We all know sharps injuries occur during surgery, but all too often we neglect the dangers of post-op practices related to sharps. As with sharps injuries that occur while we use the devices, we've identified root causes and prevention strategies for injuries that occur during disposal.

Handling all scalpels with care
While safety scalpels may eliminate much of the risks associated with scalpel assembly, disassembly and passing, they still can hurt you. Regardless of the type of scalpel you're using, during procedures you should establish a neutral zone and always use no-hands technique for handling sharps. If for some reason you're not using a safety scalpel as required by OSHA for any given patient (you'll need to fill out a patient-safety-exception form each time), here's how to safely mount and remove scalpel blades from reusable scalpel handles, and how to safely dispose of both traditional and safety models.

• Don't rush. Understand the hazards involved. Assembly and disassembly of scalpels are ideally performed in a careful, unhurried manner. Stress to your scrub person that he should plan ahead so that scalpels are assembled and ready to pass before the surgeon requests them. If you often have emergency cases that start with the scrub person unprepared to provide the scalpel to the surgeon, you already understand why converting to safety scalpels is a really good idea.
• Never use your fingers. Traditional teaching has been that scalpel blades be mounted and removed by using a hemostat - but you should never use your fingers to handle a scalpel blade. A better option would be to use a device specifically designed for this purpose. The fingers should never be used to manipulate a scalpel blade.
• Don't take safety for granted. One reason safety scalpels are gaining in popularity, aside from the fact they prevent injuries to everyone on the OR team, is that OSHA field inspectors now expect to find them in use - and will issue citations and fines when they're not used. To prevent injuries from safety scalpels, ensure that the blade is fully retracted or fully shielded after final use. Only a one-handed maneuver is acceptable when retracting or shielding the blade. This ensures that the thumb and fingers are behind the blade, preventing injury to the dominant (manipulating) hand.
• Keep your hands behind the sharp. Always try to follow the principle of keeping both hands behind the sharp. Assembly or disassembly of various devices with sharp components may require an opposing push-pull motion of the hands - a risky maneuver. Preferably, you should line up the two components vertically, place one side on the table and tap down on the other component from above to complete the seating/attaching of the components. If this isn't possible, place both hand-held components on the table to limit motion of the sharp in an unintended direction. Because of the possibility of overshoot, this is a dangerous maneuver that should be performed only with extreme care.

Using needle-counting/collection boxes
Small flat boxes, with or without magnetic linings, have been traditionally placed on the back table or instrument stand for the dual purpose of accounting for needles and scalpel blades during procedures and eventual disposal. For worker safety, these boxes may be placed on the sterile field if - but only if - a stable location can be found, for the purpose of keeping them safely at arm's reach of more than one operator during a combined procedure. An example would be coronary artery bypass graft/saphenous vein harvesting, where two procedures are simultaneously performed.

You can place suture needles used for episiotomy or laceration repair (even if they're blunt-tipped sutures, the use of which is preferable) in the box for eventual disposal into a wall-mounted sharps-disposal container. You shouldn't remove needles from local anesthesia injection syringes from the syringe - this constitutes an OSHA violation. Instead, you should place the syringe and attached needle in a wall-mounted sharps-disposal container.

It's important to note that the following guidelines for use of sharps-disposal containers apply inside and outside the OR:

• Mount properly. Correct placement of the container is critical. Ideally, you should mount it at arm's reach from the point of use. Having to cross the room to access the sharps-disposal container can and has resulted in injury and infection with HIV and/or hepatitis C virus.
• Don't overfill. Overfilled containers have been identified as a frequent cause of injury. Properly designed containers have a clearly visible full line (about three-quarters up the side of the box) that indicates it's time to replace the container. Be sure to replace containers before overfilling occurs to prevent injury during the act of disposal.
• Keep it clear. Don't let access to the opening of the container become obstructed. Healthcare workers must be able to see and reach the opening of the container easily.
• Buy the right size. Sharps-disposal containers should have an opening of adequate size to accept the sharps used in each worksite. For example, the disposal of a used epidural anesthesia tray requires a container with a large opening.

Recapping and reusing of needles
Direct disposal of used needles into an approved sharps-disposal container eliminates the need for the dangerous practice of recapping. When needles are reused during a procedure, you should take the following precautions:

• Watch your fingers. When needles are used repeatedly, as with incremental injection, you should use hemostats or other instruments to handle the needle - but never the fingers.
• Take precautions. Secure needles between incremental uses by using a safety-engineered recapping device or by inserting the needle into a rolled towel on the instrument stand or back table.

Minimize injuries
Remember, just because the procedure's over, it doesn't mean you can't be stuck by hollow-bore needles, IV catheters, scalpel blades and suture needles. Such injuries can cause infections from bloodborne pathogens in healthcare workers, and that's why safe sharps disposal is one important part of every facility's overall sharps injury prevention program. These guidelines should let OR professionals significantly reduce their risk of sharps injury and bloodborne-pathogen transmission during sharps disposal.