Surgeon's personal experiences drive home point about instrument safety

Salt Lake City-For Randall J. Olson, MD, personal experience with sharps injuries has heightened his awareness of the risks faced by surgeons and other personnel in the operating room.

It has also reinforced to him the critical importance of adopting whatever safety measures are available for eliminating such events and also for reducing the risk of transmission of infectious and prion-mediated diseases.

Last year, Dr. Olson injured himself during a cataract surgery case. After using a diamond blade to create the corneal incision, he recalled looking away momentarily while rotating the instrument in his hand so that he could transfer it handle first to the scrub technician. While manipulating the knife, he felt a slight stick that turned out to be more significant than he perceived as he noticed his glove rapidly filling with blood.

"Fortunately, this was a low-risk case, but the blade injury could have easily occurred in a high-risk setting. Considering the seriousness of the diseases I could have been exposed to, I still spent several anxious weeks waiting for the laboratory report," said Dr. Olson, who is The John A. Moran Presidential Professor and Chair of Ophthalmology and Visual Sciences, and Director, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City.

Six weeks later when the tests came back negative, Dr. Olson said he relaxed somewhat. However, he remains a little apprehensive, especially because of concerns about prion disease.

"The Western states are a high-risk area for deer and elk prion disease, cases of variant Creutzfeldt-Jakob disease suspicious for human cross-infection have occurred at our institution, there is no diagnostic test for prion disease, and sterilization does not destroy these proteins," Dr. Olson explained.

Very recently, he had a second incident in which he cut his finger with the blade of his diamond knife after it was handed to him off the tray.

"This situation was different because the injury occurred with a freshly sterilized instrument, but we know sterilization may mean nothing for eliminating the risk of prion disease," Dr. Olson said.

Those experiences gave him a greater appreciation for how common sharps injuries are in the OR setting, particularly among nurses and technicians, and the need for the ophthalmic community to take an activist position for improving surgical safety.

"There is reason to be fearful, and we need to move toward making safer all sharps used in our specialty," he said.