5 Ways to Slash Sharps Injuries

Staff Safety

By: Outpatient Surgery Editors

Published: 9/27/2019

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Take a proactive approach to protect surgeons and staff from sticks and cuts.


When members of the surgical team at University of Chicago (Ill.) Medicine were getting stuck with alarming regularity, Amber Kratochvil, MSN, RN, CNOR, was determined to find out why. "The injury rate was astronomical, and the injuries occurred across the board — surgeons, techs, nurses, residents, medical students," says the health system's perioperative manager.

Ms. Kratochvil, who sits on a committee that reviews and addresses safety issues in the surgical department, developed detailed sharps injury reports, which included specific body parts that were hurt and the circumstances surrounding the incidents. She zeroed in on the cause of the injuries by asking for feedback from members of the surgical team, who told her surgeons were passing sharps unannounced and failing to shield or protect needles before handing them back to nurses or techs.

Sound familiar? Those issues highlight the first of several methods you can use to increase sharps safety in your ORs.

1. Hands-free passing

Set clear expectations that sharps must be passed through a neutral zone, the location of which should be announced during the pre-op time out. Hands-free passing demands constant communication. Surgeons, techs and nurses must clearly announce when sharps are placed in the neutral zone and keep their hands clear of the area until the items are removed by the intended recipient.

Before removing sharps from the neutral zone, team members should always confirm that items have been placed safely in the designated area and passers have withdrawn their hands. Multiple items should never be in the neutral zone at the same time. Also, a sharp should be placed in such a way that the staff member or surgeon who's receiving it can grab behind the sharp end or point without having to reposition the item.

2. Be willing to adapt
SAFE SPOT The surgical team should identify the neutral zone before surgery begins and announce its location during the time out.

Ms. Kratochvil initially mandated the use of a commercially available neutral zone pad, but backed off the requirement when some surgeons and staff opted not to use it.

The neutral zone pad is still made available for cases, but surgical teams are permitted to determine what they'll use as a neutral zone (a basin, a folded towel) and where it will be placed (on the mayo stand, a corner of the sterile field) as long as everyone in the room verbally agrees to the location during the pre-op time out.

"It's acceptable that they designate an area for passing as long as they use it consistently,—says Ms. Kratochvil. "We've advised staff to place the neutral zone in as convenient a location as possible, while still maintaining safety for everybody involved in the procedure."

3. Dive into the data

Create a sharps safety team to analyze reports of sharps-related incidents and create a data-driven educational program to help decrease the number of injuries. Look at trends such as sharps injuries per department and clinical role, then plan various interventions based on the data.

Send quarterly injury reports to surgical leadership. The reports should note if injuries were related to product design, device failure, sudden patient movement, user error or other reasons. Then design safety education programs and informational campaigns based on identified problem areas and injury trends.

4. Increase awareness

Implement several educational initiatives to emphasize the importance of sharps safety. Include online safety training courses and face-to-face campaigns, which could include handing out posters and flyers, monthly sharps safety tips, workplace safety fairs and door-to-door conversations with clinical leaders. Place a priority on connecting with leaders who run departments with the highest injury rates. Consider creating a sharps safety email address, which staff can use to report sharps-related questions or concerns. You can use the address to send out sharps-related safety tips and information about sharps injury rates.

Perioperative educators should hold regular sharps safety huddles and educational events that cover topics such as injury prevention in the perioperative setting and a review of AORN's recommended practices for sharps safety.

5. Use safety sharps
IN THE ZONE Pass sharps through an agreed upon spot in the sterile field using a hands-free passing technique.

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To help promote the use of safety sharps, launch a sharps exception program, which would require all department managers to submit a written request for using non-safe sharp devices. Make it clear that managers must make every effort to identify a safe substitute before sending a request. Exceptions should be granted only if a safe sharp alternative is unavailable on the market or if standard sharp devices would somehow let surgeons perform safer surgery. A sharps exception program could increase collaboration among departments and inspire conversation among all clinical staff as they team up to identify procedures that use non-safety devices, find safer alternatives, identify the challenges of using safety-engineered devices and, only as a last resort, file an exception request.

Safe and confident

As you go through the process to increase sharps safety, you might find improvements don't occur in a straight line. Don't get discouraged if sharps injuries jump back up after an initial decrease. Overall injury rates should continue to decrease over time if you continue to push safety initiatives and make staff constantly aware of the dangers they face whenever sharps on introduced to the sterile field. By committing to prevention through a continuous, comprehensive and collaborative safety program, your staff will be protected from sticks and cuts, and the bloodborne pathogen infections they can cause.

Ms. Kratochvil was encouraged that the rate of needlestick injuries in University of Chicago Medicine's ORs dropped by 20% since she recommended the use a neutral zone during every procedure. She's also heard plenty of positive feedback from a grateful staff. "Surgical team members say they feel much safer during surgery and work with a greater sense of ease and confidence," she says.

The hard-working professionals in your ORs deserve the same peace of mind. OSM

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