CUTTING EDGE Many physicians resist exchanging traditional scalpels for safety-engineered ones, despite obvious handling risks.

It could be argued that safety scalpels are the most controversial of surgical supplies. Despite the protection they offer against injuries, exposure and costly consequences; despite federal requirements for their use; despite improvements in the once-derided product field, safety scalpels are still a tough sell to physicians. In a survey conducted last month, we asked readers how often safety-engineered scalpels are used in their facilities, and for their best advice on putting them to routine use. Here's what you told us.

The numbers
Out of 124 respondents, 52% said that safety scalpels are never or rarely used at their facilities. In comparison, 17.9% said they're the only available option and 18.7% said they're used most of the time. General surgery, orthopedics and podiatry are the specialties in which they're most likely to be used.

About 60% report that none or few of the scalpels they stock are safety equipped, even though about 45% are their facilities' chief decision-makers or have significant input on purchasing, and 87% are conversant with the Occupational Safety and Health Administration's sharps injury safety mandate. On the plus side, 70.5% say they've trialed safety scalpels within the past 3 years, more than half of those trials taking place in the last 12 months.

Obstacles to use
Among the respondents who said safety scalpels aren't routinely used in their ORs, the most frequently cited reason wasn't a surprise.

"The surgeons still complain that they are more dangerous than the regular scalpels," says Jay Bowers, BSN, RN, CNOR, TNCC, the surgical services educator at West Virginia University Healthcare in Morgantown. "That the weight is different, or that they cannot see over the safety device to operate safely."

A scalpel isn't a complex instrument: a sharp edge with a handle. But when a physician feels that scalpels designed with retractable blades or guards for safer passing aren't acceptable alternatives to traditional blades, physician preference carries the day.

"I can't get my doctors to even try them. They're terrible at attempting change," says Sherry Butts, RN, BSN, the OR supervisor at Albany (Ga.) Surgery Center.

Some facilities rely on their record of never having witnessed a scalpel accident as evidence that cautious handling, such as the use of a neutral passing area, is a sufficient defense. "We use the 'safe zone' method," says one respondent, "wherein the scalpel is placed in a kidney basin, the surgeon picks up the scalpel and returns it in the same basin after using it, with of course the verbal communication, 'Watch the sharp.'"

Advice for implementation
Success in adopting safety sharps relies on clinicians' compliance, which may be leveraged with a bit of persuasion. "You need backing from senior leadership and medical staff leaders," says Bruce Vierra, RN, CNOR, service line manager for Southcoast Hospitals Group in Fall River, Mass.

Hard data may also be the route to physicians' practices. "Numbers — injury reports — are the best way to persuade surgeons to try safer products," says Richard Gammill, RN, OR manager at the Rockwall (Texas) Surgery Center. "You can ask them to try a new product, but without evidence for the reason, it's hard to get them to switch."

That's not to say that a trial isn't effective, especially if you include high-quality products whose feel and handling resemble those of traditional scalpels. "Hands-on evaluation is all that will get them into the hands of our surgeons," says Vickie Schultheiss, MT, ASCP, medical administrator at Harford Lower Extremity Specialists in Bel Air, Md.

If a transition to sharps safety is your goal, make it a policy, then make it the only choice, either gradually or by tough love. "Introduce them more often in cases, so surgeons get used to using them," says Larry S. Goldstein, DPM, medical director of the Surgical Centers of Georgia in Macon. More directly, "Remove all non-safety scalpels from the trays and don't offer a choice," says David Wilkerson, RN, director of surgical services at Sumner Regional Medical Center in Gallatin, Tenn., "unless it's detrimental to the outcome of the case or a patient-safety issue."

You could let surveyors do the job for you. "Facilities only change if they're cited," says a clinical education specialist for a medical device manufacturer. One reader noted the educational effect of a run-in with OSHA. "When the facility got fined over $5,000 for not using them," says Jean Atkinson, RN, director of nursing at the Specialty Surgery Center in Crossville, Tenn., "then, they were more than glad to use them."