeons hold the needle in the needle-holder after they have passed the needle through the tissues which is not specifically appropriate (or ergonomic) if a suture is about to be tied, particularly if the surgeon holds the needle holder whilst hand tying. Moreover, the loaded needle holder placed down on the patient represents a real risk for inadvertent stick injury.

With this new technique, weakening of the suture is not an issue since the suture is being grasped just behind the needle; a section of the suture, which will never be involved in any knot. This technique has routinely been used in our unit for the past two years without a single event of inadvertent needle-related injury to the operating staff and is recommended for adoption by surgeons in their handling of tissues when the needle is not actually being driven, and when it is being returned to the scrub nurse.