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

Needle-Stick Injuries in Ophthalmic Practice

Purpose

Needle-stick injuries (NSI) are a prominent route by which blood-borne infections are transmitted. The unique microsurgical nature of ophthalmic practice constitutes an additional risk to sustain injury. This study aimed to identify the epidemiological profile of needle-stick injuries in a tertiary eye center and to evaluate the implemented safety policy in preventing sharp injuries.

Methods

This was a retrospective cross-sectional study of all sharp injuries that occurred at King Khalid Eye Specialist Hospital (KKESH). Data on all reported sharp injury incidents from 2013 to 2021 were collected. The mechanisms of injury, context, location, and type of prick were collected and analyzed. Also, this study involved an institution-based survey for all ophthalmic staff.

Results

Two hundred and one sharp injury incidents were reported over 9 years. Physicians sustained 46.8% (n=94) of injuries, followed by nurses and ophthalmic technicians, 40.8% (n=82) and 7% (14); respectively. Operating and treatment rooms were the locations of 60.7% of incidents, whereas outpatient clinics and emergency rooms accounted for 19.4% and 13.4% of injuries, respectively.

Conclusion

The current findings add to the growing body of literature on the importance of NSI prevention and reporting strategies. In the present study, sharp injuries were most commonly encountered by ophthalmic staff in the operating rooms. Continuous staff education on handling sharp instruments, encouraging anonymous reporting, and up-to-date revisions of guidelines and policies are of paramount importance to lessen the burden of sharp injuries.

Education and training for preventing sharps injuries and splash exposures in healthcare workers

BACKGROUND

In healthcare settings, health care workers (HCWs) are at risk of acquiring infectious diseases through sharps injuries and splash exposures to blood or bodily fluids. Education and training interventions are widely used to protect workers' health and safety and to prevent sharps injuries. In certain countries, they are part of obligatory professional development for HCWs.

OBJECTIVES

To assess the effects of education and training interventions compared to no intervention or alternative interventions for preventing sharps injuries and splash exposures in HCWs.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, NHSEED, Science Citation Index Expanded, CINAHL and OSH-update (from all time until February 2016). In addition, we searched the databases of Global Health, AustHealth and Web of Science (from all time until February 2016). The original search strategy was re-run in November 2019, and again in February 2020. In April 2020, the search strategy was updated and run in CINAHL, MEDLINE, Scopus and Web of Science (from 2016 to current).

SELECTION CRITERIA

We considered randomized controlled trials (RCTs), cluster-randomized trials (cluster-RCTs), controlled clinical trials (CCTs), interrupted time series (ITS) study designs, and controlled before-and-after studies (CBA), that evaluated the effect of education and training interventions on the incidence of sharps injuries and splash exposures compared to no-intervention.

DATA COLLECTION AND ANALYSIS

Two authors (SC, HL) independently selected studies, and extracted data for the included studies. Studies were analyzed, risk of bias assessed (HL, JL) , and pooled using random-effect meta-analysis, where applicable, according to their design types. As primary outcome we looked for sharps injuries and splash exposures and calculated them as incidence of injuries per 1000 health care workers per year. For the quality of evidence we applied GRADE for the main outcomes.

