Converting to safety scalpels is like any other change you attempt to institute in your ORs: If your surgeons and staff don't like them, they won't use them. Keep that in mind as you evaluate the 16 safety scalpels we included in the pullout poster to the right. "There isn't a best device, but there is a device that fits your front-line workers," says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute. "Purchasing the scalpel is not the issue. It's getting surgeons to use the scalpel." Some tips to consider:

• OSHA's watching. In 2000, the federal Needlestick Safety and Prevention Act became law. Enforced by OSHA, the law requires employers - including hospitals, ASCs and surgeons - to periodically evaluate and implement safety devices (such as blunt-tipped suture needles and safety scalpels) and safe work practices (such as a neutral zone for passing sharps). OSHA doesn't consider a lack of injuries to be a reason not to use safety devices, and it's not acceptable for a surgeon simply to refuse to use a safety scalpel. If engineering controls can reduce employee exposure either by removing, eliminating or isolating the hazard, they must be used.
• Plenty to trial. Using a safety scalpel doesn't necessarily mean that your surgeons will have to change their techniques, say experts. As you'll see in the poster, you have a variety to evaluate. The evaluation process should include a clinical trial, during which you should look for feedback about each scalpel's weight, shape and feel. Most surgeons and staff want protection without compromise - a safety scalpel that feels like a traditional scalpel - so that they can focus on the surgical site, not the instrument. But perhaps the most important feature of any scalpel is the blade. You may want to demo the device in an operating room setting before you make a final decision. Evaluating new devices is an ongoing process. If you're already using safety scalpels, continue to seek feedback from surgeons and staff regarding their ease of use and continue to evaluate new devices. Scalpels that let you hear and feel a click when the retractable blade or the retractable sheath locks in place to cover the blade, or those that allow one-handed activation of the safety device, may prove useful.
• Gaining slow but steady traction. Based on 2005 data, less than 5 percent of the acute care market for reusable scalpels has converted to safety devices, says scalpel manufacturer BD. For disposable scalpels in acute care, it's 59 percent, up from 22 percent in 2002. Among alternate sites, conversion has been slower, increasing from 10 percent in 2002 to 25 percent in 2005, says BD.
• Like a loaded gun. There's no such thing as a perfectly safe scalpel. "A safety scalpel is a safety scalpel only when its safety features are fully engaged, as a rifle is safe only when its safety catch is on," says Pankaj Kehr, managing director of Jai Surgicals. Safety scalpels protect the receiver from accidental injury when the blade is retracted inside the shell of the scalpel or the sheath is pushed into place to cover the blade during a pass. "But what if the passer fails to retract or cover the blade fully?" asks Mr. Kehr. "Use sharps passing trays or neutral zones - the equivalent of not pointing a gun at someone even with the safety catch on."