Clinician to Clinician: The virtues of blunt suture needles

As ob/gyns, our primary focus is our patients' well-being and we rarely take time to think of our own welfare, as it pertains to workplace safety. But few other fields involve greater exposure to blood and other potentially infectious fluids, so we must protect ourselves and those with whom we work. One safety measure we can put into place is use of blunt-tipped suture needles, which prevent percutaneous needlestick injuries (PNSIs).

The impact of needlestick injuries

Every year, about 800,000 health-care workers suffer PNSIs in the workplace, and about half the incidents involve suture needles.¹ Studies show that surgical glove perforations and exposure to potentially infectious blood occur in 20% to 30% of ob/gyn surgeries.^2,3 Besides the well-known link between PNSIs and infectious diseases such as HIV and hepatitis B and C, they can also transmit malaria, tuberculosis, syphilis, and herpes virus. Less studied, but no less important, is the emotional turmoil caused by PNSIs, which create great angst and uncertainty and may result in a need for antiretroviral prophylaxis and concerns about infecting others.

A 1997 study by the CDC demonstrated quite convincingly that blunt-tipped suture needles significantly reduce the chance of needlestick injury.⁵ In fact, the research showed not a single PNSI associated with the devices, that the needles effectively reduced PNSIs during gynecologic surgery, and that they should be considered for widespread surgical use.

Three years after the CDC report, because of concern for the safety of health-care workers, President Clinton signed into law the Needlestick Safety and Prevention Act. That federal legislation mandated that as safer needle devices became commercially available, employers must use them in the health-care workplace.⁶

Personal perspective

My own interest in needles and PNSIs began several years ago, when I consoled a colleague who had been stuck by a sharp suture needle during a C/S on a hepatitis C-positive patient. As we talked, I remembered a demonstration of a blunt-tipped suture needle in labor and delivery that I had seen years earlier. I immediately asked our operating room manager to order the needles and then I began to survey colleagues about their experiences with PNSI and with the devices. What I found was that 90% of attendings and residents in my department had suffered at least one needlestick injury, and the vast majority found blunt-tipped needles "excellent" for use during C/S.⁷

To date, I personally have performed nearly 500 C/S deliveries using blunt-tipped suture needles exclusively (1 Vicryl CTXB) to close both uterus and fascia, and 3-0 Monocryl CTXB when the subcutaneous layer requires closure. Although I've done no scientific follow-up on these patients, I can personally attest that changing needles in my practice has resulted in no specific complications. And no needlestick injuries or glove perforations have occurred in any of the deliveries.

If you are new to blunt-tipped suture needles, you probably will not notice any difference when you close the uterus. However, you will hear a distinct "pop" when you drive the needle through the fascia, and you may need to use more force than with a sharp needle to suture the fascia for repeat C/S. But I've found it easy to adapt to these changes and they really make the surgery no more difficult. I now also use blunt-tipped suture needles (3-0 Vicryl CTXB and 3-0 Monocryl CTXB) for vaginal laceration and episiotomy repair. Most of the types of sutures we traditionally use in ob/gyn are available with blunt tips.

The data in the literature have convinced me that PNSIs are dangerous yet avoidable with a simple change in surgical practice. If you are not already using blunt-tipped suture needles in day-to-day practice, I encourage you to consider doing so to avoid the risks of PNSI to yourself and to those with whom you work.