If the scalpels were awkward and the blunt suture needles were, well, blunt the last time you conducted a safety sharps trial, you and your surgeons may be pleasantly surprised by improved designs that make cutting and closing less risky but no less effective than with conventional scalpels and suture needles.

To be blunt
Blunt suture needles aren't standard in every OR — but they should be. The low acceptance rate is due partly to a lack of marketing by suture manufacturers, partly to cost — they're about 30% more expensive than standard needles — and partly to physician preference. Manufacturers are stepping up their marketing efforts; that, along with compelling clinical data and recommendations from the American College of Surgeons and the Occupational Safety and Health Administration, might be the ammunition you need to change your surgeons' minds.

• The data. In contrast to other clinical areas, where significant declines in sharps injury rates have occurred since passage of the Needlestick Safety and Prevention Act in 2000, injury rates in the OR have remained unchanged.[1] The biggest contributing factor for this lack of progress is the failure of most surgeons to adopt blunt suture needles for suturing internal tissue such as muscle and fascia, even though the needles have been proven highly effective in reducing suture needle injuries.[2-3] Further, a study conducted by the International Healthcare Worker Safety Center at the University of Virginia (www.healthsystem.virginia.edu/Internet/epinet) found that 59% of suture needle injuries occurred during the suturing of internal tissue, and that substituting blunt suture needles for conventional ones for internal suturing could potentially reduce sharps injury rates in the OR by as much as 30%.4 Yet marketing data show blunt needles have had a very low adoption rate in the U.S.[1]
• Improved design. A major factor in that low acceptance rate is the perception that the needles are too dull to be effective. But the term "blunt" may be a misnomer: Blunt suture needles are sharp enough to penetrate internal tissue with little or no change in technique, but not sharp enough to penetrate the skin of the user and cause injury. Manu-facturers have been refining their designs to produce sharper needles that pass through internal tissue more easily, but still keep surgeons' hands free from harm. Surgeons will likely find the newer blunt sutures easier to work with and more effective than the products they trialed 5 or 10 years ago.

Switch blades
According to data from the EPINet surveillance network coordinated by the International Healthcare Worker Safety Center, more sharps injuries in the OR are sustained by non-surgeons (OR nurses, 30.3%; surgical technicians, 37.1%) than surgeons (32.6% for surgeons and residents combined).

The numbers don't lie: Tell your surgeons that by not adopting sharps safety devices and practices, they put every member of your clinical team at risk of injury and bloodborne infections. Recent improvements in safety scalpel designs will help your cause. The first generation of safety scalpels were relatively lightweight and most surgeons did not consider them viable alternatives to conventional scalpels. Manufacturers are now providing an array of protective features with more balanced, sturdier handles made of plastic or metal.

Look for models with one-handed safety-feature activation, including blades or protective shields that lock in place with audible clicks, letting users know that safety features have been activated or deactivated. Some safety scalpels feature blades that slide into the handle with spring-loaded mechanisms or manual buttons. Other scalpel designs employ plastic sheaths that slide over the blade. Weighted models exist for disposable and reusable scalpels, providing surgeons with safety blades similar in feel to conventional ones.

Hands-free passing
Hands-free passing helps establish common routines among surgical staffers who may not work together regularly. By eliminating hand-to-hand passing, the ex-change of sharps is more controlled and predictable, says Bernadette Stringer, RN, PhD, and Ted Haines, MD, associate professors of clinical epidemiology and biostatistics at McMaster University in Hamilton, Ontario, who have conducted joint research in this area.

They recommend designating a neutral zone in the sterile field using a kidney or similar-sized basin, suture dish or Mayo stand. The neutral zone must be large enough to comfortably hold the sharps used during a case. Con-firm the location of the neutral zone before each procedure.

Sharps should be placed in the neutral zone, handles facing the surgeon. The surgeon then directs his gaze to the neutral zone and reaches for the sharp. After use, he replaces the sharp in the neutral zone, where it's retrieved by the scrub tech.