Sharps Safety & Neutral Zone

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Sherri Alexander, CST Past President,

Association of Surgical Technologists

Recommended Practices from the Point of View of the Certified Surgical Technologists

Surgeons and surgical assistants are at highest risk for injuryo 59% of sharps injuries in OR

Surgical technologists in first scrub role are second highesto 19% of sharps injuries in OR

16% of injuries involve passing sharps from hand-to-hand

Statistics

AST recommends double gloving for all surgical procedures including

endoscopic/MIS procedures

Reduces risk of exposure to patient’s blood by as much as 87% when outer glove is punctured3

Volume of blood is reduced by as much as 95% if suture needle passes through both gloves3

Double Gloving

Sharps on the Mayo stand and back table can be a hazard

Be aware of sharps at all times

Point sharp ends away from users to decrease risk of injury Too often placed towards the handler and receiving

personnel

Organization of Sterile Field

Surgeon and scrub person compliance is crucial The Three As:o Agree to useo Agree on sterile field locationo Agree that location can change during procedure

Verbal communication when a sharp is placed in the neutral zone1, 2

Neutral Zone

AST recommendationo don’t attempt recapping

Surgical procedures are unique situations

Hypodermic needles are used frequentlyo Present greater threat of a sharps injury when kept on Mayo stando If recapping is necessary, AST recommends one-handed “scoop” method for recapping

Recapping Needles

Transfer examples: lunch breaks, end of shift, and long procedure relief

Important to remember:o During counts, the CST who set up the case needs to emphasize the location of ALL sharps

o Identify the location of sharp instruments on field, Mayo stand, back table, or soaking in a basin

Transfer of Responsibility

We talk about knife blades and needles, but…

CST in first scrub role has numerous other sharps to be concerned about

There are several studies on needle stick accidentso not enough studies on sharps accidents with instruments or

prevention techniques for this type of injury

Other Sharps from a CST Point of View

Surgical Specialties

General surgeryo Gelpi retractors o Rake retractorso Sharp Weitlaner retractorso Towel clipso Trocars and Verres needles

Gynecological surgeryo Uterine/cervical tenaculum

• single or double-toothed

Other Sharps from a CST Point of View

Surgical Specialties

ENTo Rosen knife o Tracheal hooks

Plastic Surgeryo Sharp skin hookso Dermatome bladeso Iris scissors

Other Sharps from a CST Point of View

Surgical Specialties-orthopedics

Guide wires; K-wires Drill bits Saw blades

o Gigli saw Acetabular reamers Bone hooks Elevators Osteotomes

Other Sharps from a CST Point of View

Surgical Specialties-neurosurgery

Mayfield/halo pins Perforators and burrs Fish hook retractors Blades Dural hooks Sharp Adson-Beckman retractors

Other Sharps from a CST Point of View

Surgical Specialties-cardiothoracic Potts-Smith scissors Sternal saw blade Ligature carriers Sternal wires Rib spreaders

Other Sharps from a CST Point of View

Don’t forget the electrosurgical unit (ESU) tip

Needle ESU tips pose extra risk at all times during procedure Any tip left on pencil can puncture drapes, cause an injury, or

start a fire After the case these tips are considered sharps

Other Sharps from a CST Point of View

Take time to visually inspect the sterile field before drapes are

removed

Any item counted as a sharp must be confined and contained for proper disposal or reprocessing

End of Procedure

AST advocates:

Attach and remove blades and needles from all instruments and handles using an instrument such as a needle holder NEVER fingers

Confine and contain used blades and needles in puncture-proof counter on back table

Keep hypodermic needles covered with cap if possible Use transfer basins/trays for hands-free passing

Mechanical Safety Devices

Communication

Teamwork

Compliance

Keys to Success

Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. Centers for Disease Control and Prevention. http://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf. Accessed February 9, 2011.

Sharps injuries in the operating room: a new focus for OSHA. 2004. Healthcare Hazard Manage Monitor. 18(2):1-5.

Berguer R, Heller PJ. Preventing sharps injuries in the operating room. J Am Coll Surg. 2004;199(3):462-467.

References

Sharps Safety & Neutral Zone

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