Use of Blunt-Tip Suture Needles

to Decrease Percutaneous Injuries

to Surgical Personnel

Safety and Health Information Bulletin

Preface 

The Occupational Safety and Health 

Administration’s (OSHA’s) Bloodborne 

Pathogens standard (29 CFR*

 1910.1030) 

protects employees against occupational 

exposure to bloodborne pathogens. Bloodborne 

pathogens are pathogenic microorganisms 

that may be present in human blood and 

cause human disease. These pathogens include, 

but are not limited to, hepatitis B virus 

(HBV), hepatitis C virus (HCV), and human 

immunodeficiency virus (HIV). Occupational 

exposure to bloodborne pathogens may occur 

when workers receive a penetrating injury 

to their skin (percutaneous injury). Surgical 

personnel are at risk of occupational exposure 

to bloodborne pathogens from injuries 

caused by sharp surgical instruments. Such 

personnel include surgeons, nurses, surgical 

technicians, anesthesiologists, and other health 

care personnel both inside and outside the 

operating suite.

Purpose 

The purpose of this Safety and Health 

Information Bulletin is: 

1. To describe the hazard of sharp-tip suture 

needles as a source of percutaneous injuries 

to surgical personnel; 

*Code of Federal regulations. See CFR in references.

Department of Health and Human Services

Centers for Disease Control and Prevention

National Institute for Occupational Safety and Health

SHIB 03–23–2007 • DHHS (NIOSH) Publication No. 2008–101 (supersedes 2007–132)

U.S. Department of Labor

Occupational Safety and Health Administration

This document was developed by the Occupational Safety 

and Health Administration (OSHA), Department of 

Labor, and the National Institute for Occupational Safety 

and Health (NIOSH), Centers for Disease Control and 

Prevention, Department of Health and Human Services. 

OSHA’s mission is to assure the safety and health of America’s 

workers by setting and enforcing standards; providing 

training, outreach, and education; establishing partnerships; 

and encouraging continual improvement in workplace safety 

and health. NIOSH is the federal agency responsible for 

conducting research and making recommendations for the 

prevention of workplace injuries and diseases.

This Safety and Health Information Bulletin is not a standard 

or regulation, and it creates no new legal obligations. The 

Bulletin is advisory in nature, informational in content, and is 

intended to assist employers in providing a safe and healthful 

workplace. Pursuant to the Occupational Safety and Health 

Act, employers must comply with hazard-specific safety and 

health standards promulgated by OSHA or by a state with an 

OSHA-approved state plan. In addition, pursuant to Section 

5(a)(1), the General Duty Clause of the Act, employers 

must provide their employees with a workplace free from 

recognized hazards likely to cause death or serious physical 

harm. Employers can be cited for violating the General Duty 

Clause if there is a recognized hazard and they do not take 

reasonable steps to prevent or abate the hazard. However, 

failure to implement any recommendations in this Safety 

and Health Information Bulletin is not, in itself, a violation 

of the General Duty Clause. Citations can only be based on 

standards, regulations, and the General Duty Clause.
2 

2. To present evidence of the effectiveness 

of blunt-tip suture needles in decreasing 

percutaneous injuries to surgical personnel, 

particularly when used to suture muscle and 

fascia; and 

3. To emphasize OSHA’s requirement and 

NIOSH’s recommendation to use safer 

medical devices—in this case, blunt-tip suture 

needles—where clinically appropriate.

Background

Sharp-tip suture needles are the leading source 

of percutaneous injuries to surgical personnel, 

causing 51% to 77% of these incidents. 1,2,3 Sharptip suture needles not only injure surgical staff, 

but also present a risk to patients from potential 

exposure to injured staff ’s blood. Suture needle 

injuries can occur when surgical personnel: 

•	 Load or reposition the needle into the needle 

holder; 

•	 Pass the needle hand-to-hand between team 

members; 

•	 Sew toward the surgeon or assistant while the 

surgeon or assistant holds back other tissue; 

