NEUTRAL ZONE Students at the El Paso Community College use magnetic pads to create a neutral zone to prevent injuries when working in the OR.

They don't substitute for good technique, but sharps safety products can lend a big hand in preventing injuries to your staff. Luckily, there are plenty of devices to prevent some of the most common OR injuries — suture sticks, needle nicks, scalpel slices — and ways to get staff on board.

"There are really tremendous options for reducing injury risk," says Janine Jagger, MPH, PhD, founder of the International Healthcare Worker Safety Center and professor of medicine at the University of Virginia School of Medicine. "Most of them are just not widely implemented."

1. Blunt suture needles
When it comes to sharps injuries, suture needles are the biggest culprits — responsible for 43% of them, says Dr. Jagger — and one of the easiest fixes. The most obvious way to prevent them is to switch to blunt suture needles. The CDC, FDA and OSHA all recommend you use blunt suture needles, yet OR teams have been slow to adapt, says Dr. Jagger. One reason might be cost. Blunt suture needles cost 70 cents more than standard (sharp-tip) suture needles, but that's nothing compared to the costs of a suture needle injury. "They're so effective at preventing injuries that you'll recoup the costs," says Dr. Jagger, who adds that most surgeons like the blunt needles once they get used to them. In Japan — where blunt suture needles have been widely adopted — one study showed that surgeons actually felt uncomfortable when they had to use sharp suture needles over blunt ones. "You can feel the measure of security you get from those devices," says Dr. Jagger. "It's kind of like always riding in a car with a seat belt, and then having to take it off."

2. Wound-closure alternatives
Some wound-closure alternatives require no suture needles at all. For internal tissue, adhesives made to facilitate the healing process inside the body are an option, says Dr. Jagger. Newer formulas work better on wet tissue and reduce leaks, she says. For closing skin, which typically requires a sharp suture needle, newer devices adhere to the skin around the wound and create tension using mechanisms like zippers, small clamps and zip-ties, says Margaret Rodriguez, CST, CSFA, FAST, BS, a professor in the Surgical Technology Program at El Paso Community College. These devices are often touted as a time-saving convenience to surgeons. Plus, some devices even allow for patient removal, saving a return visit. And while not new, staples are also a good alternative to reduce suture needle injuries, says Dr. Jagger. "The largest cause of injury has the most safety alternatives that are not in widespread use," she says.

3. Safety scalpels
After suture needles, scalpels are the biggest threat in the OR. But while switching to safety scalpels reduces risks, Dr. Jagger notes that making the move is "a little trickier."

Tracy Diffenderfer, RN, MSN, CNOR, executive director of perioperative services for Cone Health in Greensboro, N.C., says it's possible to find the perfect scalpel, one that appeases surgeons and prevents injury. After surgeons in her health system tested new safety scalpels, they realized there was a problem. "The doctors hated the shield," she says. Leadership listened to the doctors' input and went back to the manufacturer to work on a new prototype that the docs now "feel they can use," she says.

There are safety scalpel options for everyone, and newer models are better weighted to feel like a traditional scalpel and have a more comfortable hold. Disposable scalpels, or reusable ones that have a scissor-like handle for hands-free disposal of the blade, can prevent injuries from disassembly and disposal. To prevent cuts during passing or use of the scalpel, shielded or retractable models work great, says Dr. Jagger.

4. Neutral zone transfer trays
Passing sharp instruments from person to person is inherently risky. A neutral zone or a hands-free transfer is proven to work — studies suggest it can reduce sharps injuries during operations by up to 59%. The newest trays are expandable, fit a variety of handles and instruments, and come with an optional adhesive bottom so they can be used as a designated neutral zone.

Other options include magnetic pads to mark a neutral zone, which Ms. Rodriguez's students use. The magnets keep instruments in place, which prevents injuries caused by surgical staff trying to catch falling instruments. They also have foam backing to provide better traction and reduce the likelihood of an instrument puncturing a patient, something that may happen when facilities use towels to mark the neutral zone, says Ms. Rodriguez.

NEEDLELESS Unlike traditional IV systems, needleless IV systems don't have uncapped hollow-bore needles left in the tubing.

5. Double-gloving
It's harder to drive a needle into your finger if you're wearing 2 layers of gloves. New indicator gloves alert staff sooner when the first layer is broken, thanks to bright colors that peek through from underneath. Heavy-duty gloves made of thicker latex or nitrile, a material highly resistant to punctures, can be especially helpful during more sharps-prone procedures, like orthopedics. Double-gloving can be a hard sell, says Ms. Diffenderfer, as some providers argue they lose their tactile feel. Offer fittings to staff, she says, so they can find the right sizes and combinations.

6. Safety IV catheters
While safety IV catheters have been largely implemented, workers are still getting stuck, especially if they aren't activating the safety feature. Safety IV catheters are either active, which means the safety engineering is manually activated, or passive, in which case it is automatic. Ms. Diffenderfer notes that when it comes to passive vs. active, passive safety IV catheters are her preferred option. But she notes that it's important for each facility to find what works for them. "If half the people who trial it say they hate it, you'll have a very low adoption rate," she says. "Be open to listening and modifying."

Reducing sharps injuries from IV systems isn't just about the catheters. Needleless IV tubing removes the risk of uncapped hollow-bore needles piercing the tubing if it's bent or twisted. By using the needleless system, Ms. Rodriguez says, there's been a "substantial reduction in sharps injuries."