Handing off Sharps

Question: Is there a fail safe way to hand off sharps?

Response: The Operating Room is the second most common environment where sharps injuries occur. The Center for Disease Control provides an excellent resource on line, Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program. I believe this is the most important approach to preventing injuries to health care personnel. An interdisciplinary team initiative with a focus on building a culture of safety that addresses sharps injuries with a strong prevention program. Emphasis needs to be placed on engineering controls, isolating the hazards and providing safer devices for use by the health care worker. All team members need to be invested in the program.

The Occupational Safety and Health Administration (OSHA) mandates a standard on Bloodborne Pathogens which explicitly require use of safety engineered sharp devices. OSHAs fact sheet, Bloodborne Pathogens online states Bloodborne pathogens are infectious materials in blood that can cause disease in humans, including hepatitis B and C and human immunodeficiency virus, or HIV. Workers exposed to these pathogens risk serious illness or death.  (http://www.OSHA.gov)

Now to the root of the question. There are a number of methods to safely hand off sharps in the operating room and procedure areas.

• Use of engineering controls such as safety scalpels with retractable blades that protect the handler from the blade by retracting the blade within a sheath. Use of blunt needles for the facial layer.

• Isolating the hazard through work practice controls such as establishing a neutral or hands free zone. This is a defined area where sharps are placed by the scrub nurse and then retrieved by the surgeon and vice a versa. This could be a specific basin or tray or commercially available safe zone. Whichever is used the important aspects are that only one person is placing or retrieving the scalpel or needle, and there is only one sharp at a time in the zone. The sharp end of the needle or blade is pointed away from the health care worker.

• When the surgeon is using a microscope or loupes looking away to retrieve from the safe zone may not be efficacious. At this time the sharp may have to be handed direct and attention by both parties should be on the hand off with a verbal identification that the sharp is being passed, with a time of hesitancy while the person handing the sharp retreats.

• The CDC Workbook also recommends work practice controls: "With the current focus on engineered technology, there is little new information on the use of work-practice controls to reduce the risk of sharps injuries during patient care. One exception is the operating room. Work-practice controls are an important adjunct for preventing blood exposures, including percutaneous injuries, in surgical and obstetrical settings because the use of exposed sharps cannot be avoided. 

      Operating room controls include:

• Using instruments, rather than fingers, to grasp needles, retract tissue, and load/unload needles and scalpels;

• Giving verbal announcements when passing sharps;

• Avoiding hand-to-hand passage of sharp instruments by using a basin or neutral zone;

• Using alternative cutting methods such as blunt electrocautery and laser devices when appropriate;

• Substituting endoscopic surgery for open surgery when possible; and Using round-tipped scalpel blades instead of sharp-tipped blades (85-88)."  

The Association of Perioperative Registered Nurses, AORN has developed a Guidance Statement: Sharps Injury Prevention in the Perioperative Setting. Many of the engineering and work practice controls addressed are covered. The statement also emphasizes the importance of adopting and incorporating safe habits into daily work activities when preparing and using sharp devices. Other important areas of focus are directing attention to the task at hand and minimizing rushing and distractions when handling sharps. The Guidance Statement gives rational information on broader risk reduction strategies, responsibilities for the individual perioperative nurse, employer responsibilities, overcoming obstacles to compliance and selecting and evaluating new products. It is another tool to assist the Registered Perioperative Nurse and the surgical team to provide a safe environment for the patient and the employee.

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Workbook for designing, implementing, and evaluating a sharps injury prevention program, Centers for Disease Control and Prevention, http://www.cdc.gov/sharpssafety (accessed 5/25/06)

Bloodborne Pathogens OSHA Fact Sheet, http://www.OSHA.gov (accessed 5/25/06 )

Standards, Recommended Practices, and Guidelines 2006 Edition With Official AORN Statements, AORN, Inc.