Sharps Safety & Neutral Zone Recommended Practices from the Point of View of the Certified Surgical Technologists Sherri Alexander, CST Past President, Association of Surgical Technologists Main Image Here

Statistics Surgeons and surgical assistants are at highest risk for injury 59% of sharps injuries in OR Surgical technologists in first scrub role are second highest 19% of sharps injuries in OR 16% of injuries involve passing sharps from hand-to-hand

Double Gloving 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

Organization of Sterile Field 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

Surgeon and scrub person compliance is crucial Neutral Zone Surgeon and scrub person compliance is crucial The Three As: Agree to use Agree on sterile field location Agree that location can change during procedure Verbal communication when a sharp is placed in the neutral zone1, 2

Recapping Needles AST recommendation don’t attempt recapping Surgical procedures are unique situations Hypodermic needles are used frequently Present greater threat of a sharps injury when kept on Mayo stand If recapping is necessary, AST recommends one-handed “scoop” method for recapping

Transfer of Responsibility Transfer examples: lunch breaks, end of shift, and long procedure relief Important to remember: During counts, the CST who set up the case needs to emphasize the location of ALL sharps Identify the location of sharp instruments on field, Mayo stand, back table, or soaking in a basin

Other Sharps from a CST Point of View 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 accidents 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 surgery Gelpi retractors Rake retractors Sharp Weitlaner retractors Towel clips Trocars and Verres needles Gynecological surgery Uterine/cervical tenaculum single or double-toothed

Other Sharps from a CST Point of View Surgical Specialties ENT Rosen knife Tracheal hooks Plastic Surgery Sharp skin hooks Dermatome blades Iris scissors

Other Sharps from a CST Point of View Surgical Specialties-orthopedics Guide wires; K-wires Drill bits Saw blades 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

End of Procedure 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

Mechanical Safety Devices 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

Keys to Success Communication Teamwork Compliance

References 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.

Sharps Safety & Neutral Zone The End