In the past, percutaneous injuries and mucocutaneous exposures were considered to be an accepted occupational hazard for the surgeon. Although the potential for injury, exposure, and contraction of blood-borne disease was well known, there were no attempts to reduce risk of such events. When the human immunodeficiency virus was described in 1981 we began to pay greater attention to health care worker safety in the operating room. In 1983 the Centers for Disease Control and Prevention (CDC) recommended "caution" when handling body fluids from patients suspected of having AIDS. Initially HIV and AIDS were considered to be rare and confined to particular groups at high risk. This inaccurate notion changed rapidly as the disease reached epidemic proportions, and by 1987 the CDC recommended "Universal Precautions," 1 which state that blood and body fluid precautions be used with all patients. It was at this time that the CDC made their first recommendations for use of appropriate barrier protection and against resheathing contaminated needles. In 1991 The Occupational Safety and Health Administration required use of Universal Precautions with the enactment of the Bloodborne Pathogen Standard. 2 This standard has been revised and updated several times, most recently in 2001. 3 Although discovery of AIDS and HIV was the driving force behind development of Universal Precautions, it is widely appreciated that many serious illnesses can be contracted through contact with contaminated blood and body fluids. Unfortunately the published literature indicates that surgeons demonstrate poor compliance with Universal Precautions. 4 Perhaps even more unfortunate is the failure of Universal Precautions and the Bloodborne Pathogen Standard to fully address the needs of the high-risk operating room environment. Injuries to surgeons and scrub personnel continue to occur.
The operating room environment is unique because of the carefully orchestrated team approach to surgical care. Surgeons, scrub nurses, and operating room technicians work very closely together handling the same instruments in a confined space. Consequently, surgeons and scrub personnel are injured in similar ways with similar equipment and not infrequently by each other. A team approach to safety in the operating room is critical if injury rates are to be reduced.