•	 Tie the tissue with the needle still attached,

•	 Leave the needle on the operative field, 

•	 Place needles in an over-filled sharps 

container; or 

•	 Place needles in a poorly located sharps 

container.4 

Suture needle injuries frequently occur during 

suturing of muscle and fascia.2 In 2005, the 

American College of Surgeons (ACS) issued 

a statement supporting universal adoption of 

blunt-tip suture needles for suturing fascia 

and encouraging further investigation of their 

appropriate use in other surgical applications. The 

ACS stated that “all published studies to date have 

demonstrated that the use of blunt suture needles 

can substantially reduce or eliminate needle-stick 

injuries from surgical needles.” 5 The Association 

of Perioperative Registered Nurses (AORN) 

endorsed this ACS statement in support of blunt-tip 

suture needle use where effective and clinically 

appropriate.6 The ACS and AORN are two of the 

seven member organizations of the Council on 

Surgical and Perioperative Safety, all of which have 

endorsed this statement. The other five member 

organizations are: the American Association of 

Nurse Anesthetists, the American Association 

of Surgical Physician Assistants, the American 

Society of Anesthesiologists, the American Society 

of PeriAnesthesia Nurses, and the Association of 

Surgical Technologists.

Engineering Controls

Engineering controls are defined in OSHA’s 

Bloodborne Pathogens standard as controls that 

isolate or remove the bloodborne pathogens hazard 

from the workplace [29 CFR 1910.1030(b)]*9. The 

standard states “Engineering and work practice 

controls shall be used to eliminate or minimize 

employee exposure” [29 CFR 1910.1030(d)(2)

(i)]. This means that if an effective and clinically 

appropriate safety-engineered sharp exists, 

an employer must evaluate and implement it. 

However, if using a safer device compromises 

either patient safety or medical integrity its use 

would not be required. 

Blunt–tip suture needles are identified by OSHA 

as an example of an engineering control to reduce 

percutaneous injuries (CPL 02-02-069, XIII 

D.2) (Citation Guidelines). As an alternative to 

sharp-tip suture needles, blunt-tip suture needles 

can be used to suture less-dense tissue such as 

muscle and fascia. Since as many as 59% of suture 

needle injuries occur during suturing of muscle 

and fascia,1 the replacement of conventional sharptip suture needles with blunt-tip suture needles 

for these surgical tasks will reduce injury rates to 

surgical personnel. Conventional sharp-tip suture 

needles may be needed to suture skin, bowel, and 

blood vessels, although suture-less techniques 

for these procedures are available for use at the 

discretion of the surgeon. Several case studies 

suggest, but do not conclusively demonstrate, that 

blunt suture needles may also be used for suturing 

bowel and skin.7
3 

Evidence of Effectiveness of 

Blunt-Tip Suture Needles

Multiple studies have reported the effectiveness 

of blunt-tip suture needles in decreasing 

percutaneous injuries. A Centers for Disease 

Control and Prevention (CDC) study of suture 

needles in gynecologic surgery found a statistically 

significant reduction of injury rates when blunt-tip 

suture needles were used (Figure 1).8 In addition, 

use of these devices resulted in minimal clinically 

apparent adverse effects on patient care and were 

generally accepted by participating surgeons.8

Other trials and reports have shown that blunt-tip 

suture needles are technically satisfactory when 

used appropriately and that their use results in 

substantial reduction or elimination of injuries to 

surgical personnel.2

Conclusion 

OSHA and NIOSH strongly encourage the use 

of blunt-tip suture needles, whenever feasible and 

appropriate, to decrease percutaneous injuries 

to surgical personnel. Clinical use and scientific 

studies have established the effectiveness of 

blunt-tip suture needles in decreasing the risk of 

percutaneous injuries. Employers in workplaces 

that use suture needles have the responsibility 

under the Bloodborne Pathogens standard to 

evaluate the use of blunt-tip suture needles as well 

as other appropriate safer medical devices. After 

this evaluation, which must include input from 

non-managerial employees responsible for direct 

patient care [29 CFR 1910.1030(c)(1)(v)] -e.g., in 

this case surgical personnel—employers must use 

safer devices to replace corresponding conventional 

sharp-tip suture needles in their workplaces when 

clinically appropriate. The introduction of any 

device must include training of staff in its proper 

use and follow-up to ensure a successful transition 

from conventional to safer devices. Where an 

employer has determined that the use of available 

safer devices is not feasible, the clinical justification 

for this determination must be documented in the 

facility’s Exposure Control Plan and the employer 

must implement alternative means of protecting 

surgical personnel from percutaneous injuries.

