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5 Steps to Safer Sharps Handling
These precautions limit risks of sticks and cuts.
Sherri Alexander
Publish Date: March 31, 2015   |  Tags:   Staff Safety
handling sharps safely

I'm a surgical technologist by trade. Handling sharps in the sterile field is a big part of what I do. My advice: Make sure your staff understands the importance of these straightforward but effective ways to limit their risk of injury from scalpel blades, needles and instruments. They shouldn't have to learn about sharps safety the hard way, like I did.

1 Know before you reach
Many years ago, I was cleaning up after an ortho trauma case. Another staff member, who had entered the room to help, placed a newly sharpened osteotome in the pan of water I was using to rinse instruments. I stuck my hand in the pan to grab a sponge and cut my left index finger on the instrument. It took 4 stitches to close the gash, but a blood test revealed no infection. I was lucky.

The incident served as a valuable learning experience, one that provided me with lessons I remember to this day: Always know where sharps are located, from the time they're needed to the moment they're disposed of, and always look before you reach.

2 Keep the sterile field organized
Sharps should always be easily visible and placed where they are at no risk to you or anyone who reaches onto the Mayo stand or back table. To help keep track of where sharps are at all times, place them in standardized spots, no matter what kind of case you're working. Managing the same setup — needles here, blades there — lets you know intuitively where to reach and where to avoid. Keep very few sharps on the Mayo stand; store them instead on the back table.

3 Maintain eye contact
You know surgeons will keep their gaze on the surgical site when passing, so it's your responsibility to watch sharps to ensure they're handled correctly. Keeping direct eye contact on the sharp — never pass a sharp while looking at the back table, which I've seen done — lets you meet the surgeon's hand to place or remove items in a safe way.

Master the Single-Handed Scoop


Syringes are often used intraoperatively to inject local anesthetic at the surgical site. Best practice is to avoid recapping the needles between uses by placing syringes in basins on the back table, where they're kept safely until needed again. Try this if you do have to recap a needle: Touch its bevel to the inside of the cap and scoop the cap onto the needle before pushing it securely into place. Never attempt to hold the cap in one hand and place the needle in it with the other.

— Sherri Alexander, CST, FAST, CRCST

Using a neutral zone for hands-free passing is an added precaution, as long as the surgeon and the surgical team agree on where on the sterile field the zone will be located and verbally confirm it before the case begins. Some teams pass sharps through a basin, but surgeons and techs have to reach into it to remove items, a practice that could increase the risk of injury.

Surgeons should say "sharp back" or "knife on the Mayo stand" when passing items back to assistants, although some docs are more vocal than others. You can set a positive example by always announcing the items you pass to surgeons. A lot of the verbal communication that goes on during passing depends on the experience of the surgeon and his assistants. Pairings that have worked together for years may not have to alert each other about sharps entering and leaving the field. The bottom line: Develop a system that works for your surgical teams, agree on where and how instruments will be passed before each case, and stick to the protocol during every sharps exchange.

4 Pay attention
Sounds simple, doesn't it? It is, but I've seen many surgical assistants try to do more than one thing at a time, lose focus and take their eyes off of the sharp being passed. Surgeons and surgical assistants are at the highest risk of sticks and cuts, and it's hard to predict what causes sharps injuries, but most often it involves someone not paying attention to the task at hand.

Multitasking is inevitable, and even acceptable, during most phases of surgery, but not when sharps are being passed. Focus on nothing else during that time. Don't turn away or lose visual contact with the sharp you're passing until you feel and see the surgeon's hand close around it. It's only acceptable to move onto the next step of surgery once you know the sharp has been handed off safely. That's tough to do, because we're all driven by the need to improve case efficiencies, but your safety is worth a few more seconds of operative time. Besides, taking several moments to ensure sharps are handled correctly won't have a major impact on case times.

Alert staff to the dangers of sharps safety, especially new hires, who are often na??ve about the dangers they face. Remind all team members to treat each patient like she's infected with every harmful disease imaginable. That's one mental trick I've used throughout my career to keep me vigilant about personal protection during every case.

5 Clean up carefully
Risks of sharps injuries do not go away when the case is over, as mishaps can occur during clean-up and room turnover. Always look before disposing of items in a sharps container, because getting stuck by overflowing items can occur. Most staffers who are stuck while disposing of sharps will admit they weren't looking while placing the items in the container. If a container is three-quarters full, change it out. That's basic common sense and common courtesy. Don't wait for someone else to do it — take the responsibility to protect yourself and your colleagues.