I can tell you how to conduct a great sharps study, but you're on your own when it comes to convincing your surgeons to use safety devices. We're still trying to clear that giant hurdle here at Baylor University Medical Center in Dallas.

We found out the hard way that getting the several hundred surgeons who work in our 42 ORs to change their ways is like trying to herd cats. It's not that our 12-month study on sharps injuries didn't arm us with the data we needed to make a compelling argument for conversion to safety sharps. Quite the opposite, in fact.

Knowing that healthcare professionals are data-driven, we painstakingly chronicled 81 needlesticks that occurred in 2004 by department, date, time, room, device and how the stick occurred (mostly by suture needles and carelessness, it turned out).

When we provided our surgeons safety-shielded scalpel blades to trial, the verdict was quick and near-unanimous: "These are much too light and could be detrimental to patients." We then trialed reusable scalpel handles and disposable scalpels that allow for touchless retraction and disposal of used blades. The handles have the same weight, size and feel of traditional scalpel handles. The reviews were good; so good, in fact, that when we got consensus on them we ordered several hundred of the scalpel handles at a considerable cost. But they just sat on the shelf because the surgeons preferred not to use them and the nurses didn't feel comfortable putting them on the sterile field.

Our surgeons also greeted the sample blunt suture needles with negative evaluations, even though the American College of Surgeons supports the universal adoption of blunt suture needles as the first choice for fascial suturing to minimize or eliminate needlestick injuries from surgical needles.

Our efforts to convert our surgeons to safety devices weren't successful. Unless you're in an institution where you can influence your surgeons, converting to safety sharps may well be a matter of if, not when. As police officers know, some people comply with the rules of the road and some choose to speed until they get caught or have an accident.

Inside our self-study
In an effort to identify the source of sharps injuries, we tracked injuries from data supplied by our employee health department, focusing on those from scalpels, needles and assorted instruments. For 12 months, we tracked how the injuries occurred (for instance, "stuck self during biopsy," "uncapped sharp left in basin" or "while passing sharp") and what devices were associated with the injuries (such as 22g needle, scalpel # 11 or bipolar forceps).

Somewhat surprisingly, we found that most injuries in the OR resulted from self-inflicted suture needlesticks and during passing sharps or instruments. Notably, we found that some injuries were caused by the attending physician instead of the new residents or new perioperative nurses, as we had expected. And, more importantly, a majority of staff injured themselves with suture needles, with the most injuries coming while loading or passing a suture needle. Nationally, suture needles are the main source of needlesticks to OR personnel, causing 51 percent of all sharps injuries in surgical settings. Scalpel blades rank a distant second, with 12 percent of injuries, according to a 1998 study in AORN Journal.

As a result of these findings, the perioperative staff reviewed with staff and physicians the importance of using a hands-free passing zone to decrease the occurrence of sharps injuries.

Advice for you
Getting a hospital to commit to a new technology can involve navigating through a maze of committees. If you're interested in implementing the survey process in a smaller facility, data collection could probably be less involved. You may only need to assess a few factors.

• Where and when the injury occurred. Is your facility all-inclusive of the various services or do you have special rooms set aside for specific services? Do you have more than one shift for the staff?
• What was the source of the injury? Simply list the culprit, be it scalpel, suture needle, hollow bore needle or instrument.
• How did the injury occur? Was a sharp being passed hand to hand, or during the clean up of the back table? Was someone drawing up medication or removing a blade? Was it self inflicted or as a result of someone else? Was the sharp inadvertently disposed of in the regular trash where it could injure the environmental staff?
• What was the job title of the injured person? RN, ORT, medical staff, resident, physician assistant?

Putting it into practice
When educating your surgeons and staff, focus on practical things they can instantly apply to reduce sharps injuries. Some ideas you might consider:

• Avoid recapping or removing hollow bore needles from a syringe;
• use devices with safety features;
• use the hands-free area for passing sharps; and
• place puncture-resistant sharps boxes in each operating room convenient to the sterile field for easy disposal during clean up.

Remember that the emotional impact of a sharps injury can be severe and long lasting, even when an infection is not transmitted.