The OR is a dangerous place. Every day, surgical staff trip over cords, get splashed by blood and bodily fluids, are cut and punctured by scalpels and syringes, are exposed to radiation, and pull muscles or strain tendons while trying to lift or move heavy objects (or patients). The injuries are not always the kind you'd expect. A recent reader survey turned up these hard-to-believe injuries:

• Employee stepped on a piece of glass while changing.
• Hydrogen peroxide spray from a cleaning wipe went into an employee's eye.
• Hit head on open cabinet.
• Cut by an instrument.

Not much you can do to prevent those types of injuries, but here's some advice on keeping your staff safe, starting with surgical smoke.

1. Smoke evacuation. What good is a smoke evacuator if your team doesn't use it? That's the problem Terri Foster, BSN, RN, CNOR, the surgical services educator at Allegiance Health in Jackson, Mich., recently was up against. Smoke evacuators were being used in less than one-third of cases.

"The initial barriers included the bulkiness of the tool and the loudness of the machine in operation," says Ms. Foster. "The biggest thing surgeons wanted was something that wasn't going to be in the way. Noise was the other consistent objection."

The solution: an evacuator that activates automatically. An accessory that connects between the electrocautery machine and the smoke evacuator device triggers the evacuation to turn on when the cautery pencil is in use and to shut off when it's not in use.

2. Safety sharps. Chances are you've witnessed a sharps injury, or may have even been sliced or stuck yourself, and know firsthand the deep emotional and physical scars the injuries can cause. Safety scalpels would reduce the potential for injury to surgical team members, but surgeons are notoriously reluctant to use them.

You can remind your surgeons that they aren't the only ones at risk of being cut, says Ron Stoker, founder and executive director of the International Sharps Injury Prevention Society in Salt Lake City, Utah. You can also tell your reticent docs that they don't have a choice in the matter. OSHA's bloodborne pathogen standard requires you to conduct annual evaluations of sharps safety devices.

At the Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Fla., one surgeon in particular was responsible for an inordinate number of needlestick injuries. "He was just careless," says QI Coordinator Barbara J. Holder RN, BSN, LHRM, CAPA. "He would put instruments down and pick them up again because he'd change his mind."

So they created a no-touch zone between the surgeon and the scrub, especially critical when he's suturing. They set up an additional safety tray for the doctor so that a staff member's hands wouldn't be in the tray with the doctor at the same time.

"Even though we're taught not to anticipate a doctor's move, sometimes we do," says Ms. Holder.

3. Exposure to blood-borne pathogens. Wearing the appropriate personal protective equipment (PPE) is just the start, says David L. Taylor III, RN, MSN, of San Antonio, Texas. During a busy orthopedic sports medicine day, he was circulating a messy arthroscopic knee procedure. Outfitted with complete PPE that included shoe covers, a scrub jacket, headgear and a surgical mask. He also wore eye protection, but he removed the glasses and let them hang from his neck as he updated the electronic medical record.

"I thought nothing of the maneuver," he says, "as it allowed me better visualization of the computer's screen."

When he was done documenting, he returned to the procedure and bent down to adjust some of the equipment. As he bent over, the pen in his pocket fell and landed into the bloody liquid that had pooled on the floor, splashing blood and fluid onto his unprotected face (luckily missing his eyes).

"It was that moment that led me to take a critical look at not only my own practices," says Mr. Taylor, "but also the practices of those around me and the risks we all took with potentially infectious material."

He says recent nursing school graduates are sticklers for following personal protection protocol, but over time seem to become desensitized to the dangers they are exposed to in the OR.

"Surgical services leaders have a responsibility to take a proactive approach to protecting their employees," says Mr. Taylor. "Be vigilant in researching PPE options, and outfit your teams with the best available products."

4. Double gloving. How do you convince your surgeons and staff to double-glove? By making double-gloving mandatory. Don't make it a matter of if your surgical team will double-glove — make it a matter of when, says Kimberly J. Elgin, MSN, RN, CNOR, CLNC. Barrier protection is mandatory. Anyone working in the room who handles sharp instruments must wear a two-color indicator system for double gloving, says Ms. Elgin, the quality and compliance RN at Virginia Commonwealth University Health System in Richmond, Va. Of the 3 safety techniques that can prevent percutaneous needlesticks and bloodborne pathogenic exposures, double-gloving might be the easiest and least expensive intervention when compared with hands-free zones and blunt-tip sutures, adds Ms. Elgin.

Health care is hazardous

The rate of occupational injury and illness to healthcare workers has surpassed that of the general industry population. According to the number of work-related injuries and illnesses that employers have reported to OSHA, it has become more hazardous to work in health care than it is to work in mining or construction. OSM