We read with great interest the article by Patterson et al, ¹ which dealt with surgeons’ risk awareness and behavioral methods of protection against bloodborne pathogen transmission during surgery.

This large and well-conducted survey highlights the fact that most surgeons underestimate the risk of bloodborne pathogens and that the actual incidence of exposure to needle-stick injury and puncture wounds is much higher than usually thought. The article focused on two important protection strategies, i.e., vaccination and double-gloving. The former, at present available against the hepatitis B virus, is still not used by all surgeons, and it does not protect against the hepatitis C and human immunodeficiency viruses. Double-gloving is presently used only by 12% of surgeons, although Quebbeman et al ² have shown that the risk of blood contamination for surgeons’ hands can be significantly reduced by seven- to eightfold with double-gloving without impairment of tactile sensation. They reported an equal number of needle-stick injuries wearing one pair of gloves or two, however, so double-gloving seems ineffective in protecting the surgeon if unavoidable injuries occur, and their use could dramatically increase the cost of medical care.

The most common exposure to patient’s blood is from needle-stick injury. Its incidence varies from 5.3% to 12.8% and depends on several factors, such as surgical specialty (there is greater risk in gynecologic, cardiothoracic, trauma, general, and vascular procedures), role of the individual (greater risk for the surgeon and first assistant), duration of operation, number of needles used, and surgeon experience. ^3,4 Reading the article of Patterson and colleagues, we were surprised that they did not mention an important protection strategy against needle-stick injuries, i.e., the round-tipped blunt needle (BN).

Because needle-stick injuries occur during suturing, especially celiotomy closure, the use of BN could reduce the risk of percutaneous injuries and glove perforation and the subsequent contact between exposed skin and patient blood. During celiotomy closure, which requires a great effort by the needleholder to pass the needle through muscles and fascia, the needle tip is often hidden from the direct vision of the surgeon, especially if excessive adipose tissue is present. Furthermore, the surgeon may have decreased attention, being at the end of a surgical procedure. This is, in fact, a common part of the operation, but one that probably does not get quite the detailed attention that it deserves. In an our study, ⁵ we prospectively determined the incidence of glove perforation in emergency abdominal procedures and the efficacy of BN in increasing safety for the surgeon. Sharp needles (SN) were responsible for all injuries and for the majority of glove perforations. The risk of glove perforation was fifteenfold greater if sharp needles are used. Furthermore, the use of blunt needles does not represent an additional increase in medical expense, as does double-gloving, because its cost is equal to that of a sharp needle.

In conclusion, we would emphasize the most effective methods to limit surgeon exposure to patient blood are those surgeon can take himself. In fact, vaccination against hepatitis B, the recognition that celiotomy closure is a high-risk portion of the operation for blood contamination, the adoption of a hands-off technique, and the use of BN and double-gloving are the most effective modalities to prevent needle-stick injuries and contamination and should always be used to increase the safety for surgeons.