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10 Keys to an Ophthalmic Safety Knife Conversion
If your surgeons are reluctant, here are ideas for winning them over.
Irene Tsikitas
Publish Date: September 4, 2008   |  Tags:   Ophthalmology

Are safety knives the shape of things to come in ophthalmology? That's the considered opinion of some leading cataract surgeons, who like the way today's safety scalpels perform and protect in the OR. But these doctors are quick to point out that one thing stands in the way of widespread acceptance: their colleagues who are reluctant to give them a try, even though the law says you have to at least consider them. Here are 10 tips for clearing this high hurdle.

1. Make the case for safety. Surgeons need to know that trialing and implementing safer ophthalmic blades isn't a choice — it's a requirement. Educate them about state and federal laws governing sharps safety. The biggies are the 2000 Needlestick Safety and Prevention Act and OSHA's 2001 revision of its Bloodborne Pathogen Standard, which requires healthcare facilities to regularly evaluate safety devices and keep a log detailing sharps-related injuries. The Premier Safety Institute and the Centers for Disease Control and Prevention offer free workbooks, posters and CD-ROMs to help you educate your staff about these laws and how to promote sharps safety (for details, go to www.premierinc.com/safety/). "New products should never be forced on a surgeon," says Ron Stoker, executive director of the International Sharps Injury Prevention Society. But you may be able to convince your surgeons to at least give safety blades a try if you can explain the risk of an OSHA citation or employee lawsuit.

Randall Olson, MD, professor and chairman of ophthalmology at the University of Utah School of Medicine, notes that regardless of the law, "a sharps injury is no small deal" for the surgeons and staff at risk. OR nurses and techs are increasingly demanding better protection against sharps injuries. "If the nursing staff believes that all you care about is the almighty dollar and you don't care about them, they're going to go elsewhere," adds Mr. Stoker.

2. Put it in dollars and cents. Dr. Olson, who also serves as CEO of the University of Utah's John Moran Eye Center, sees economics as the biggest issue hindering widespread safety sharps adoption. Many ophthalmologists still prefer diamond knives, both because of the sharpness of the blades and because they're reusable. But if you take into account the cost of thoroughly cleaning, sterilizing and sharpening diamond blades, plus the high cost of repair or replacement should the delicate blades become damaged, Dr. Olson says diamonds aren't necessarily more cost effective than single-use safety knives. He predicts that as more people make the switch to disposables, the cost differential between metal or silicone and diamond blades will reach a "break-even point."

"The real cost issue is what happens if you don't use" safety blades, says Mr. Stoker, who points to the potentially massive expense of paying for blood tests, post-exposure prophylaxis and long-term care for employees who are injured and exposed to such infectious diseases as hepatitis or HIV.

3. Focus on infection prevention. Because the shields built into the handles of ophthalmic safety knives don't hold up well in the autoclaving process, the blades are designed for a single use (although not everyone adheres to this protocol). As clinicians seek to reduce the risk of TASS, prion disease and other infections, Dr. Olson foresees a rise in the use of disposable blades for ophthalmology. "I think eventually we'll move to single-use instruments," he says, noting that this is already the standard in some other countries.

4. Call in the reinforcements. If your pleas for cooperation continue to fall on deaf ears, consider enlisting a safety expert or risk manager to help make the case for safety blades. In hospitals, "the risk management department is really wielding a lot of influence over physicians" in terms of getting them to use safety products "so they don't get cited and don't get sued," says Mr. Stoker. If you don't have a risk-averse hospital administration backing you up, an outside consultant may help you send a stronger message to your physicians.

5. Make it a team effort. Your conversion to safety blades won't be successful if you're the only one behind it. "You really have to get everyone on board to make it work," says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute. "Change is hard. Some surgeons just don't like to change." OSHA's guidelines demand that frontline workers, not just management, be involved in the evaluation and selection of safety devices. That doesn't mean every single individual needs to trial them; it may be easier to appoint a trial team that's representative of your facility's surgical staff.

6. Find a "champion." Just be sure to choose people who are dedicated to the cause. Converting to safety sharps "requires a champion within your staff to really believe in it" and "set the stage for the operating room," says Ms. Pugliese. Team members resistant to change may be more receptive to a trial and actually use the new devices if they're encouraged by one of their peers to do so.

7. Bring in the vendors. Instrument manufacturers can also be a great resource, says Patti Barkey, COE, OCS, practice administrator of Bowden Eye Associates and the Eye Surgery Center of North Florida in Jacksonville. "Be open and receptive," she advises. "The reps know the products inside and out." When Ms. Barkey's ophthalmology center opened in November 2007, she wanted to make the facility "as compliant as possible with OSHA." She invited Angiotech reps to the facility for two to three days of comprehensive trials on all their SharpGuard ophthalmic safety blades. Neither the surgeon nor the staff had used safety blades before, so the experience was new for everyone. The reps remained on site throughout the trial to assist and answer questions.

