It's tough to loosen a surgeon's grip on his belief that safety scalpels are far inferior to traditional scalpels. But are these deep-rooted beliefs based on fact or fiction? Here's how to counter 5 common misperceptions that your surgeons may hold.

1. They have little impact on injury prevention. "Our surgeons don't believe that safety scalpels offer more safety. Of the 16 sharps exposures we've had over a 2-year period and 20,000 cases, one might have been prevented with a safety scalpel."

Absolutely not true. When used correctly, safety scalpels are useful tools in preventing sharps injuries, says Wendy Clark, BSN, RN, CNOR, surgical services clinical educator at Memorial Healthcare System in Chattanooga, Tenn. By definition, safety devices are intended to reduce injuries, but proper education and policies on how to use them are equally important, she says. For example, Memorial instituted a neutral passing zone policy and launched a surgery safety program when implementing safety scalpels in 2009, says Ms. Clark. To her knowledge, the hospital — which handles more than 20,000 cases a year — has had 1 injury related to improper blade loading and another due to a stuck safety knife sheath in that time.

Overall, "our sharps injuries were reduced significantly after launching our surgery safety program," she says. "Was it because of safety scalpels? Yes, in part. But really it was because of enormous education and launching the use of safety devices and a neutral passing zone policy collectively."

2. They're not hefty enough. Safety scalpels "are too light, and need to be weighted to feel more like a metal one for surgeons' comfort and confidence level."

This perception may have been accurate in the past, but many manufacturers have begun to address safety scalpels' lack of heft, says Gina Pugliese, RN, MS, vice president of the Premier Safety Institute, a Charlotte, N.C.-based provider of healthcare safety tools and resources. "There are more than 20 brands of safety scalpels on the market today," she says. "And they come in a variety of sizes, shapes and weights. So [weight] should no longer be an issue."

Indeed, "there is a new generation of safety scalpels that are much better than the original crop" in terms of replicating the weight and feel of traditional scalpels, says Ron Stoker, executive director of the International Sharps Injury Prevention Society in South Jordan, Utah. Many of these newer safety knives include protective features with plastic or metal handles to more closely mimic conventional scalpels, he says.

3. The safety mechanisms are awkward to activate. "Safety scalpels have cumbersome handling parts or pieces, which interfere with the physician's job."

Many safety knives rely on "active" safety features, such as a sheath or retractable blade that requires manual activation, says Mr. Stoker. Some new models include one-handed or even hands-free safety feature activation. But overall, more "passive" safety features are needed to enable surgeons to simply set the scalpel down without having to trigger safety features at all, says Mr. Stoker.

4. The blade's not sharp enough. "The blade is not as sharp and isn't always appropriate. For example, in arthroscopic knee surgery, the safety scalpel shield blocks the depth to which the surgeon can go."

Safety scalpel blades continue to be a difficulty for many physicians, says Mr. Stoker. "Sometimes when a surgeon's making a deep incision, he doesn't have control over how deep he can go," he says. "That's a real issue, and is one of the biggest reasons I hear for non-compliance." Still, some manufacturers are making strides toward rectifying this problem. For example, several new safety scalpels feature a handle that is essentially a traditional scalpel handle with a safety shield. Surgeons can use their own blade, and change it multiple times throughout a procedure.

Memorial Healthcare System implemented safety scalpels more than 3 years ago. Several surgeons initially resisted using the devices, due in part to their feelings that safety knife blades "weren't high quality, or dulled quickly," says Ms. Clark. This was true of some of the products the center evaluated, but Memorial surgeons were eventually able to agree on a scalpel with a disposable, weighted blade that "felt the most like a knife handle," says Ms. Clark. "The best part was that we were able to keep our blades, which were sharp. But we could also change the blade if necessary."

5. They cost more. "I believe safety knives are safer than traditional non-safety scalpels, although they cost more."

Cost is a legitimate concern, says Mr. Stoker, but the real issue is measuring hard costs against soft costs. Safety scalpels are ultimately cost-effective, he says, when considering the costs of scalpel injuries over the long haul — time lost due to injuries and increased insurance premiums, for example. The initial outlay for purchasing safety scalpels may initially seem significant, but ultimately pales in comparison in the long term, says Mr. Stoker.

Overcoming objections
So it seems manufacturers have taken significant steps to increase the variety and overall quality of safety knives, as well as their similarity to traditional scalpels. But that doesn't mean you won't encounter resistance when it comes time to evaluate safety knives at your center. So how do you get your surgeons on board with using them? A few tips:

Find a champion. "All you need to do is convert 1 surgeon over to safety scalpels," says Ms. Pugliese, "and they'll be a leader in promoting their use within your facility." Seek out a surgeon at your facility who is typically an early adopter of new technologies, techniques and devices, and shows a particular interest in sharps safety. Such a physician can be a powerful ally to help you lead the way.

"Surgeons will often listen to other surgeons when it comes to changes in practice and innovative or new techniques and devices," says Ms. Pugliese.

Get surgeons involved. Inform your doctors before evaluating safety knives, and stress their integral role in the process, says Ms. Clark. "If surgeons are informed that their participation and opinions are crucial to the decision process, that will help you get them over the hurdle of trying something new."

At Memorial, the OR team held in-services in the physician lounges, letting surgeons feel various knife handles and provide feedback on each one, she says. Physicians shared their likes and dislikes regarding various products. Many had issues with safety knife handles, but their honest input ultimately helped the team move closer to achieving a true consensus, says Ms. Clark.

"Change is often difficult, no matter what you do to make the process better," she says. "Now, 3 years down the road, no one even questions the safety knife handle anymore."

Offer plenty of options. Do your due diligence, and provide surgeons with a variety of safety knives to choose from, says Ms. Clark. Over the course of 3 years, Memorial trialed several products, including 4 types of safety blades and hands-free blade detachment devices, before making a final selection, she says.

"The real push is to find something that works well for you," says Ms. Clark. "Help the surgeon understand that we'll never have a perfect safety device, but we can come close."

Put safety first. It's true that your center is required by law to conduct evaluations of available safety devices. But don't try to push safety scalpels on your docs as an OSHA-imposed edict. In fact, surgeons who aren't technically employees of the surgery center can't even be cited for not using safety scalpels. Rather, you should stress to surgeons that using the devices is more a matter of improving safety than it is a compliance issue, says Mr. Stoker.

And while OSHA may not come after your surgeons, make sure your docs understand that the center has a duty to provide a safe environment for its employees, and can be cited for not doing so, says Ms. Pugliese. It may take a lot of time and repetition to drive this point home, but looking after your OR team's safety is a vital part of the administrator's job description, she says.

"Ultimately, you have a responsibility for safeguarding your workers. So if something in your surgical environment is posing a risk, your duty is to protect them."