MAIN RESULTS

Seven studies met our inclusion criteria: one cluster-RCT, three CCTs, and three ITS studies. The baseline rates of sharps injuries varied from 43 to 203 injuries per 1000 HCWs per year in studies with hospital registry systems. In questionnaire-based studies, the rates of sharps injuries were higher, from 1800 to 7000 injuries per 1000 HCWs per year.  The majority of studies utilised a combination of education and training interventions, including interactive demonstrations, educational presentations, web-based information systems, and marketing tools which we found similar enough to be combined. In the only cluster-RCT (n=796) from a high-income country, the single session educational workshop decreased sharps injuries at 12 months follow-up, but this was not statistically significant either measured as registry-based reporting of injuries (RR 0.46, 95% CI 0.16 to 1.30, low-quality evidence) or as self-reported injuries (RR 0.41, 95% CI 0.14 to 1.21, very low-quality evidence) In three CCTs educational interventions decreased sharps injuries at two months follow-up (RR 0.68, 95% CI 0.48 to 0.95, 330 participants, very low-quality evidence). In the meta-analysis of two ITS studies with a similar injury rate, (N=2104), the injury rate decreased immediately post-intervention by 9.3 injuries per 1000 HCWs per year (95% CI -14.9 to -3.8). There was a small non-significant decrease in trend over time post-intervention of 2.3 injuries per 1000 HCWs per year (95% CI -12.4 to 7.8, low-quality evidence). One ITS study (n=255) had a seven-fold higher injury rate compared to the other two ITS studies and only three data points before and after the intervention. The study reported a change in injury rate of 77 injuries per 1000 HCWs (95% CI -117.2 to -37.1, very low-quality evidence) immediately after the intervention, and a decrease in trend post-intervention of 32.5 injuries per 1000 HCWs per year (95% CI -49.6 to -15.4, very low quality evidence). None of the studies allowed analyses of splash exposures separately from sharps injuries. None of the studies reported rates of blood-borne infections in patients or staff. There was very low-quality evidence of short-term positive changes in process outcomes such as knowledge in sharps injuries and behaviors related to injury prevention.  AUTHORS' CONCLUSIONS: We found low- to very low-quality evidence that education and training interventions may cause small decreases in the incidence of sharps injuries two to twelve months after the intervention. There was very low-quality evidence that educational interventions may improve knowledge and behaviors related to sharps injuries in the short term but we are uncertain of this effect. Future studies should focus on developing valid measures of sharps injuries for reliable monitoring. Developing educational interventions in high-risk settings is another priority.

An Integrative Review of the Hands-Free Technique in the OR

Sharps injury rates are proportionally higher in perioperative areas than in other practice settings. The hands-free technique (HFT) has been shown to decrease the hazards of sharps injuries when passing sharps during surgery. We reviewed and synthesized research studies regarding compliance with the HFT and factors facilitating its use using a key word search of online databases and a secondary search of references. We reviewed English language studies published since 2001 regarding HFT compliance rates or related factors using the Johns Hopkins Nursing Evidence-Based Practice Model and Guidelines. We found 14 articles reporting a wide range of HFT compliance rates (ie, 5% to 84%), which identified that a number of organizational factors and health care workers' perceptions of infection risks influenced the use of the HFT.

Needlestick and Sharps Injuries in Dermatologic Surgery: A Review of Preventative Techniques and Post-exposure Protocols

Background: Needlestickand sharps injuries are the leading causes of morbidity in the dermatologicfield. Among medical specialties, surgeons and dermatologists have the highest rates of needlestickand sharps injuries.The high rates of needlestickand sharps injuries in dermatology not only apply to physicians, but also to nurses, physician assistants, and technicians in the demnatologic field. Needlestickand sharps injuries are of great concern due to the monetary, opportunity, social, and emotional costs associated with their occurrence. Objective: A review of preventative techniques and post-exposure protocols for the majortypes of sharps injuries encountered in dermatologic practice. Design: The terms "needle-stick injuryT'sharps injuryTdermatologic surgery? "post-exposure prophylaxis,"and "health-care associated injury" were used in combinations to search the PubMed database. Relevant studies were reviewed for validity and included. Results The authors discuss the major types of sharps injuries that occur in the dermatologic surgery setting and summarize preventative techniques with respect to each type of sharps injury.The authors also summarize and discuss relevant post-exposure protocols in the event of a sharps injury. Conclusion: The adoption of the discussed methods, techniques, practices, and attire can result in the elimination of the vast majority of dermatologic sharps injuries.

Suture needle handling in the operating theatre; what is the safest method? A survey of surgical nursing opinion

INTRODUCTION

Suture needle handling methods vary extensively between units. Securing the needle tip by locking it against the shaft of the needle holder prior to transfer (protected method) has been suggested to improve safety, although this is not evidence based. Some teams prefer to transfer the needle mounted perpendicularly to the needle holders with the tip exposed (unprotected method). We investigated scrub nurses' preferred method of needle transfer, and noted the safety of each by investigating their experience of needlestick injuries (NSIs).

