1. 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
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2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

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

11. 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

12. 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

13. Other Sharps from a CST Point of View
Surgical Specialties-cardiothoracic
Potts-Smith scissors
Sternal saw blade
Ligature carriers
Sternal wires
Rib spreaders

14. 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

15. 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

16. 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

17. Keys to Success
Communication
Teamwork
Compliance

18. References
Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. Centers for Disease Control and Prevention. Accessed February 9, 2011.
Sharps injuries in the operating room: a new focus for OSHA 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):

19. Sharps Safety & Neutral Zone
The End