A twitch, a blink, a sudden movement. When you're passing sharp objects in a busy operating room, the slightest miscalculation can result in — ouch! — a painful and potentially dangerous stick. It's one of the frightening realities that your OR staff live with. So is the reality that although you never know for sure what any given patient might be carrying, you do know that it takes only an instant for one person to infect another. That's why everyone should treat every sharps injury as something that could have severe consequences.

At our hospital, we receive sharps-injury reports every month, so it was a little surprising and concerning when we saw increasing rates of sharps injuries. Between 2014 and 2016, the numbers had risen from 121 to 135 to 140. And of course, we knew those were just the reported sticks. We strongly encourage staff to report injuries, but studies suggest that sharps incidents often go unreported, either because people are afraid or embarrassed, or because they decide it's just not worth the trouble. Either way, we knew it was time to reverse the trend. Here's how we did it.

1. Hands-free passing

As we dug deeper into why members of our surgical team were getting injured more often than they should, all signs pointed to hand-to-hand passing as the biggest culprit. That became our first target of process improvement. We mandated the use of safety zones — or neutral zones — as a means to encourage and facilitate hands-free passing. The concept is straightforward and proven effective: If you're passing a sharp object to someone else, you need to put it down before the other person picks it up. The safety zone requires a little extra time to set up, but it's a matter of safety for everyone.

It sounds easy, but old habits can be tough to break. A good way to constantly remind staff about the hands-free passing of sharps is to add a safety zone discussion to your pre-op timeouts. The idea is to make sure everyone knows not just the safety zone's location for that particular case, but also to remind them to use it.

Our nurse managers and nurse practice specialists conducted monthly audits to make sure our teams included the safety zones in timeouts and properly ob-served them during procedures. Their watchful eye helped promote the time out initiative and increase compliance.

2. Use of safety-engineered devices

We assigned a team of surgical staffers to a "sharps committee," which constantly assesses products that promote sharps safety. The committee looks into trialing new safety blades, hypodermic protectors and blunt suture needles. The goal is for everyone to remain vigilant, so we also encourage staff members who become aware of other new products to bring them to the committee to see if they're worth pursuing. If they are, we'll add them to our arsenal in the battle to reduce sharps injuries.

One of the things we quickly discovered was that there are several good safety zone products available — silicone mats, magnetic pads and pans, to name a few. We collected data and feedback from surgeons and other members of the surgical team to find out which products they preferred and found they generally did not have a preference. Ultimately, we found that acceptance of safety zone products is driven by an individual team's preference, that's why we offer several options for teams to consider using during their cases.

The surgical team also discovered they didn't necessarily need a particular product to ensure sharps were passed through a safety zone. They instead simply used a toweled-off area on the Mayo stand or even a pan or basin that was part of a surgical pack. That's important, because the hands-free-passing concept itself is more important than how your team achieves it. It's perfectly reasonable for your team to approach what will be used as the safety zone on a case-by-case basis based on whatever works best and is appropriate. You can be flexible in your requirement of what surgical teams use as the neutral zone. The important thing is that they use one during every case.

Don't forget to assess the safety of your sharps disposal process. We've recently added 2 larger sharps disposal bins to every OR, and eliminated the smaller sharps containers from anesthesia carts, because we felt overfilling the smaller bins was more likely to cause injuries than to prevent them.

3. Buy-in and momentum

One of the big challenges in improving sharps safety is knowing how to kick off the initiative. You need to get everyone's attention, and you also want discussion and feedback. We recommend launching the initiative at an OR staff meeting. Don't simply say, "This is what we're doing." Welcome your staff's insights about how to best improve sharps safety based on the way they currently work and the practice improvements that they believe are realistic. Ultimately, everyone on your team is going to be involved in making change happen, so everyone has to be on board with the effort.

But that doesn't mean you won't get some initial pushback when pushing for sharps safety, so energetically publicize and promote the initiative. We got everyone involved and brainstorming by sponsoring a safety zone slogan contest. (The winning slogans were "Be Sharp — Don't Get Stuck" and "Needle Say More?"). We also recruited several surgeon-champions to help us trial products and to further raise everyone's awareness. Some surgeons in particular were especially conscientious about passing and sharps safety, so those were the ones we approached. They agreed to do all they could to promote the idea.

Sharps safety products are presented to the hospital's Perioperative Quality Assurance Committee and the committee's findings are shared with the surgical team on a quarterly basis to obtain the team's support and feedback.

We also made posters that explain the safety zone concept and hung them near the main OR desks. We also created laminated sheets with safety zone bullet points, which we put in all our ORs. The sharps safety committee created a video to showecase our efforts and to help drive home the message, and we added a segment on sharps safety to our perioperative boot camp. Now, every new surgeon and staff member learns about safe sharps handling and the safety zone concept. Our goal is to create a mindset in which sharps safety is considered the norm, not the exception.

Not done yet

Improving sharps safety is an ongoing journey. We're constantly sharing sharps safety statistics with staff and surgeons — we reduced sharps injuries by a few ticks last year — and we've definitely made the surgical team much more aware of the issue. In that sense, the initiative has definitely been a success, and one we plan to keep building on. The support we've gotten from hospital leadership has been unwavering, which helps motivate us to keep going. OSM