TRY IT, YOU'LL LIKE IT Kristin L. Thompson, RN, BSN, CNOR, RNFA, shows ENT surgeon and board chair Joel Perloff, MD, a safety scalpel.

You never forget your first needlestick. Mine? I was rushing to recap a syringe. The needle slipped while I was pushing the cap on. It tore through my glove and pierced the tip of my finger. It wasn't a deep puncture, but I got woozy thinking about all the horrible things that could happen.

I was relieved when the blood tests came back negative, but I also had a new resolve. That accidental needlestick, which occurred years ago, left an indelible impression on me about the dangers of working in the OR. Now, as the director of nursing at a surgical center in suburban Philadelphia, I appreciate how fortunate we are to work in a time when safety devices are so well-designed that surgeons don't mind using them. Nearly two-thirds of the 180 surgical facility leaders Outpatient Surgery Magazine polled last month are using safety sharps some (38%) or all (27%) of the time. So the questions remain: Why don't we use safety sharps whenever possible for the safety of our staff, surgeons and patients? Why wasn't I using a device that would have shielded my hands from exposed needles? We're about to conduct a safety sharps trial at our center. We've mapped out the keys to what will make the test drive a success.

1. It's just a trial
You've heard it time and again. Get buy-in and engage your core group of stakeholders before you try to get folks to change old habits. It's trite, but it's true. Without a positive presentation, don't expect the support of your surgeons and staff. Don't blindside your surgeons by showing up unannounced one day with a handful of safety scalpels for them to trial. They're sure to resist such a strong-armed tactic. You'll also set yourself up for failure if your goal is to convert surgeons. All you're trying to do is to get them to trial the devices. No pressure. No expectations. Their safety, your safety, everybody's safety is the reason for the trial.

Set a collaborative and cooperative tone for the trial. You'll stand a better chance of converting your docs if you empower them to be a part of the decision-making process. Enlist the help of staff members to promote the safety devices to surgeons. Ask them to recommend safety devices they've worked with before. Ask them what scenarios make them nervous: sharps passing, capping needles, starting IVs?

2. Follow the leader
The person who spearheads your sharps safety trial must swing a big bat in your facility. She must have the authority to change policy and be looked upon as a respected leader. That someone is me at my center. It helps that I'm also our infection preventionist. I run our quarterly infection control committee meetings, which we hold concurrently with our patient safety meetings. These meetings were the perfect platform to discuss safety sharps and to lay the foundation for buy-in.

3. Pick the products to trial
We approved 3 safety products to trial, each from the same vendor.

• Disposable safety scalpel handle. This is an ingenious product that lets you place any size blade on a weighted disposable handle. The fact that the handle is weighted is no small detail. Surgeons will quickly reject an otherwise satisfactory safety scalpel if the plastic handle is too light. It doesn't feel right in my hands, they'll say. Too flimsy. A safety guard slides over top of the blade and locks into place via a hooking mechanism, protecting the entire blade, regardless of the size. This safety scalpel makes it safe to hand-pass the device back and forth with the surgeon. Surgeons want to make the incision at once as soon as we hand them the scalpel, so they're going to have to learn to take one more step — that takes less than a second — to slide the safety guard back and forth to activate and deactivate the guard. If you anticipate that your surgeons will balk at having to activate the safety device, ask them if it's worth it to prevent a life-changing injury.

At an earlier stop in my career, we trialed a disposable knife handle and blade. Our surgeons complained that the handle was too light and the cover that went over the blade prevented them from making an incision and pushing the blade deep enough to separate the tissue. This time, we think we've found the answer: a weighted handle that can accommodate any blade, and a cover that goes over the blade.

DANGER ZONE With scalpels, needles and other sharp instruments, the OR is a hazardous area.

• Hypodermic needle. We're going to trial a needle that has a safety guard as well. I'm concerned that our surgeons may resist this product. The safety guard on some earlier versions of safety needles had a metal piece that slid up the guard to hold it in place. When you slid the guard back, it shortened the length of the needle and prevented you from injecting completely into the tissue. As a workaround, some surgeons would remove the safety guard by cutting the plastic spring wire that flips the guard over the needle. I intend to be in the room with surgeons when they use this device to observe them injecting and to document their concerns. If this device doesn't work, we'll look for another. The good news is there's no shortage of viable options. Bottom line, we need a product that's not only similar to the product they've been using, but also one that's not going to force our doctors to alter their technique. Safety products must conform to your doctors, not the other way around.
• Neutral zone tray. This bright orange tray, about the size of an emesis basin, is designed to eliminate hand-to-hand transfer of sharps. The adhesive bottom ensures it'll stay put on the sterile field or Mayo stand. After the surgeon uses a sharp device like a scalpel blade, suture or needle, he'll simply toss it in the bin. It's unobtrusive and expands to accommodate cases with more sharps, such as total joints.

