Sharps Safety & Neutral Zone Main Image Here 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 injury o 59% of sharps injuries in OR  Surgical technologists in first scrub role are second highest o 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 punctured 3  Volume of blood is reduced by as much as 95% if suture needle passes through both gloves 3 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 use o Agree on sterile field location o Agree that location can change during procedure  Verbal communication when a sharp is placed in the neutral zone 1, 2 Neutral Zone

 AST recommendation o don’t attempt recapping  Surgical procedures are unique situations  Hypodermic needles are used frequently o Present greater threat of a sharps injury when kept on Mayo stand o 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 accidents o 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 o Gelpi retractors o Rake retractors o Sharp Weitlaner retractors o Towel clips o Trocars and Verres needles  Gynecological surgery o Uterine/cervical tenaculum single or double-toothed Other Sharps from a CST Point of View

Surgical Specialties  ENT o Rosen knife o Tracheal hooks  Plastic Surgery o Sharp skin hooks o Dermatome blades o 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. Accessed February 9, 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): References

Sharps Safety & Neutral Zone The End