Blunt Suture Needles Advocated as Safe and Effective

A new statement from the American College of Surgeons endorses the universal adoption of blunt suture needles for all potential applications in the operating room.

"There are surgeons who don't even know that blunt sutures exist for fascial and muscle closure," said Lena M. Napolitano, M.D., a surgeon who chairs the ACS Committee on Perioperative Care, which assembled the statement. "What we are proposing is that this should become the standard. Rather than using sharp needles to close the fascia and muscle, we should convert to using blunt suture needles because that's the safest for our health care workers in the OR."

Released in August, the statement (see www.facs.org) comes on the heels of mounting research demonstrating how the OR lags behind other hospital areas in implementing safety-engineered devices required by the Needlestick Safety and Prevention Act of 2000. According to a study of percutaneous injuries that occurred at various hospitals in the United States between 1993 and 2002, a 38.1% reduction in injuries was seen in patient rooms, compared with only a 5.7% drop in the OR.

The study, conducted by the International Healthcare Worker Safety Center at the University of Virginia Health System, Charlottesville, also found that while injury rates from hollow-bore needles declined by 32.8% between 1993 and 2002, injury rates from suture needles increased by 26.8% over that same period.

"There has been a sea change of progress in [needlestick safety], but most of it has been focused on hollow-bore needles such as syringes, blood-drawing devices, and IV equipment," said Janine C. Jagger, Ph.D., professor of research of internal medicine at the University of Virginia, Charlottesville, and director of the International Healthcare Worker Safety Center. "The Needlestick Safety and Prevention Act of 2000 requires employers to purchase devices with needlestick prevention features on them. But it seems as though the operating room is the last frontier."

Dr. Jagger called the new ACS statement on blunt suture needles "an extremely important step" in improving safety for surgeons, health care workers, and patients. "What we do in America has a huge impact elsewhere in the world," she said, noting that sharp suture needles are the number-two cause of needlestick injuries in the hospital setting, right behind syringes. "There are countries that use American standards to set their own standards. Surgical societies around the world will be influenced by this."

Blunt suture needles have been on the market for more than 10 years. They can be used for suturing most internal tissues, such as muscle, fascia, and fat, but not to suture vascular tissue or skin.

In 2004 they accounted for only about 3% of the suture needle market for general closure. Ethicon Inc. and U.S. Surgical market the needles, which currently cost about 10% more than sharp suture needles.

"When these needles were first developed, there was not much uptake by surgeons," said Dr. Napolitano, who is also professor of surgery and associate chair for critical care at the University of Michigan, Ann Arbor. "We are a little bit behind [in using them]. I don't think it's a matter of surgeons not embracing [these needles]. I just don't think people know about them."

She added that switching from sharp suture needles to blunt suture needles requires little change in technique. "Until you use them a couple of times, you do feel a little more resistance to tissue penetration, as you would expect. But you get used to that very quickly," she said.

Blunt suture needles may not yet be widely accepted in the United States, but they are in Japan, thanks largely to Dr. Jagger, who has helped that country's surgeons establish a national surveillance program for needlestick injuries and promoted the use of blunt suture needles in the process.

"It was a very simple thing for the Japanese to undergo this transition," she said, adding that the surgeons there presumed blunt suture needles were part of routine clinical practice in the United States until she informed them otherwise. "There was no resistance. They only found further advantages when they started using them. I've never seen a device transition go so quickly and so smoothly."

Dr. Jagger said it is ironic that surgeons in the United States have not widely adopted them, "especially since they're the simplest and cheapest of all the safety devices. When surgeons start using them, they don't have any objections. The hard part is just to get them to try."