UNDETERRED
If at First You Don't Succeed

CULTURE OF SAFETY Jennifer L. Fencl, DNP, RN, CNS-BC, CNOR, clinical nurse specialist, operative services, Cone Health, samples a safety scalpel.

Yes, try, try again. Our first go-round with safety sharps didn't go well. After equipping more than 70 ORs across our 7 operative sites with safety scalpels, a not-so-funny thing happened. Some of the safety sheaths fell off of the blades while they were in use. Talk about your product malfunctions. We had no choice but to pull them and start over. The product might have failed, but our commitment to sharps safety has grown stronger. Now it's just a matter of finding the right product to trial and implement.

• Ask the OR to follow the ER. Our sister departments in the ER, GI and cardiology have successfully adopted safety blades and their numbers of sharps injuries have continued to dwindle. The OR for some reason has lagged behind. "We can look to their success," says Wayne McFatter, MSN, RN, CNOR, RNFA, executive director of operative services for Cone Health in Greensboro, N.C.
• Reach out to surgeons. We formed a Sharps Safety Task Force to educate not only our nurses about sharps safety, but our doctors as well. One of the pivotal things we did was ask our nurses to name the doctors who'd be open-minded enough to give us honest feedback on what is important to them in a safety product. Once we engaged physicians at that level, they were willing to talk to their colleagues about sharps safety.
• Show them the data. Surgeons respond to numbers and science, so we tracked data on who were injuring themselves and how they were injuring themselves. We then asked, "Which of these injuries could a safety scalpel have prevented?" We stressed to our docs that the literature reflects that 70% of blade injuries are preventable with safety devices, and our blade injuries mirrored those statistics. Most sharps injuries were not occurring during passing, but when reaching for unprotected blades on the Mayo stand or back table, and when removing the blade from its handle.
• It's not an all-or-nothing proposition. We acknowledged that a safety blade might not be applicable for every application, but we strongly recommend it for skin incision. But in a tight spot, where the sheath could obstruct visualization of field (spine and GYN surgery, for example), it's not safe to use a safety blade. Same goes for arthroscopic procedures, where you must plunge the blade into the tissue to a certain depth.
• Tug on their heartstrings. We asked a staff member who suffered a needlestick and thought she'd contracted HIV (the test ended up being a false-positive) to go to all of our ORs to present and to tell her story. This really drove home the point about the impact sharps injuries can have.

YWe've since grown from 7 to 9 operative sites, and we're looking for another product to trial and implement. It's a matter of when, not if. And when we find the right product, that will be a good day.

— Jennifer L. Fencl, DNP, RN, CNS-BC, CNOR

Dr. Fencl ([email protected])) is a clinical nurse specialist, operative services, at Cone Health in Greensboro, N.C.

4. Organize the trial
Don't overlook logistics. Order enough product, set a timeline and capture surgeons' evaluations. We ordered 250 blade handles for our 18 surgeons in the hopes that each doc will use the safety blade at least 12 times in a month. This would accommodate a surgeon who operates on 4 patients on his once-weekly visit to our center. During the trial, we'll ask surgeons to use the safety devices on every patient.

5. Collect feedback
The first time surgeons trial a product, we'll be in the room with them to observe them using the devices and then ask them for their feedback on the spot — both what they liked and what they didn't like. We'll also ask staff for their impressions. How easy was it to load a blade on the handle? What extra steps did you have to take with this handle, versus our regular blade handle?

The goal is zero
What obstacles do I expect? What if not all surgeons buy in? What if there's a tie, half like the product, but half don't? If there are only a few outliers, I intend to go with what the group has chosen. I also plan to call on the product rep if need be. And if the trial doesn't yield a winner, I'm already on the lookout for new products to trial.

In the past 5 years, we've had 3 reported sharps injuries at our center. That's 3 too many. Simple, small injuries, but potentially devastating. In one, a reprocessing tech got a tiny needlestick while he was cleaning up a tray. Somebody forget to take a needle off of the table, and it got caught up in the instruments. My goal is to have zero sticks. We want to provide the safest instruments to our staff so that they don't have to worry about a sharps injury.

If we were to convert our facility to 100% sharps safety products, we'll spend an additional $30,000 per year in supplies. If we were to adopt just the safety blade handle and sharps collection basin, we'll spend about $15,000 more per year. This additional cost is well worth it if it prevents just one needlestick or sharps injury.