METHOD

Scrub nurses from Oxford University Hospitals Trust, Chelsea and Westminster and Wexham Park Hospitals were surveyed anonymously between November 2013 and August 2014. Nurses selected their preferred method (protected, unprotected or either), and indicated previous NSIs with either technique. Multinomial regression analysis and χ(2) with Yates correction were used to assess associations.

RESULTS

One hundred and seven scrub nurses from 12 specialities were interviewed. 80/107 (75%) preferred protected transfer, 20/107 (19%) preferred unprotected transfer and 7/107 (6%) expressed no preference. There was no significant association between needle-mounting preference and years of scrub experience or speciality. Significant differences between preferences and four of the six hospitals were observed. Nine (9/107, 8%) scrub nurses reported NSIs with the protected method compared with 40 (40/107, 37%) in the unprotected group, this difference being statistically significant (p<0.001, χ(2)=25.17). Five (5/107, 5%) reported NSIs with both methods.

CONCLUSIONS

Protected needle transfer seems safer than the unprotected method. Needle-handling guidelines and appropriate training are required to help prevent the occurrence of NSIs in the operating theatre.

Sharps injury prevention guidance among health care professionals: A comparison between self-reported and observed compliance

BACKGROUND

This study was performed to compare self-report and observation methods for measuring compliance with double gloving (DG) and the hands-free technique (HFT).

METHODS

The participants were 81 health care professionals (29 nurses, 52 doctors) working in 22 operating rooms in a tertiary hospital in Busan (South Korea). All participants were asked to complete a self-report questionnaire. Additionally, compliance with DG and the HFT was observed from March-May 2014. Data were analyzed using descriptive statistics, χ(2) test, and κ statistic using SPSS version 18.0 (SPSS, Chicago, IL).

RESULTS

The participants who always complied with DG and the HFT were 30.9% and 7.7% according to the self-report method, respectively, and 30.9% and 0.0% according to direct observation, respectively. The κ value comparing the self-report and observation methods was 0.557 for all study participants, 0.259 for nurses, and 0.668 for doctors for DG. The κ value was 0.027 for all participants, 0.131 for nurses, and 0.020 for doctors for the HFT.

CONCLUSION

DG compliance and HFT compliance showed moderate and low levels of agreement between the 2 methods, respectively. Doctors showed higher agreement than nurses between the 2 methods for DG compliance but similar to nurses for HFT compliance. Therefore, the levels of compliance with DG may be measured by either the self-report or observation methods for doctors.

Implementing AORN recommended practices for sharps safety

Prevention of percutaneous sharps injuries in perioperative settings remains a challenge. Occupational transmission of bloodborne pathogens, not only from patients to health care providers but also from health care providers to patients, is a significant concern. Legislation and position statements geared toward ensuring the safety of patients and health care workers have not resulted in significantly reduced sharps injuries in perioperative settings. Awareness and understanding of the types of percutaneous injuries that occur in perioperative settings is fundamental to developing an effective sharps injury prevention program. The AORN "Recommended practices for sharps safety" clearly delineates evidence-based recommendations for sharps injury prevention. Perioperative RNs can lead efforts to change practice for the safety of patients and perioperative team members by promoting the elimination of sharps hazards; the use of engineering, work practice, and administrative controls; and the proper use of personal protective equipment, including double gloving.

Reducing the burden of surgical harm: a systematic review of the interventions used to reduce adverse events in surgery

OBJECTIVE

To perform a systematic review of interventions used to reduce adverse events in surgery.

BACKGROUND

Many interventions, which aim to improve patient safety in surgery, have been introduced to hospitals. Little is known about which methods provide a measurable decrease in morbidity and mortality.

METHODS

MEDLINE, EMBASE, and Cochrane databases were searched from inception to Week 19, 2012, for systematic reviews, randomized controlled trials (RCTs), and cross-sectional and cohort studies, which reported an intervention aimed toward reducing the incidence of adverse events in surgical patients. The quality of observational studies was measured using the Newcastle-Ottawa Scale. RCTs were assessed using the Cochrane Collaboration's tool for assessing risk of bias.

