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Scalpel Safety – Protecting Patients and Clinicians

Over the last 20 years I have visited many hospitals and clinics in a sharps injury prevention role.   I have enjoyed the opportunity of visiting with clinicians concerning safety products on an international basis and discussing sharps injury prevention.
Many institutions have become more compliant with the revised OSHA Bloodborne Pathogen Standard. Unfortunately, not all departments in hospitals are as compliant with  all  requirements  of the law. One area in the hospital struggling to be compliant  is  the  operating  room.  There  are many clinicians who are still hanging onto standard scalpels rather than making the conversion to safety scalpels.As we are all aware, scalpels are small but extremely razor-sharp knives used during surgery.
The razor-sharp blade is attached to a flat or round handle that is often very slippery. Accidents happen and the risk of injury and potential infection from bloodborne pathogens is very high.
Scalpel blade injuries are among the most frequent sharps injuries, second only to the ubiquitous needlestick. Scalpel injuries make up 7 percent to 8 percent of all sharps injuries. One of the challenges of scalpel blade injuries is their severity. Typically these scalpel blade injuries are deeper and more dramatic than needlestick injuries. It was estimated in 2005 that less than 5 percent of the acute care market for reusable scalpels had converted to the use of safety devices. For disposable scalpels in acute care the conversion was about 59 percent.
Why Don’t More Surgeons Use Safety Scalpels?
According to the literature there are a variety of reasons why many surgeons are are reluctant2 to adopt the use of safety scalpels. Some surgeons have indicated that they saw a patient safety issue because the safety scalpels were not rigid enough in their hand during deep tissue incisions. Another surgeon indicated that he found the sheet covering the blade awkward to use. He felt that it did not retract or slide back over the blade easily. Other reasons include: concerns for patient safety, felt too clumsy in their hand, obstructs vision of incision, etc.
One additional reason could be the current generation of safety scalpels are “active” safety devices, meaning the safety feature of the product has to be activated by the clinician. This is different than the passive blood collection devices that are on the market. These passive devices simply require the insertion of the needle into the patient to activate the safety feature. With a safety scalpel,   the safety feature has to be activated by retracting the blade or by shielding it following use.
In one study, sponsored by the Centers of Disease Control and Prevention (CDC), the authors discovered the safety features of “active” safety devices (where the safety mechanism needs to be activated by the user, in contrast to “passive” safety devices where the safety mechanism is activated automatically) were not always activated. In fact,  the activation rates in their study ranged from a low of 17 percent to 90 percent. This was quite a range—the activation rates recorded in this study were 17 percent, 27 percent, 67 percent and 90 percent.
In yet another study, it was reported that 4.1 percent of the scalpel injuries inflected during the study were due to injuries suffered from safety scalpels. An additional 4.1 percent were injuries suffered from reusable scalpels. At first the authors thought that there were an equal number of injuries from safety scalpels as from reusable scalpels. However, this figure was misleading because there are not equal amounts of safety scalpels used as compared to reusable scalpels. Using the assumption that only 20 percent of scalpel usage has been converted to safety scalpels, this study indicates that there were actually four times more injuries with safety scalpels than reusable scalpels.