Procedures such as using a neutral zone for passing blades and needles may vary from facility to facility, but six basic principles apply to everyone who works with sharps.

Account for all pointed instruments.
Policies for passing, cleaning and disposing of sharps should apply to all potentially dangerous tools and instruments. Scalpels and needles cause the most sharps injuries, but orthopedic wires, drills and other pointed instruments can penetrate skin.

Enforce a no-touch sharps policy.
Staff should attach and remove blades to and from knife handles with a heavy clamp or safety device — never their bare hands. You might consider purchasing retractable, disposable blades or knives with safety handles as an added protection. Also use an instrument, not your fingers, to replace trocar shields used with drains.

Keep fingers from needles.
To remove a needle from a syringe, use a hemostat or safety device. Needles should never be purposely bent, broken, removed from disposable syringes or otherwise manipulated by hand. Employ a one-handed technique or use a mechanical device to recap needles and blades. When repositioning a needle for a left-handed surgeon, AORN recommends the use of heavy forceps instead of fingers.

Place instruments in a neutral zone.
Injuries can occur when passing needles or blades, mounting or repositioning needles, or when tying suture with the needle still attached. The best way to avoid sharps injuries when passing is to place the instrument — always one at a time — in a neutral zone, such as a tray, rather than passing it from hand to hand. The neutral zone approach is consistent with the goal of maintaining a no-touch policy when handling sharps.

If you don't use a neutral zone, staff must follow strict guidelines when passing or returning sharps:

• The sender and recipient make eye contact and verbally confirm that the sharp is being passed.
• The knife, syringe or other device is passed with the sharp end pointed down and protected by the sterile person's hands. Retractable blades should be closed and pointed down, with the tips in view.
• Only one sharp is passed at a time.

Contain all sharps on the back table in the OR.
Remove sharps from the field as soon as possible to reduce the risk of injury. Place all used needles, scalpel blades and other sharps in a puncture-resistant needle counter box for disposal. Place reusable sharps in a puncture-resistant container for transport to the reprocessing area.

When to replace sharps containers?
Replace them when they're 75 percent full, as injuries can occur when sharps are placed in overfilled counter boxes. Keep your sharps containers in convenient locations so staff don't have to walk long distances to dispose of items such as trocars, wires and pins. The back table is a good spot for the needle counter box, which should never be stored on the Mayo stand or surgical field. Remove all stray sutures from needles, and use an instrument when counting sharps placed in the counter box. The scrub person must verify the number of blades before closing the box. During transport, ensure that the needle counter box is closed and no sharps are sticking through it.

Stick with it
In addition to regular check-ups with staff, use the sharps safety checklist below to evaluate compliance in the OR. The best way to monitor adherence to your sharps safety policies is by examining the behaviors and attitudes of your staff in practice and using that data to identify opportunities for improvement.