RESULTS

Ninety-one studies met inclusion criteria, 26 relating to structural interventions, 66 described modifying process factors. Only 17 (of 42 medium to high quality studies) reported an intervention that produced a significant decrease in morbidity and mortality. Structural interventions were: improving nurse to patient ratios (P = 0.008) and Intensive Care Unit (ITU) physician involvement in postoperative care (P < 0.05). Subspecialization in surgery reduced technical complications (P < 0.01). Effective process interventions were submission of outcome data to national audit (P < 0.05), use of safety checklists (P < 0.05), and adherence to a care pathway (P < 0.05). Certain safety technology significantly reduced harm (P = 0.02), and team training had a positive effect on patient outcome (P = 0.001).

CONCLUSIONS

Only a small cohort of medium- to high-quality interventions effectively reduce surgical harm and are feasible to implement. It is important that future research remains focused on demonstrating a measurable reduction in adverse events from patient safety initiatives.

Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence?

BACKGROUND

The occupational hazard associated with percutaneous injury in the operating room (OR) has encouraged harm reduction through behaviour change and the use of safety-engineered surgical sharps. Some Canadian regulatory agencies have mandated the use of "safety scalpels." Our primary objective was to determine whether safety scalpels reduce the risk of percutaneous injury in the OR, while a secondary objective was to evaluate risk reduction associated with other safety practices.

METHODS

We used evidence review methods described by the International Liaison Committee on Resuscitation and conducted a systematic, English-language search of Ovid, MEDLINE and EMBASE using the following search terms: "safety-engineered scalpel," "mistake proofing device," "retractable/removable blade/scalpel," "pass tray," "hands free passing," "neutral zone," "sharpless surgery," "double/cutproof gloving" and "blunt suture needles." Included articles were scored according to level of evidence; quality; and whether they were supportive, opposed or neutral to the study question(s).

RESULTS

Of 72 included citations, none was supportive of the use of safety scalpels. There was high-level/quality evidence (Cochrane reviews) in support of risk reduction through double-gloving and use of blunt suture needles, with additional evidence supporting a pass tray/neutral zone for sharps handling (4 of 5 articles supportive) and use of suturing adjuncts (1 article supportive).

CONCLUSION

There is insufficient evidence to support regulated use of safety scalpels. Injury-reduction strategies should emphasize proven methods, including double-gloving, blunt suture needles and use of hands-free sharps transfer.

Sharps injuries: the risks and relevance to plastic surgeons

Surgeons are at risk for injury in the operating room daily. Because of the ubiquity of occupational hazards, injuries remain prevalent and expensive. Although occupational hazards can include musculoskeletal conditions, psychosocial stress, radiation exposure, and the risk of communicable diseases, sharps injuries remain the most common among surgeons in practice and the most frequent route of transmission of blood-borne pathogens. Therefore, increased attention to the health, economic, personal, and social implications of these injuries is essential for appropriate management and future prevention.

Evaluation of an antimicrobial surgical glove to inactivate live human immunodeficiency virus following simulated glove puncture

BACKGROUND

Percutaneous injuries associated with cutting instruments, needles, and other sharps (eg, metallic meshes, bone fragments, etc) occur commonly during surgical procedures, exposing members of surgical teams to the risk for contamination by blood-borne pathogens. This study evaluated the efficacy of an innovative integrated antimicrobial glove to reduce transmission of the human immunodeficiency virus (HIV) following a simulated surgical-glove puncture injury.

METHODS

A pneumatically activated puncturing apparatus was used in a surgical-glove perforation model to evaluate the passage of live HIV-1 virus transferred via a contaminated blood-laden needle, using a reference (standard double-layer glove) and an antimicrobial benzalkonium chloride (BKC) surgical glove. The study used 2 experimental designs. In method A, 10 replicates were used in 2 cycles to compare the mean viral load following passage through standard and antimicrobial gloves. In method B, 10 replicates were pooled into 3 aliquots and were used to assess viral passage though standard and antimicrobial test gloves. In both methods, viral viability was assessed by observing the cytopathic effects in human lymphocytic C8166 T-cell tissue culture. Concurrent viral and cell culture viability controls were run in parallel with the experiment's studies.

