A funny thing happened when we traveled to the Reading Hospital Surgicenter in Wyomissing, Pa., for our first safety sharps challenge. The new generation of safety scalpels caused such a buzz that the center's administrative director grabbed a sterile model off our table for use in an arthroscopy that was minutes away from starting.

Forget about a controlled trial. A real surgeon was about to cut into a real patient with a weighted safety scalpel we'd brought. It was show time. Pam Ertel, RN, BSN, CNOR, RNFA, peered in through the OR's window. "Let's see if he likes it," she said.

Orthopedic surgeon Robert Sutherland, MD, glanced up from the incisions he made and spoke volumes for sharps safety products without uttering a single word. Thumbs up. Ditto from the surgical tech. Forty minutes later, we found Dr. Sutherland outside the staff lounge. "It felt like a scalpel to me," he said. For a doc to say a safety blade felt like a scalpel is the ultimate compliment, and indicative of how much the quality of safety sharps products has improved over recent years. But don't take our word for it.

What makes a good safety scalpel?
Our panel of experts evaluated many of the options available today in safety scalpels and syringes. The trial (see "How We Put These Products to the Test") revealed many features that truly impressed our panelists, as well as some design concepts that still need some work. Here are the features our panel liked in scalpels.

• Weighted handle. Nurses and surgeons agreed that heavier scalpels feel more like traditional scalpels and they thought that fact would require less of a change in technique. Said one panelist, "Making an incision with a lighter instrument requires a different feel; because it's light, you could overcompensate with too much pressure and cut too deeply." One nurse noted that the lightweight plastic scalpels felt more like box cutters than scalpels.
• Hearing or feeling the safety mechanism engage. Panelists felt more comfortable with products featuring an audible or tactile click that signified the safety mechanism was in place.
• Smooth, intuitive action. The nurses and surgeons preferred products that opened smoothly and easily. Some retractable blades require a great deal of effort to engage. One panelist said, "If I am having a difficult time opening it now, I can only imagine how hard it would be to open with wet gloves on."
• Color-coded blade sizes. Panelists liked the scalpels that used different colors for different blade sizes because they could quickly and easily identify the scalpel they needed when they were pulling the item off the shelf.
• Opaque sheath. Panelists felt more secure using the blades with colored sheaths. "I could see how someone might think the blade was fully covered when it was not," said one nurse of products with clear sheaths.

What makes a good safety needle?
Here are the features our panel liked in safety needles.

• Ability to draw more fluids. The panelists liked the safety offered by retractable syringes but felt they could be impractical in certain clinical settings. Numerous injections are often required in the OR, and some retractable syringes can only be used once because the needles automatically retract after an injection is given. The safety mechanism of syringes boasting a snap-away plunger, however, is activated by the clinician and therefore can be used multiple times before the needle is secured within the syringe.
• Retractable needles. Panelists liked retractable needles because of the innovative and automated action of the device. Our experts also believed retractable needles would be ideal for IM injections because they could be handled like conventional syringes; manipulating the needle into a patient's muscle would not require a change in standard technique due to the lack of a protruding sheath included on other models of safety needles.
• One-handed activation. Panelists didn't like products that required both hands to engage the safety feature. "Because most needle sticks happen to your guiding hand, products that require you to use that hand to activate the safety device seem like they could potentially put you at risk of a stick," said one nurse.

Safety sharps in your facility
Once you've decided to convert to safety sharps products, your ability to incorporate them into the OR might depend on whether your staff and surgeons will change their minds and their habits. Neither is an easy thing to do. Here's some advice.

• Give your staff a voice. The willingness of your staff to use safety sharps will increase dramatically when you give them an opportunity to determine what works best for them. Sue Seitz, RN, MSN, CNOR, clinical nurse specialist for Greenville Hospital System, in Greenville, S.C., presents new products at monthly OR team meetings, but also takes the time to make rounds during the day to gather staff opinions in the hospital halls between cases. "Sometimes you have to get to them whenever and wherever you can," she says. "Listen to what they have to say - and accept the feedback. I'm not a surgeon, so it's unfair for me to tell the staff what they have to use without trying to understand what will and won't work for the people who will actually use the products."
• Educate, educate, educate. Make a concerted effort to keep the importance of safety sharps fresh in the minds of your staff. Ms. Seitz hangs posters displaying safety sharps policies and injury statistics around scrub sinks, on employee bulletin boards and in the staff lounge. Her hospital's OR schedule starts an hour late on the first Wednesday of every month to allow for safety-centric staff meetings. Ms. Seitz often uses these morning meetings to reinforce the hospital's safety sharps policy; she also brings in expert speakers to lend some credence to her message. Making her administration aware of the financial ramifications of a sharps exposure is also effective. According to Ms. Seitz, a facility spends $64 to $225 on blood work alone each time an employee suffers a sharps exposure.
• Create accountability. After a massive education effort, the next step is developing a sense of accountability within the staff, says Michelle Bushey, BS, BSN, CIC, infection control practitioner for Greenville Hospital Systems.

