Thumbs Up on Safety Scalpels

Here's a look at the key findings of Outpatient Surgery's Safety Scalpel Survey. Results are based on the 187 leaders of operating rooms in hospitals and ambulatory surgery centers who completed our in-depth online survey:

• The haves. 18.82% of our respondents report that their surgeons "always" use safety scalpels; 13.44% say their physicians "usually" use them and 11.29% say they "sometimes" use them. Add it up, and you get a usage rate of 43.55%.
• The have-nots. Safety scalpel use is still far less than expected: 40.86% of respondents say their physicians "never" use them while another 15.59% say they use them "rarely." On the bright side, the needle, pardon the pun, is moving slightly in the right direction. In 2011, when Outpatient Surgery conducted a similar survey, we found that 60% of respondents were not using safety scalpels in their ORs compared to 56.45% today.

The No. 1 reason our respondents cited for not using safety scalpels: Surgeons refuse to use them (65.38%). A distant second: Facility has not found acceptable safety scalpel brand/model (35.38%).

• Preference. Safety scalpel users prefer disposable plastic (64.52%) to reusable metal (35.48%) handles by nearly a 2:1 margin. Similarly, they prefer a safety sheath (60.8%) to a retractable blade (31.2%).
• Cost could be a factor. More than half (56.91%) of our respondents believe that safety scalpels are safer than traditional non-safety scalpels, but also note that they cost more. Some add that the blades on disposable scalpels dull faster, so they go through more safety scalpels during a case.

"Cost could be a factor, but safety will win out. The sharpness of the blade and ease of exposing the blade are the biggest factors," says a respondent.

• Holding steady. While about two-thirds (65.38%) say scalpel usage at their facilities has stayed the same over the last 5 years, 10.99% say it's "increased a great deal" and 16.48% say it's "increased." Only about 7% of respondents say usage has decreased, suggesting that once facilities adopt safety scalpels, their surgeons will continue to use them, as these write-in responses illustrate.

"At this point they are used to safety scalpels and it seems like just second nature," says one respondent. Another strong-arms her surgeons: "We just muscled them onto the trays. In other words, we put them in place and didn't offer many options." And finally, this facility gave its docs an ultimatum: "We adopted the policy with the chief of surgery's buy-in. It was use them or don't do surgery."

Many respondents cite age as a factor. The older a surgeon is, the more he'll resist safety scalpels by rolling out the same tired, hard-to-shake excuses: they're too dull, too light, too difficult to activate and too obtrusive (the safety shield blocks my line of sight).

"It's a mixed bag. The older surgeons do not feel they are necessary. The younger, fresh-out-of-residency surgeons feel that everyone should use them," says Jimmy Henderson, materials manager at the Outpatient Surgery Center of Jonesboro (Ark.).

Says another respondent: "They were trained using the traditional scalpels. The safety scalpels require them to make a change and the feel is slightly different. Surgeons are reluctant to change unless mandated. They don't want anything new, especially if it might slow them down a few seconds."

"There is a place for safety blades," she says. "But I also think we need to be aware that we're handling a sharp piece of equipment. We need to be careful and pay attention to what we're doing."

For certain surgeries, safety scalpels may not be ideal. Our respondents listed tonsils, circumcisions, plastic surgery and hand surgery as cases that require more precise cutting and finer tips than they feel safety devices can deliver.

"For the small hand surgeries, our hand specialist thinks they're clumsier and more dangerous than a regular scalpel," says Ms. Stuckert.

Ms. Johnson's facility follows a simple policy: Surgeons who are adamant about using a free blade can do so under certain circumstances. For example, your orthopedic surgeons could feel the length of the blade with the protected cover is not long enough to make the port incision for arthroscopy cases.

"I think it depends on the surgeon and the procedure: general surgeons always use them, orthopedic surgeons do not. As long as there is a safe zone, I think either is appropriate," says Corinna Quimby, BS, RN, CNML, of Hartford Healthcare, Windham Hospital in Willimantic, Conn.

If your surgeons still turn their thumbs down and their noses up at the mere mention of safety scalpels, tell them it's a matter of when, not if, they'll use safety scalpels. And give them some say in the matter.

"I have implemented them and let them know we are going sharps safety all the way," says Mardalla Criswell, RN, surgery manager at Goodland (Kan.) Regional Medical Center. "They have a chance to weigh in and give their opinion of which safety scalpel they would like. We gave them a few to choose from and let the majority vote rule."

Be flexible, as well. One facility agreed to switch to a reusable metal handle with a safety sheath to give the surgeons a more normal feel.

Kristi Sorbello, RN, CNOR, director of nursing at Upstate Orthopedics ASC in Syracuse, N.Y., says her surgeons have trialed numerous safety scalpels of all different configurations and have yet to find one that they like.

"They complain about the flimsiness of the plastic ones, the obstructed views caused by the protective shields, decreased depth of scalpel handle length by the sheath and the lack of one-handed [activation of the safety mechanism] that is truly user-friendly," says Ms. Sorbello. "They also need a sturdy handle for orthopedic/bone work."

When we asked our respondents to describe the one design change they hoped safety scalpel manufacturers would make, nearly all wished for a safety mechanism that is easier to activate and deactivate.

"Some are easier to use than others," says one.

"When it takes time and it takes 2 hands [to activate], there is a greater risk of an injury." Says another: "A better mechanism than a sheath that is sloppy.

It's not machined to be a very solid or precise piece of gear." One wished for left- and right-handed sheath cover activation.