RESULTS

All controls involving tissue culture and viral viability were performed according to study design. Mean HIV viral loads (log(10)TCID(50)) were significantly reduced (P < .01) following passage through the BKC surgical glove compared to passage through the nonantimicrobial glove. The reduction (log reduction and percent viral reduction) of the HIV virus ranged from 1.96 to 2.4 and from 98.9% to 99.6%, respectively, following simulated surgical-glove perforation.

CONCLUSION

Sharps injuries in the operating room pose a significant occupational risk for surgical practitioners. The findings of this study suggest that an innovative antimicrobial glove was effective at significantly (P < .01) reducing the risk for blood-borne virus transfer in a model of simulated glove perforation.

Risk of bloodborne pathogen exposure among Zambian healthcare workers

PURPOSE

Understanding the risks of bloodborne pathogen transmission is fundamental to prioritizing interventions when resources are limited. This study investigated the risks to healthcare workers in Zambia.

DESIGN

A survey was completed anonymously by a convenience sample of workers in three hospitals and two clinics in Zambia. Respondents provided information regarding job category, injuries with contaminated sharps, hepatitis B vaccination status and the availability of HIV post-exposure prophylaxis (PEP).

RESULTS

Nurses reported the largest number of injuries. The average annual sharps injury rate was 1.3 injuries per worker, and service workers (housekeepers, laundry, ward assistants) had the highest rate of these injuries, 1.9 per year. Injuries were often related to inadequate disposal methods. Syringe needles accounted for the largest proportion of injuries (60%), and 15% of these injuries were related to procedures with a higher-than-average risk for infection. Most workers (88%) reported the availability of PEP, and only 8% were fully vaccinated against hepatitis B.

CONCLUSIONS

The injury risks identified among Zambian workers are serious and are exacerbated by the high prevalence of bloodborne pathogens in the population. This suggests that there is a high risk of occupationally acquired bloodborne pathogen infection. The findings also highlight the need for a hepatitis B vaccination program focused on healthcare workers. The risks associated with bloodborne pathogens threaten to further diminish an already scarce resource in Zambia - trained healthcare workers. To decrease these risks, we suggest the use of low-cost disposal alternatives, the implementation of cost-sensitive protective strategies and the re-allocation of some treatment resources to primary prevention.

Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation

BACKGROUND

The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings.

STUDY DESIGN

We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members.

RESULTS

Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others.

CONCLUSIONS

Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.

Surgeons' and residents' double-gloving practices at 2 teaching hospitals in Ontario

BACKGROUND

Surgeons and residents are at increased risk of exposure to blood-borne pathogens owing to percutaneous injury (PI) and contamination. One method known to reduce risk is double-gloving (DG) during surgery.

METHODS

All surgeons and residents affiliated with the University of Western Ontario (UWO) and McMaster University in 2005 were asked to participate in a Web-based survey. The survey asked respondents their specialty, the number of operations they participated in per week, their age and sex, the proportion of surgeries in which they double-gloved (DG in ≥75% surgeries was considered to be routine), and the average number of PIs they sustained per year and whether or not they reported them to an employee health service.

RESULTS

In total, 155 of 331 (47%) eligible surgeons and residents responded; response rates for UWO and McMaster surgeons were 50% and 39%, respectively, and for UWO and McMaster residents, they were 52% and 47%, respectively. A total of 43% of surgeons and residents reported routine DG; 50% from McMaster and 36% from UWO. Using logistic regression to simultaneously adjust for participant characteristics, we confirmed that DG was more frequent at McMaster than at UWO, with an odds ratio of 3.32 (95% confidence interval 1.35-8.17). Surgeons and residents reported an average of 3.3 surgical PIs per year (2.2 among McMaster participants and 4.5 among UWO participants). Of the 77% who reported at least 1 injury/year, 67% stated that they had not reported it to an employee health service.

CONCLUSION

Percutaneous injuries occur frequently during surgery, yet routine DG, an effective means of reducing risk, was carried out by less than half of the surgeons and residents participating in this study. This highlights the need for a more concerted and broad-based approach to increase the use of a measure that is effective, inexpensive and easily carried out.

