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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
The End
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