Blunt needles for the reduction of needlestick injuries during cesarean delivery: a randomized controlled trial. Influence of blunt needles on surgical glove perforation and safety for the surgeon. Randomized trial of blunt-tipped versus cutting needles to reduce glove puncture during mass closure of the abdomen. Blunt-tipped versus sharp-tipped needles: wound morbidity. [The risk of needle-stick-injuries during abdominal closure]. A randomized controlled trial of double-versus single-gloving in vascular surgery. Needle stick injury. Reducing the risk. Glove perforation during hip arthroplasty. A randomised prospective study of a new taperpoint needle.
To compare the rate of glove perforation as a proxy for needlestick injuries between blunt and sharp needles used during cesarean-delivery closure and to survey physician satisfaction with blunt needles.
                Patients requiring cesarean delivery were assigned randomly to receive closure with either blunt (study group) or sharp needles (control group). Patient demographics, operator experience, and other clinical variables were collected. Physicians reported any percutaneous injuries and were surveyed regarding satisfaction with the assigned needles. Glove perforation was determined using a validated water-test method. Differences between patient groups were tested using chi and Fisher exact test for categorical variables and Student t-test or Wilcoxon rank-sum test for continuous variables.
                There were 194 patients enrolled in the trial: 97 in the control group and 97 in the study group. There were no statistical differences between groups in patient demographics. There were no differences between groups in clinical variables, type of cesarean delivery, or experience level of the surgeon. There was a significant reduction in total glove perforation rate for the primary surgeon with blunt needles (7.2%) compared with sharp needles (17.5%) (relative risk [RR] 0.66, 95% confidence interval [CI] 0.49-0.89) as well as for the assistant surgeon (RR 0.54, 95% CI 0.41-0.71). There was poor correlation between reported perforations and those detected by water test (R=0.3). Physicians reported that they were not as satisfied with blunt needles compared with sharp needles (P=.001).
                There was a significant decrease in the rate of glove perforation for surgeons and assistants performing cesarean-delivery closure with blunt needles. Assistant surgeons had the greatest reduction in glove perforations. However, physicians reported decreased satisfaction performing the surgery with blunt needles.
                ClinicalTrials.gov, www.clinicaltrials.gov, NCT00844636
                I. Round-tipped blunt needle (BN) may decrease the risk of needlestick injuries and hand contamination. We prospectively determined the incidence of glove perforations in emergency abdominal procedures and the efficacy of BN in increasing the safety for surgeons.
                Two hundred patients were randomized to undergo closure of the abdominal fascia using sharp needle (SN) or BN. Gloves were tested at the end of the procedure.
                Surgeons had 14 needlestick injuries and 76 perforations recorded in 69 pair of gloves. Sharp needles were responsible for all injuries and 58 (76%) perforations (P < 0.00004 and P < 0.00001, respectively). This difference was still higher when considering the perforations related to the abdominal fascia closure (BN 7% versus SN 50%; P < 0.0006).
                The risk of glove perforation is sevenfold greater if SN are used. Blunt needles reduce sharp injuries and improve safety for surgeons. Eighty-five consecutive patients were randomized to undergo mass closure of the abdomen with no. 1 polydioxanone mounted on either a blunt-tipped (n = 46) or cutting (n = 39) needle. Gloves were changed before closure and tested for perforation afterwards using standard air or water techniques. Fourteen pairs of gloves were punctured when using a cutting needle, and three pairs when a blunt-tipped needle was used. The majority of punctures were to the non-dominant glove. The surgeon was aware of the puncture in eight of the 14 instances involving a sharp needle and in one of the three involving a blunt-tipped needle. Blunt-tipped needles, while not eliminating the risk, significantly reduced the incidence of surgical glove puncture (P < 0.001, Fisher's exact test). The use of cutting needles for abdominal closure should be abandoned. Blunt-tipped needles have previously been shown to reduce needle-stick injury but the issue of morbidity had not been addressed. As awareness of the need for universal precautions heightens, concerns have been raised about any possible morbidity brought about by their use. We present the results of a randomised, controlled study which investigated wound morbidity following caesarean section. Of the 204 women randomised to closure with sharp or blunt-tipped needles, none developed anything other than superficial infection and there were no significant differences between the two groups. We conclude that the use of blunt-tipped needles does not cause an increase in wound morbidity. A randomized study is being presented, which compares closure of laparotomy with 2 different needles (sharp: HR48, blunt: HR48PP = protect point). Handling and glove perforation rate is to be compared. 400 gloves in 100 laparotomies have been tested. Slightly more effort was reported from the surgeon to perforate the fascia with the blunt needle, but there was also a significantly lower perforation rate in the glove of his non-dominant hand. To avoid a contamination during operation the use of blunt needles has to be recommended. With the increasing incidence of hepatitis B and HIV, and the increasing awareness of the risk and prevalence of hepatitis C, it is becoming even more necessary to adopt stricter policies to safeguard personnel and to reduce the risk of transmission. Previous studies have shown a need for eye protection, protective clothing and the use of double-gloving during operative or interventional procedures. The risk of infection is much less with unbroken skin and conversely more likely when hollow needles are used. Arguments against the routine use of double-gloving include the loss of dexterity and the discomfort incurred, and the potential loss of dexterity that might theoretically result in more rather than fewer needle-stick injuries. The incidence of penetrating skin wounds and needle penetration of gloves during operation was studied in orthopaedic surgeons. Significant hand wounds were found in 11% of surgeons before operations. Glove penetration during closure of the deep tissues occurred in 16% of outer gloves and 6% of inner gloves when standard needle points were used. The surgeon sustained a needle-stick injury in 6% of this group. When a needle with a protective point was used, there were no glove perforations. This simple precaution reduces the risk of transmission of blood-borne disease during operation. Exposure to blood is a hazard for all surgeons. We assessed the incidence of glove perforation and needlestick injury from a new blunt taperpoint needle designed to penetrate tissues other than skin with the minimum of force. We performed a prospective, randomised trial comparing the incidence of perforations of surgical gloves with the new needle and a standard cutting needle during wound closure after hip arthroplasties. There was at least one glove perforation in 46 of 69 such procedures (67%). The use of the taperpoint needle produced a significant decrease in perforations (p = 0.049).
There is high quality evidence that the use of blunt needles appreciably reduces the risk of exposure to blood and bodily fluids for surgeons and their assistants over a range of operations. It is unlikely that future research will change this conclusion.