Figure 1. Rate of injury associated with the use of curved suture needles during gynecologic surgical 

procedures and percentage of suture needles used that were blunt, by quarter—three hospitals, New York 

City hospitals, April 1993–June 1994

7

6

5

4

3

2

1

0

Injury rate/per 100 procedures

% Blunt needles used

Blunt needle use

Injury rate

60

50

40

30

20

10

0

Apr–Jun Jul–Sep Oct–Dec Jan–Mar Apr–Jun

1993 1994
4 

Additional Tools and 

Information 

Additional information and resources on 

bloodborne pathogens and percutaneous 

injury prevention, including the complete text 

of OSHA’s Bloodborne Pathogens standard 

and the Needlestick Safety and Prevention 

Act, are available on OSHA’s Safety and 

Health Topics Page at http://www.osha.gov/

SLTC/ bloodbornepathogens/index.html and 

on NIOSH’s Safety and Health Topic Page: 

Bloodborne Infectious Diseases HIV/AIDS, 

Hepatitis B Virus, and Hepatitis C Virus at http://

www.cdc.gov/niosh/topics/bbp. 

OSHA’s web site www.osha.gov contains extensive 

resources on workplace safety and health as 

well as contact information for asking OSHA a 

question or filing a workplace safety and health 

complaint. NIOSH’s web site www.cdc.gov/niosh 

also contains extensive resources on workplace 

health and safety and contact information, 

including access to CDC’s Workbook for Designing, 

Implementing, and Evaluating a Sharps Injury 

Prevention Program which may be found at 

http://www.cdc.gov/ sharpssafety. The Workbook 

contains detailed information on how to select and 

evaluate sharps devices with engineered sharps 

injury prevention features as well as a sample 

device evaluation form.

References 

1. Jagger J, Bentley M, Tereskerz P. A study of 

patterns and prevention of blood exposure in OR 

personnel. AORN J. 1998; 67(5):979–81, 983–4, 

986–7. 

2. Berguer R, Heller PJ. Preventing sharps injuries 

in the operating room. J Am Coll Surg. 2004; 

199(3):462–7. 

3. Makary MA, Al-Attar A, Holzmueller CG, 

Sexton JB, Syin D, Gilson MM, Sulkowski 

MS, Pronovost PJ. Needlestick injuries among 

surgeons in training. N Engl J Med. 2007 Jun 28; 

356(26):2693–9.

4. Davis MS. Advanced Precautions for Today’s OR: 

The Operating Room Professional’s Handbook for 

the Prevention of Sharps Injuries and Bloodborne 

Exposures, 1st ed. Atlanta; Sweinbinder; 1999. 

5. American College of Surgeons (ACS). Statement 

on blunt suture needles. Bull Am Coll Surg. 2005 

Nov; 90(11):24. Available from http://www.facs.

org/fellows_info/statements/st-52.html 

6. Association of Perioperative Registered Nurses 

(AORN). AORN Guidance Statement: Sharps 

Injury Prevention in the Perioperative Setting. 

In: 2005 Standards, Recommended Practices, 

and Guidelines. 2005; 199–204. Available from 

www.aorn.org/about/positions/pdf/SECTI2esharpssafety.pdf 

7. Dauleh MI, Irving AD, Townell NH. Needle 

prick injury to the surgeon—do we need sharp 

needles? J R Coll Surg Edinb. 1994; 39(5):310–1. 

8. Centers for Disease Control and Prevention 

(CDC). Evaluation of blunt suture needles 

in preventing percutaneous injuries among 

health-care workers during gynecologic surgical 

procedures—New York City, March 1993–June 

1994. MMWR Morb Mortal Wkly Rep. 1997; 

46(2):25–9. Available from http://www.cdc.gov/ 

mmwr/preview/mmwrhtml/00045660.htm

9. CFR (Code of Federal regulations). Title 29 Part 

1910, OSHA. Washington, DC: U.S. Government 

Printing Office, Office of the Federal Register.

To receive more information about occupational safety 

and health topics, contact NIOSH at 

Telephone: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

E-mail: cdcinfo@cdc.gov

or visit the NIOSH Web site at www.cdc.gov/niosh.

For a monthly update on news at NIOSH, subscribe to 

NIOSH eNews by visiting www.cdc.gov/niosh/eNews. 

Mention of any company or product does not constitute 

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sites external to NIOSH do not constitute NIOSH 

endorsement of the sponsoring organizations or their 

programs or products. Furthermore, NIOSH is not 

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This document is in the public domain and may 

be freely copied or reprinted.

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