Safety Scalpels Research Articles

Refocusing on standard precautions and other non-pathogen-specific initiatives to prevent nosocomial transmission of bacterial pathogens in the acute healthcare settings

Refocusing on standard precautions and other non-pathogen-specific initiatives to prevent nosocomial transmission of bacterial pathogens in the acute healthcare settings

Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: What is the evidence?

The occupational hazard associated with percutaneous injury in the operating room (OR) has encouraged harm reduction through behaviour change and the use of safety-engineered surgical sharps. Some Canadian regulatory agencies have mandated the use of "safety scalpels." Our primary objective was to determine whether safety scalpels reduce the risk of percutaneous injury in the OR, while a secondary objective was to evaluate risk reduction associated with other safety practices. We used evidence review methods described by the International Liaison Committee on Resuscitation and conducted a systematic, English-language search of Ovid, MEDLINE and EMBASE using the following search terms: "safety-engineered scalpel," "mistake proofing device," "retractable/removable blade/scalpel," "pass tray," "hands free passing," "neutral zone," "sharpless surgery," "double/cutproof gloving" and "blunt suture needles." Included articles were scored according to level of evidence; quality; and whether they were supportive, opposed or neutral to the study question(s). Of 72 included citations, none was supportive of the use of safety scalpels. There was high-level/quality evidence (Cochrane reviews) in support of risk reduction through double-gloving and use of blunt suture needles, with additional evidence supporting a pass tray/neutral zone for sharps handling (4 of 5 articles supportive) and use of suturing adjuncts (1 article supportive). There is insufficient evidence to support regulated use of safety scalpels. Injury-reduction strategies should emphasize proven methods, including double-gloving, blunt suture needles and use of hands-free sharps transfer.

Clinical Issues—September 2012

Implant expiration dates Key words: expiration date, event related sterility, useful life. Hazardous chemical lists in the workplace Key words: hazardous substance, Occupational Safety and Health Administration (OSHA), material safety data sheet (MSDS), safety data sheet (SDS), hazardous chemical. OSHA compliance fines for refusal to use safety devices Key words: safety scalpel, Occupational Safety and Health Administration (OSHA), safety-engineered device.

Safety Precautions in Mohs Micrographic Surgery for Patients with Known Blood-Borne Infections: A Survey-Based Study

A survey-based study was conducted to gather expert experience on safety procedures used when performing Mohs micrographic surgery (MMS) on patients with known infectious hepatitis or human immunodeficiency virus (HIV). Six hundred eighty-four fellowship-trained Mohs surgeons were surveyed to examine the types of safety protocols used when treating patients with known infectious hepatitis or HIV and the frequency of exposure injuries to laboratory and surgical personnel from these patients. One hundred eighty-eight (27.5%) surveys were collected; 64.7% of respondents reported at least one exposure injury to surgical or laboratory personnel in the past year, and 4.8% reported exposure from a patient with known hepatitis or HIV infection. Risk of reporting at least one injury from a patient with known infection within the past year was significantly less when also reporting disposal of the ink applicator after each use (relative risk [RR]=0.109) and greater when employing laboratory personnel with no medical education or background (RR=3.857). No exposures were reported from respondents using blunt skin hooks, safety scalpels, safety syringes, smoke evacuators, a separate ink supply, or 24-hour formalin fixation. Although firm associations cannot be made from this study, the data suggest that certain measures may help to reduce the rate of exposure injuries in MMS.

“Scalpel Safety,” not “Safety Scalpel”: A New Paradigm in Staff Safety

Scalpel injuries account for between 7% and 12% of all sharps injuries. Efforts to increase the awareness of potential hazards of sharps injuries and related prevention efforts began in the early 1980s. Research shows convincingly that a single-handed scalpel blade remover combined with a hands-free passing technique (HFPT) is a safe alternative choice to the safety scalpel. The concept of “scalpel safety” is based on providing nurses the freedom of choice to select the best safety device for their individual needs on a case-by-case basis. Team members can now choose between a safety scalpel and a single-handed scalpel blade remover combined with a HFPT to achieve the correct balance between patient safety and staff safety.

Scalpel safety in the operative setting: A systematic review

The complex environment of the operative setting provides multiple opportunities for health care workers to sustain scalpel injuries; scalpels are the second most frequent source of sharps injuries in this setting. Little evidence has been published detailing the effectiveness of proposed safety procedures and devices. A systematic search strategy was used to identify relevant studies. Studies were included based on the application of a predetermined protocol, an independent assessment by 2 reviewers, and a consensus decision. Nineteen articles formed the evidence base for this review. Little high-level evidence was available. The results of studies reporting on 5 different devices/procedures were identified: the use of cut-resistant gloves/liners decreased the number of glove perforations in comparison with double latex gloves alone but lessened the wearer's dexterity and tactile sensation; the benefit derived from the use of the hands-free passing technique seemed equivocal; "sharpless surgery" was found to be feasible; a single-handed blade remover prevented at least as many injuries as a safety scalpel; and some shoe materials provided superior foot protection. The lack of available evidence highlights the need for the generation of a methodologically rigorous, clinically relevant, and statistically valid body of primary research in this area to support appropriate and effective safety interventions.

“Scalpel safety”: Modeling the effectiveness of different safety devices' ability to reduce scalpel blade injuries

Background: The objective of this study was to analyse and compare the potential effectiveness of two safety strate- gies in reducing scalpel blade injuries. The two strategies examined were safety scalpel vs. a single-handed scalpel blade remover combined with a hands free passing technique (HFPT) (e.g. passing tray or neutral zone). Methods: This was a retrospective study involving review of a 550-bed adult metropolitan tertiary referral hospital's sharps injuries database, chart review, and hypothetical modelling of the data to determine potential preventable injuries. The modelling was done twice, firstly assuming 100% effectiveness of each safety device and secondly using previously published activation rates for safety devices which were considered to be a more accurate reflection of real-life work practices. Results: A total of 141 scalpel injuries were reported between 1987 and 2003. Clinical charts were reviewed for 137 of these injuries. Just under 50% of injuries were sustained while the scalpel was in use and these were assumed to be not preventable. Assuming 100% effectiveness for each safety device resulted in 72 injuries being prevented by safety scalpels and 69 injuries being prevented by a combination of a single-handed scalpel blade remover and an HFPT. When injury prevention was calculated using published data on activation rates for safety devices, the number fell to as low as 12 for safety scalpel and to 61 for the combination of a single-handed scalpel blade remover and an HFPT. Conclusion: Both safety strategies are potentially effective in reducing scalpel blade injuries. However the safety scalpels are active devices and as such are subject to widely variable activation rates. We recommend use of a single-handed scalpel blade remover in combination with an HFPT as this can potentially prevent 5 times as many injuries as safety scalpels.

Safety scalpels; turnover time; personal clothing; implant sterilization; using suture packets to rectify counts

Safety scalpels; turnover time; personal clothing; implant sterilization; using suture packets to rectify counts

A safety scalpel.

A safety scalpel.