CAN'T LOOK AWAY Scott Miller, MD, of the Surgery Center of Ophthalmology Consultants in Fort Wayne, Ind., keeps his eyes on the task and his knife-passing safe.

We weren't using safety blades for our cataract surgeries a year ago. But we're using them now, along with safety-engineered suture needles, IV starts, everything. Here are some of the factors that went into our purchasing decision.

Concern over compliance
Our OR staff hadn't seen much in the way of sharps injury incidents, and our surgeons, like most surgeons, were of the opinion that something that's working well doesn't need to be changed. But managers have been seeing an increased push for safety sharps, from federal and state regulators, from accreditation agencies and from healthcare industry organizations, each of which has been demanding ongoing quality improvement and monitoring to ensure the protection of employees in the surgical workplace. So finding an ophthalmic blade that delivered safe use without compromising on functionality made itself a high-priority item on our to-do list.

Hands-on agreement
You won't be able to adopt safety blades, or even run a trial on them, without first selecting your potential options and literally putting them into your surgeons' hands. Even after a vendor's representative dropped by with a convincing argument and the offer of a 6-week trial, it was a little bit of a struggle to get our 3 surgeons on board. We told them about the looming requirements from OSHA, the state of Indiana and our accreditor, and also drew a reassuring line: All 3 docs had to agree to adopt a particular type of safety knife, or we wouldn't switch to that product. We weren't going to buy separate products for each one of them.

The quality of the blade
When they used the safety knives that would end up being their choice, the physicians were sold primarily on the fact that they had high-quality blades. The highest-quality ophthalmic knives have diamond blades, which are expensive to obtain, delicate to maintain and usually lacking in safety features. Most knives with safety features have stainless steel blades. But we'd found sapphire blades, which didn't require the amount of care and maintenance that diamond blades do, and also had safety guards. It wasn't all-things-to-all-people, but it was pretty close.

Cost per case
That they were reusable was another strong selling point. When your case mix is largely cataracts, your business is driven by Medicare reimbursements. When costs go up, your revenues go down. Single-use blades eliminate reprocessing, between-use damage and cross-contamination, and give you a fresh blade every time. When we tallied the reusable blades' uses, we found that their sharpness held up as their cost-per-case outdid disposable products. Plus, their cleaning and sterilization requirements were not complicated.

Who'll be the user?
If you're planning to adopt safety knives, it might be advisable to seek the support of your younger physicians. As with surgical technology, they're likely to be more familiar with the use of safety features and the need for them. Of our 3 surgeons, 2 are within a decade of retirement, while the third is just about a decade past residency. Keeping in mind that their younger partner will someday be in charge of the practice, the elder partners gave him a bit more weight in the decision resulting from the trial.

That's not the only issue involving use that you'll have to address, though. No matter how user-friendly a knife's safety features are, you still have to spell out exactly who is activating them. In short, what's the process for passing? Will your surgeons retract and shield the blade themselves, or will your scrub techs use a neutral passing zone? A bit of training is in order to ensure that you're putting your safety-engineered instruments to best use.

Accutome
AccuSharp Guarded Ophthalmic Knives
accutome.com
(800) 979-2020
Pricing: $38 to $70 per box of 6
FYI: Accutome built a reputation on its reusable diamond knives, then incorporated their quality and consistency into the AccuSharp line of single-use ophthalmic blades. The recently launched AccuSharp Guarded knives offer added protection without added costs. Available in a variety of sizes and styles, including slit, stab and crescent, the knives feature a 2-piece handle system with protective guards for safer passing.

Alcon
ClearCut S Safety Knife
alconsurgical.com
(800) 862-5266
Pricing: not disclosed
FYI: A simple and smoothly activated safety mechanism on Alcon's ClearCut S ophthalmic knife exposes the blade from under a protective hood, locks it in place for surgery and shields it again after use. The ergonomically designed handle features a safety grip for easy actuation and stable control. The single-use blade, available in a selection of types, ensures sharpness with each use.

Angiotech
SharpGuard Guarded Knives
angiotech.com
(877) 991-1110
Pricing: not disclosed
FYI: Aiming to protect surgical personnel from sharps injuries and blades from perioperative damage, SharpGuard guarded knives feature a textured, sliding, protective sheath that conceals the blade until it's retracted by the user. This single-use ophthalmic line is available in stab, slit, crescent and paracentesis blades in sizes from 2.2mm to 3.2mm.

Bausch + Lomb Storz
Laseredge Guarded Knives
storzeye.com
(800) 338-2020
Pricing: $40 to $120 per box of 6
FYI: Bausch + Lomb Storz's Laseredge Guarded Knives are designed to provide surgeons with a precision cutting edge combined with a unique handle that guards that edge when it's not in use. Blade options include stab incision, slit, clear corneal, single-edge, double-edge and trapezoid configurations. Supplied in boxes of 6, Laseredge knives are also available in Bausch + Lomb's Custom Procedure Packs and Instrument Select Packs.

Beaver-Visitec International
Beaver Safety Cataract Knives
beaver-visitec.com
(866) 906-8080
Pricing: $20 to $51 per knife
FYI: Designed for exceptional sharpness, consistency and precision, Beaver Safety Cataract Knives feature easy-to-use, retractable safety shields designed to protect users and handlers from the risk of sharps injuries during passing, between steps, after use and during disposal. The single-use products are available in slit, crescent and sideport blades in a wide range of sizes.

Diamatrix
ProTekt Sharps Safety Knives
diamatrix.com
(800) 867-8081
Pricing: $76 to $275 per box of 6
FYI: The Snap-Safe handle on Diamatrix's ProTekt line of ophthalmic safety knives features an ergonomic grip and sliding sheath that snaps into place. ProTekt knives are available in a wide range of blade sizes and configurations, including new micro-incisional cataract surgery sizes, which include 1.9mm/2.4mm trapezoid and 2.2mm slit blades. All sizes are available in single-use or validated multi-use formats.

Feather Safety Razor
Feather Safeshield Ophthalmic Scalpels
oasismedical.com
(800) 528-9786
Pricing: not disclosed
FYI: Distributed in the U.S. by Oasis Medical, Feather's Safeshield ophthalmic blades combine single-use plastic handles with stainless steel blades in incision, slit and round tunnel styles. The safety feature is activated by twisting the guard to release the lock, pulling it back to expose the blade and twisting it again to lock in place while the knife is in use.

Oasis Medical
Premier Edge Safety Scalpels
oasismedical.com
(800) 528-9786
Pricing: not disclosed
FYI: The Premier Edge Safety line for ophthalmic surgery offers protection, single-handed operation, a ridged handle for non-slip grip and an unrestricted view of the surgical field. The transparent safety guard slides fully over the stainless steel microblade for protection while not in use, and retracts fully onto the handle while the blade is in use. The single-use instruments are available in incision, thin-line slit, crescent and MVR versions.

Surgistar
Surgistar Safety Knives
surgistar.com
(865) 671-4300
Pricing: $60 to $72 per box of 6
FYI: With more than 20 years of experience in ophthalmic cutting instruments, Surgistar offers sharpness and consistency from knife to knife. The company's safety knives also meet OSHA's requirement to adopt safer sharps by offering simply activated, one-handed protection features. The knives, manufactured in Vista, Calif., are available in stab, crescent, phaco slit and MVR/sideport styles.