8. Conduct thorough trials. Mr. Stoker recommends researching all the safety knives available on the market, bringing them in for a trial and evaluating each product "stem to stern" — examining everything from how the packages open to how the knives are disposed. During the trials at Ms. Barkey's facility, all members of the surgical team used the safety knives during actual cases after first working the safety features and signing off that they understood how to use them. All members of the team should follow the same protocols for deploying the safety shield (usually during passing and handling).

"The ideal safe product," says Mr. Stoker, is "one that does not alter the surgeon's technique." Your surgeons will need to get used to the grip and weight of the handle and the safety shield, which may be deployed with a one-handed or two-handed technique, depending on the manufacturer. "There's going to be a little bit of a learning curve for surgeons to adapt" to the different feel of the knife, says Stephen Lane, MD, managing partner of Associated Eye Care in Stillwater, Minn., who sees safety knives as "the way things are going" in ophthalmology.

9. Emphasize quality, not just safety. "The real key is surgeon acceptance of the blade," says Mr. Stoker. This is particularly the case in delicate, small-incision surgeries like cataracts, adds Ms. Pugliese. "When you start to switch surgical devices, it makes a big difference." Dr. Lane believes some surgeons are reticent to use disposable safety knives because they're concerned about the "consistency of the sharpness, the ability to make consistent wounds with these knives, compared to whatever they've been using."

Dixie Hewitt, RN, surgery manager of the Marion Surgicenter in Marion, Ind., admits that sharps safety was far from her surgeons' minds when they decided to go with safety knives for their ophthalmic procedures. "I offered samples and it just happened that the blade they liked was also safety," says Ms. Hewitt. Her experience suggests the conventional wisdom that disposable safety blades are inferior to reusable diamond blades is no longer true. Manufacturers say metal blades are becoming sharper and more precise in response to the growing demand for microincisions. And Dr. Olson says new silicon blades from BD Medical (for whom he serves as a consultant) are nearly as sharp as diamonds, but cost about the same as steel.

Ms. Barkey says the quality of the metal safety blades her surgeon trialed was by far their biggest selling point. "He was concerned at first" about how the knife would feel in his hand, she recalls, but he was ultimately comfortable with the handle and impressed by the sharpness and reliability of the blade. "There's no skimping in quality," she says.

10. Follow up. Once you've evaluated, selected and purchased safety blades, continuously monitor how the devices are used to ensure that staff are maximizing the safety features. If nurses, techs and surgeons aren't actually sliding the protective sheath over the blade before passing or handling it, then the time and money you spent trialing the products will have been wasted. Mr. Stoker also recommends coupling the use of the devices with other sharps safety strategies such as neutral zones, passing trays and verbal cues.

On the Web

For more on OSHA's Bloodborne Pathogens Standard and the Needlestick Safety and Prevention Act, go to www.osha.gov/SLTC/bloodbornepathogens/index.html

Let's Explore Your Ophthalmic Safety Blade Options Although the technology is still relatively new, "there's been an unbelievable proliferation of safety scalpels" in the past few years, says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute. Getting your surgeons to trial them — let alone use them in the OR — is another matter. Five companies currently make disposable safety blades for ophthalmology. Here's a look at each of them, as well as contact information for the manufacturer and a thumbnail sketch of the safety knife.

— Compiled by Irene Tsikitas

SharpGuard Guarded Knives
(877) 991-1110
List price: for a box of five, prices vary by blade style — $67 for stab; $97 for paracentesis; $137 for crescent and slit; $157 for clear corneal
FYI: Angiotech's SharpGuard knives feature the company's Sharpoint metal blades, a simple-to-operate sliding guard that locks into place and an ergonomic grip for precise control and comfort, says the company.

Bausch & Lomb
Storz Instruments Guarded Disposable Knives
(800) 338-2020
List price: $95 to $110 for a box of six
FYI: The initial offering in this newly launched line of safety knives includes 14 blade sizes and styles, including blades for microincision cataract surgery (sub-2.0mm). The handle's textured guard easily slides and clicks into place to maximize surgeon comfort and protection, says Bausch & Lomb.

BD Medical
BD Atomic Edge (silicon) and BD Beaver (metal) Safety Knives
(866) 515-7233
List price: not disclosed
FYI: The Atomic Edge (white) comes with a built-in, retractable safety shield and is designed to perform like a diamond, says the company. BD's Beaver (gray), which also has a retractable shield, includes safety slit knives (1.4mm to 3.2mm), plus safety sideport and crescent knives.

ProTekt Sharps Safety Knives
(800) 867-8081
List price: $76 to $235 for a box of six
FYI: The safety feature on these stainless steel blades can be engaged and disengaged with either a one-handed or two-handed technique. The handles also feature an ergonomic grip for comfort and control, says Diamatrix.

OASIS Medical
Feather SafeShield Microscalpel
(909) 305-5400
List price: not disclosed
FYI: These Feather safety knives, distributed by OASIS and available in six styles, feature stainless steel blades and one-handed operation of the safety device. Each blade comes in its own case.