Sharps injuries in ophthalmic practice

PURPOSE

Accidental sharps injuries are a potential route for transmission of blood-borne infection to healthcare workers. Ophthalmic staff in particular are at risk of sustaining such injuries due to the microsurgical nature of the speciality. Forthcoming European Union legislation aimed at reducing sharps injuries requires the development of risk-based sharps policy. The authors believe that this is the first study to assess the risks of sharps injuries and their management specific to ophthalmic practice within the European Union.

METHODS

A retrospective review of all reported sharps injuries across three eye units in the UK over a period of 6 years was undertaken. Data were analysed to determine the circumstances surrounding the injury, occupation of the injured person, and whether appropriate actions were taken following incidents.

RESULTS

A total of 68 sharps injuries were reported over the 6-year period. Nurses sustained 54.4% (n=37) of needlestick injuries, doctors 39.7% (n=27), and allied healthcare staff 5.9% (n=4). In all 51.5% (n=35) of sharps injuries occurred in the operating theatre, 30.9% (n=21) in the outpatient clinic, 13.2% (n=9) on the ophthalmic ward, and 4.4% (n=3) in unspecified locations. There was a median rate of 1.3 sharps injuries per 1000 surgical procedures per year and a range of 0.4-3.5 per 1000.

CONCLUSIONS

This study demonstrates the need to raise awareness of the unique risks of sharps injuries in ophthalmic practice. This is necessary in order to develop speciality-specific policy that promotes strategies to reduce such injuries, enhances the accuracy of reporting of such events, and provides guidance for appropriate management.

Increase in sharps injuries in surgical settings versus nonsurgical settings after passage of national needlestick legislation

BACKGROUND

The operating room is a high-risk setting for occupational sharps injuries and bloodborne pathogen exposure. The requirement to provide safety-engineered devices, mandated by the Needlestick Safety and Prevention Act of 2000, has received scant attention in surgical settings.

STUDY DESIGN

We analyzed percutaneous injury surveillance data from 87 hospitals in the United States from 1993 through 2006, comparing injury rates in surgical and nonsurgical settings before and after passage of the law. We identified devices and circumstances associated with injuries among surgical team members.

RESULTS

Of 31,324 total sharps injuries, 7,186 were to surgical personnel. After the legislation, injury rates in nonsurgical settings dropped 31.6%, but increased 6.5% in surgical settings. Most injuries were caused by suture needles (43.4%), scalpel blades (17%), and syringes (12%). Three-quarters of injuries occurred during use or passing of devices. Surgeons and residents were most often original users of the injury-causing devices; nurses and surgical technicians were typically injured by devices originally used by others.

CONCLUSIONS

Despite legislation and advances in sharps safety technology, surgical injuries continued to increase during the period that nonsurgical injuries decreased significantly. Hospitals should comply with requirements for the adoption of safer surgical technologies, and promote policies and practices shown to substantially reduce blood exposures to surgeons, their coworkers, and patients. Although decisions affecting the safety of the surgical team lie primarily in the surgeon's hands, there are also roles for administrators, educators, and policy makers.

Is use of the hands-free technique during surgery, a safe work practice, associated with safety climate?

BACKGROUND

A better safety climate has been linked to better compliance with safety behaviors. This study assessed whether "management support," the most commonly measured safety climate dimension, was associated with greater use of the hands-free technique (HFT), a work practice recommended for use during surgery to prevent exposure to blood and body fluids.

METHODS

Questionnaires from operating room nurses participating in a test retest reliability study and in training sessions for an intervention study, from 9 hospitals in 3 Canadian provinces, were analyzed.

RESULTS

Response rates in the hospitals varied from 61% to 97%. Four hundred forty-two operating room nurses responded; 16% reported using the HFT approximately 75% or more of the time in surgery, and 39% had received HFT training. Management support and HFT training were each associated with increased HFT use: odds ratio (OR), 6.63; 95% confidence interval (CI): 1.89-23.30 and OR, 6.36; 95% CI: 1.97-20.51, respectively. When training occurred in a context of management support, HFT use was further increased: OR, 9.12; 95% CI: 2.71-30.72.

CONCLUSION

Consistent with previous research linking management support for health and safety to uptake of safety practices, management support and HFT training acted synergistically to increase HFT use most of the time in surgery.