James Fox, MD, a surgeon at the Southern California Orthopedic Institute in Beverly Hills, Calif., has experienced firsthand the effects of a sharps injury, and that's one reason he uses safety scalpels at his facility. "Although there wasn't the threat of HIV back then, we still had to contact the patient and request that she get tested for hepatitis," he says. "I also had to be tested and retested after six months. It was very scary."

Dr. Fox was interested in protected scalpel blades when they first came on the market, but he didn't find any that appealed to him because they didn't have the right feel to them. "Surgery depends a lot on the feel and sensation. I wanted something weighty in my hand. Even an ounce of difference is perceptible when you're dealing with small movements," says Dr. Fox.

Dr. Fox and other surgeons are finding that today's safety scalpels have come a long way. "Anything we can do to improve the safety of our staff and patients is very important, and with today's blades there is increased safety with very little adjustment for the surgeon," says Dr. Fox.

Here's a look at what's new.

Weightier scalpels
Mary Jane Patterson, RN, director of surgical services at Fisher Titus Medical Center in Norwalk, Ohio, hasn't had luck yet selecting a scalpel her surgeons like. "We're looking for something that feels like a traditional scalpel. Our surgeons don't like the lightweight feel of the safety scalpels we've tried so far," she says. If you have had similar trouble finding blades for physicians who don't like the lightweight, plastic scalpels, here are three new devices that claim to offer the weight and feel of a traditional scalpel.

• Deroyal Canica Ejectable Scalpel Handle. This resembles a retractable pen with a round, stainless-steel body. With a push of a button at the end of the handle, the blade is ejected. The autoclavable handle takes Ion Fusion disposable scalpel blades, which come in most industry-accepted sizes and can be used for a variety of specialties and procedures. The blade's champagne-gold edge is treated with an ion-annealing process, which heats then cools the metal to reduce brittleness, for a sharp cutting edge, says the company.
• Personna Plus Safety-Scalpel System. This is the first safety scalpel system with the same weight and feel of a traditional scalpel, the company says. It includes a reusable metal handle and MicroCoat blade, surrounded by a plastic sheath, which you can open and close repeatedly throughout the procedure, so the user never has to touch the blade, according to the company. At the end of the procedure, the sheath is closed and ejected into a sharps container. The product is available with five handle sizes and nine blade sizes. It is also available in a disposable unit.
• Sandel Medical's Weighted Disposable Safety Scalpel. This may offer your surgeons the feel of a traditional safety scalpel from a disposable device. The blade is covered with a bright orange shield, which is locked and unlocked with the orange button on the side of the handle. The company says the button can be activated using the left or right hand. The scalpel comes covered with a removable sleeve with the words "time out" printed on it as a reminder to the surgical team to stop before the incision in compliance with JCAHO's Universal Protocol. The scalpel is also available in a non-weighted version.

Ophthalmic knives
While some ophthalmologists might still prefer the sharpness of their diamond blades, Randall Olson, MD, an ophthalmic surgeon at the University Medical Center in Salt Lake, Utah, says that disposable cataract knives offer a three-fold advantage over diamonds.

"The safety blades of course protect the surgeon and scrub nurse from potential exposure to HIV and hepatitis, but they also protect patients from possible contamination from prions found in ophthalmic tissue, which cannot be destroyed during sterilization," says Dr. Olson. "And because they are disposable, you don't have to worry about care and cleaning of delicate diamond knives."

Here are two cataract knives to consider.

• BD Safety Knife with Xstar Blade. This is equipped with a retractable safety shield that protects the blade during the procedure and handling. The user activates the shield, using a spring-assisted slider that provides tactile and audible confirmation when it's in the shielded and unshielded positions. According to the company, the arch-style, single-bevel blade geometry lets the surgeon create scleral and corneal incisions. The knife is available with a stainless-steel slit blade in several popular sizes. Other blade types will be available soon.
• Diatrix patented Protekt handle. Designed to protect staff before, during and after use, the surgeon activates the cylindrical sheath with a screwing motion (this can be done with one hand) the sheath rests on the handle during use and screws back on after the procedure. The blade material is designed to stay sharp for multiple uses, the company says. Blades are available for trapezoid, clear corneal, scleral and sideport incisions.

Sheathed and retractable scalpels
Disposable sheathed and retractable scalpels are still the most widely used safety scalpels. Many safety scalpels incorporate a sheathing safety mechanism. Here's what's new.

• BD Bard-Parker Protected Disposable Scalpel. This features a transparent retractable shield that locks into place to enclose the stainless steel blade after use. To expose the blade, simply depress the button on the shield and pull it back toward the handle. The shield can be manipulated multiple times. There are three ways to confirm whether the shield is locked during or after use - an audible click, a tactile sensation and a lock-indicator line. The locking feature minimizes the risk of accidental movement or retraction of the shield, which could expose the blade, says the company. The scalpel is close in size and weight to a conventional disposable scalpel. This product was designed with the help of surgeons from 10 different specialties to ensure it could be used for a variety of procedures.
• Feather Safety Razor Company's Safeshield Scalpel. This disposable scalpel was designed for delicate procedures like plastics, orthopedic and oral and maxillofacial surgery, the company says. With the scalpel's Suregrip, you activate the blades safety shield by pressing in a button on the handle and sliding the shield up or down the rounded scalpel body. Scalpels come in sizes 10, 11, 14, 15 and 15c.
• Futura Safety Scalpel from Hypoguard. This scalpeloperates with a spring-retracted blade. To expose the blade, place your thumb on the textured slider and push forward until the blade is locked in position. When you are done, press down on the raised surface at the end of the slider and the blade will spring back into the handle. According to the company, the advantage of being able to activate the safety mechanism by pressing a button at the rear of the slider is that it keeps hands away from the blade. The Futura Safety Scalpel comes in multiple blade sizes; 10, 11 and 15 are the most popular.
• Miltex Retractable Safety Scalpel. This product has a stainless steel, razor-sharp cutting edge for clean incisions, the company says. To activate the safety mechanism, you depress the slider with your thumb and move it up and down to expose and retract the blade. The device is available in three sizes: 10, 11 and 15.

Making your case
Dr. Fox admits that surgeons can be one of your facility's biggest stumbling blocks in making the transition from conventional to safety devices. He recommends that you talk to your risk managers and get an estimate of the cost of just a single sharps injury.

"Show your surgeons the cost of someone being poked with a scalpel blade as far as time, treatment, paperwork and follow-up, not to mention the psychological impact," he says. "The little extra effort to switch over to safety blades will be rewarded in thousands of dollars."