◙ PASSING MAKES PERFECT Constant communication and neutral zones are critical components of proper sharps handling.

In our battle against sharps injuries, we depend on sharp eyes, sharp observational skills, and sometimes even sharp tongues. It's all part of a larger effort to take a close look at what we do, consider how and why we do it, and ask questions — lots of questions.

Why do injuries happen?
When we surveyed our staff about the sharps hazards they saw, everyone expressed concern about the constant rushing. It's true. We're all so focused on time and turnover and minutes and efficiency that rushing is a big contributor to injuries. We talk about being fully present in our work, but it's hard when, as a nurse, you're expected to be a patient advocate, to make sure the surgeon has everything he needs, and at the same time, to look out for yourself and everybody you're working with. How can you be fully present when you have to consistently and constantly multitask?

We're always concerned about our patients' safety, but we tend to be less focused on our own. And our environment is fraught with hazards. Raising awareness so that we're not only mindful about not harming patients, but also about not letting anything happen to us, requires a significant attitude change.

When our occupational health group and staff members worked together to assemble and train observational teams, it was a chance to have conversations about safety that never really take place in a concerted way — to bring to the surface the root causes of injuries. Talking to people in the room and asking questions while things are happening is immensely important. That dedicated conversation about details simply never happens otherwise.

The questions may be simple, like, "If the needle box were in a different place, would it make needlesticks less likely?" or "Do you recap needles and do you know recapping needles is a high-risk event?" or "How do you pass or receive sharps so you avoid injury?" But they lead to important feedback.

◙ ZONE DEFENSE Place sharps in an agreed-upon location on the sterile field.

HANDS FREE
3 Keys to Safe Passing

A neutral zone should be used during all surgical procedures for the passing of scalpel blades, suture needles, hypodermic needles and sharp surgical instruments to prevent surgical technologists, nurses and surgeons from simultaneously handling contaminated sharps. Using a neutral zone will decrease the risks of sharps injuries to surgical personnel and patients. Follow these passing tips when sharps are on the sterile field.

◙ Establish a neutral zone. Before the first incision is made, identify where all sharps will be placed and received on the sterile field in order to avoid hand-to-hand transfers. Emesis basins, instrument mats or magnetic pads serve as effective neutral zones. Discuss the location of the neutral zone with the surgeon throughout the procedure and move it to another area of the sterile field if needed as the surgery progresses.

◙ Verbalize actions. Whenever placing a sharp in the neutral zone, alert the other members of the surgical team that an instrument or needle is in the zone. Announce the sharp by name or say "sharp" or "safety zone." Withdraw your hand until the sharp is retrieved.

◙ Focus on placement. Only a single sharp should occupy the neutral zone at any time. Orient the sharp so the person who's retrieving it can place her hand behind the sharp end or point without having to reposition the item.

Source: The Association of Surgical Technologists' Recommended Standards of Practice for Sharps Safety and Use of the Neutral Zone

On the lookout
We're also reaching out to other ORs in our community to identify best practices we can consider adopting in our environment. In fact, our team just completed a field trip to a neighboring hospital where they use safe zones (see "3 Keys to Safe Passing"). They draw a circle or a rectangle on the tray and designate that as the safe zone during surgery. Their safe zone practice is hard-wired as it's discussed during the pre-surgery time out. That's something we can learn from. We're also implementing and investigating several other changes, including:

• using blunt-tip suture needles for closing, in compliance with American College of Surgeons guidelines (surgeons who want to use sharp needles have to apply for exemptions);
• a thorough review of safety scalpels, in light of recent technological improvements;
• providing sharps safety education for all incoming medical students and residents; and
• a more in-depth focus on how we handle instruments not only during procedures, but also post-procedure from sterile field to sterile processing.

It's an ongoing process as we continue to look at different safety blade prototypes and designs. They might not all work with the particular kind of procedures we're doing, but we're always on the hunt for products and technologies that will work in our surgical environment.

Maintaining momentum
The methodology we used to address sharps safety works for any organization. First, you need an unambiguous charter that makes the team goals crystal clear. Then identify the current situation by, for example, developing and implementing a survey, so you have input from the front line. Find a champion, someone in the organization who sees the importance of what you're doing, and work with that person first.

For example, a nurse who's had 4 sharps injuries during his career here saw the personal impact injuries can have. Now he's very involved in our sharps safety effort, because he doesn't want to see any of his colleagues injured.

Safety tends to be a top-down concern. People in charge respond to accidents and incidents by sending some sort of edict out. We're driving safety from the bottom up. The best way to really make big strides is to have the effort driven by the people who do the work, and who know best what the hazards are and what the solutions might be.