Ms. Bushey heads an Awards/Alarm program, a creative way to bring problem areas to the attention of the staff and recognize good behavior. Here's how the program works: A circulating nurse manager makes rounds and issues a ticket of sorts for compliance or a lack of compliance with safety policies. She randomly checks in on cases and assesses the safety precautions the surgical team made. Do they have goggles on? Are they double-gloved? Using a neutral passing zone?

The nurse manager will then issue a ticket - she must meet a quota of writing five a week - documenting either a violation of or accordance with the hospital's safety policy. Photocopies of the tickets, both the positive and negative varieties, wind up in employee personnel files. When it's time for staff evaluations, nurse managers have documented proof of an employee's safety record.

Use a manager who already circulates around the ORs, says Ms. Bushey, one familiar with employees and the daily functioning of the surgical teams. A known face will get a more honest assessment of staff behavior than a foreign manager policing the OR area, she says.

• Champion a doc. The most difficult, and most essential, hurdle to incorporating safety sharps in your facility is getting a surgeon on board with the concept. Safety sharps compliance is often blocked by the whims of a veteran surgeon, and as most of you know, there are no easy answers to dealing with a stubborn doc.

Alice Heiser, RN, infection control coordinator for the Reading SurgiCenter, says developing a rapport with surgeons is the most effective way to get their ears. Once you establish a relationship, she says, convince your surgeons to give safety sharps a chance. "Get your docs to at least try safety equipment once. When you're thinking of buying a car, you test drive all sorts of models. You might end up buying the same car you've always owned, but how are you going to know what you like if you don't at least see what else is out there?"

Ms. Seitz recommends garnering support from your facility's ownership or administration, believing in the power of numbers to sway docs. She also takes advantage of her health system's OR committee, using the monthly gathering of surgeons to present new equipment options and safety concerns of the staff.

Above all, says Ms. Seitz, be sure to capitalize on the opportunity of swaying young and still impressionable docs. "I give lectures to medical students and new residents," she says. "I'm hoping we're creating a whole new generation of surgeons who are aware of and open to OR safety."

• Collect data. Collect accurate data about sharps injuries at your facility and use the results to reinforce the importance of taking proper safety measures. Ms. Seitz gets a report every time a member of her staff is stuck by a needle or blade. She then uses the information to determine where and how the error occurred. Did the stick occur between steps of a procedure? What protection was the employee using? During what kind of procedure and in what surgical department did the exposure take place?

Ms. Seitz graphs the sharps-injury data and posts the results - along with preventive measures - on a prominent bulletin board. Her charts let employees know what equipment people are getting stuck with, which departments are suffering the most injuries and most importantly, the steps the OR team could have taken to prevent the exposures.

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  Develop open communication. The success of a sharps safety program relies heavily on communication between the staffs of the OR and the infection control division, says Ms. Seitz. Larger facilities - hospitals in particular - often have an infection control nurse assigned specifically to the OR staff. Smaller facilities may not be as lucky. "It's still important for an infection control manager in a small facility to be diligent in making the rounds to the ORs," says Ms. Seitz. "Get to know the safety practices of your staff and be diligent in establishing a collaborative presence."
• Research your options. There are plenty of resources available to stay current on new options in safety sharps products. The Internet and professional journals are great research tools, and conferences are an ideal place to sample new products. Bonita Koller, purchasing coordinator for the Reading Hospital Surgicenter, uses old-fashioned word of mouth to get a pulse of the product lifeline. "Most surgery centers are willing to share information. Keep the lines of communication open and don't get caught up in the daily activity of your center," she says. "Be active and be aware of what's out there."

Ms. Seitz likes to use message boards on the Web sites of professional organizations. "I'll post questions about products on message boards, and managers from around the country offer advice. What products are they using? Have they had any problems with the equipment? It's a great way to get a feel for what colleagues are using."

Another look
Manufactures have worked hard to improve on the first generation of safety sharps equipment. If you haven't recently explored the latest in safety blade and syringe design, consider the results of our challenge and take another look at safety sharps. Ms. Ertel is certainly glad she did.

"During the initial round of safety initiatives, no one came up with anything we could use in the OR. The design wasn't there," says Ms. Ertel. "We were scared off by the quality and haven't taken the time to go back and find out that there are better products available now."