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Hands free technique and operating theatre injuries


Clinical bottom line

High use of hands free technique meant one fewer percutaneous injury, a cutaneous contamination, or a glove tear for every 33 operations (95%CI 24 to 56) than in operations with a low use of the technique.


B Stringer et al. Effectiveness of the Hands free technique in reducing operating theatre injuries. Occupational and Environmental Medicine 2002 59: 703-707.


This was a study over about six months in same day surgery operating theatres and main operating theatres working constantly, and with a full time circulating nurse present. All operating theatre personnel were included, with the exception of anaesthetists.

Circulating nurses recorded an assessment of whether the hands free technique was used, and whether it was 0% to 100% of the time. Hands free technique involves transfer of sharp instruments between personnel so that only one person touches the instrument at a time, usually using a neutral zone from which instruments can be retrieved. Only operations in which the technique was used 75% or 100% of the time were judged to be truly hands free.

Detailed information was collected at the occurrence of each incident, whether a percutaneous injury, a cutaneous contamination, or a glove tear.


There were 3,800 eligible operations, in which there were 143 incidents (40 percutaneous injuries, 51 contaminations, and 52 glove tears). The event rate in operations with a high rate (75%, 100%) of use of hands free technique was 2.1% of operations, compared with 5.1% in those with a low rate (0%, 25%, 50% (Figure 1). The relative risk was 0.4 (95%CI 0.3 to 0.6). High use of hands free technique would mean one fewer incident for every 33 operations (95%CI 24 to 56).

Figure 1: Incident rate according to use of hands free techniques in 3,765 operations

Higher incidence rates were associated with more people in the operating theatre, cardiothoracic and cerebrovascular surgery, operations longer than two hours, and where the blood loss was more than 100 mL. Clearly some of these would be related one to another.


This is a really interesting paper, based on a large number of observations. Only 40% of operations used a high level of hands free technique, despite it being hospital policy.