Neutral Zones: The Bordered Region

The two most common staff injuries in the perioperative setting are suture needle and scalpel injuries, which occur when these items are passed between the intraoperative team members within the sterile environment. There are several methods to prevent staff sharps injuries, such as the no-touch technique, eliminating the sharp hazard, using personal protective equipment, and providing education (and then more education). But what about the neutral zone? What is it, and how can it be used to protect staff and patients?

Defining the Neutral Zone

The neutral zone is a designated area for staff members to pass sharps (eg, instruments, blades, needles); it can be on the mayo stand or created using a transfer device, such as a magnetic pad or basin. Sharps are placed within or on the neutral zone after each use during a procedure, with verbal notification of its placement. The objective of the neutral zone is to confirm that the sharp is only being handled by one team member at a time.

Establishing a Policy

Within my personal practice environment, the neutral zone is not always used; however, our surgeons and perioperative leaders are getting stricter with enforcing its use because they have seen the associated decline in injuries. To establish the use of a neutral zone, a sharps safety policy should be developed. The surgeon and other surgical team members should first discuss the best location for the neutral zone within each service line procedure. A facility policy can then be created using this information and other specifics for each service line (and possibly also using universal physician preferences). The sharps safety policy should include the procedures for which the neutral zone compromises safety and cannot be used (eg, minimally invasive procedures where the surgeon cannot turn away from the monitor) and when use of the neutral zone can be modified (eg, hand off of instrumentation or equipment directly to the surgeon, with the instrument or equipment returned to the neutral zone).

Encouraging Use of the Neutral Zone

By encouraging the use of the neutral zone, novice nurses can help to reduce sharps injuries and, subsequently, exposure to blood and bloodborne pathogens for themselves and their colleagues. There are several ways this can be achieved.

• One key to the successful use of a neutral zone during a procedure is to establish it during the preoperative briefing with the surgeon, surgical technician or scrub nurse, and any other staff that may be pertinent to the procedure (eg, physician assistants, residents). During preoperative huddles, make it a habit of discussing with the surgeon where the neutral zone will be placed and whether the zone will change throughout their various cases.
• The OR should be a safe place where all staff feel empowered to speak up for staff and patient safety. If given grief about the neutral zone, discuss with the surgeon that the neutral zone stems from staff safety issues and is enforced by leadership to protect them and others working alongside them. Escalate to your chain of command if necessary.
• Monitor how often the neutral zone is being used in practice within each service line to gauge where to better focus efforts on promoting its use (eg, particular service lines, physicians, or procedures).

AORN Resources 

AORN members can access: 

• Sharps Safety FAQs | AORN
• Sharps Safety Guideline Essentials | AORN
• Guideline Quick View: Sharps Safety - AORN Journal
• Guidelines in Practice: Sharps Safety - AORN Journal
• Preventing Perioperative Sharps Injuries - AORN Journal
• Understanding Causes of Needlestick and Other Sharps Injuries Among OR Personnel - AORN Journal
• Devices most commonly implicated in needlestick and sharps injuries - AORN Journal
• Suture Needle Injuries During Wound Closure: Examining Sources of Distraction in the OR - AORN Journal

If your facility subscribes to eGuidelines+, you can access: 

• Sharps Safety Guideline | AORN eGuidelines+