NEUTRAL ZONE You create a hands-free neutral zone that minimizes injuries when the OR team places and retrieves sharp instruments on a brightly colored instrument tray.

Two years ago, OR team members across our health system were stuck or cut 276 times, which was 276 more times more than we'd have liked. We implemented a safety program that reduced sharps injuries by 37%. Here's how we pulled it off.

1Sharing of stats
Surgeons, nurses and techs are typically guilty of focusing more on patient safety than on their own well-being and often take sharps safety for granted. Sticks and cuts? Can't happen to me. But it can and does at alarming rates around the country. To get your staff and surgeons to change their sharps handling practices, you first have to convince them of the very real dangers that sharps present. Try sharing these compelling numbers: 30% of the estimated 380,000 sharps injuries and needlesticks that occur in health care happen in the OR; and sutures (43%), scalpels (17%), and syringes (12%) account for most sharps-related percutaneous injuries.

We started to see dramatic improvements in sharps handling practices after presenting those stats at monthly physician-led committees and staff meetings. The constant sharing of statistics and clinical data about the incidences and risks of exposure will hammer home the importance of sharps safety. Show new surgeons, nurses and techs the same information before they step foot in your ORs. Make your facility's culture of safety crystal clear before they pick up a sharp for the first time.

2Neutral zone passing
The surgical team should verbally agree during the pre-op briefing whether a case will involve hand-to-hand passing or use of a hands-free neutral zone. Whenever possible, you should use a neutral zone. Your team should designate and announce the area where sharps will be placed for surgeons or techs to pick up. Using a towel on the corner of a Mayo stand works, and is definitely better than using no neutral zone at all, but we've found that commercially available products such as brightly colored magnetic basins and rubber pads work best for several reasons. They offer a visual cue of where the neutral zone is located, they're more stable (Mayo stands can get bumped during cases) and they keep sharps in place once they're laid on the surfaces.

Only permit hand-to-hand passing of sharps during cases or instances when the surgeon cannot avert his eyes from the surgical field, such as during ophthalmic surgery or the suturing of delicate vessels. If the surgeon needs to switch from neutral zone passing to hand-to-hand passing mid-procedure, he must announce the transition to the entire surgical team to put everyone in the room on high alert and increase the awareness of whoever is making the sharps exchange. For safety's sake, place the sharp in a surgeon's hand in a way that makes ergonomic sense and so that he doesn't have to reach to grab it. Also, deliver the sharp close to where it will be used, so the surgeon can implement it almost immediately and without excess hand movements.

POINT TAKEN Stick sutures, the leading cause of sharps injuries, in sharps pads after use.

3Constant communication
Do your surgeons and techs announce the passing of sharps during each transaction? Needle back, needle up, sharp forward, sharp back. That active dialogue increases the awareness of every team member, all of whom need to always know where sharps are located within the surgical field. Keeping safety practices consistent during every case makes them hardwired events that become part of routine practice. Our surgical team members have told us that announcing the location of a sharp has become as second nature as the pre-op time out.

4Weekly safety audits
Randomly assign members of your surgical team to observe sharps passing during actual cases. That will provide an accurate assessment of how well your team is following safety protocols and will also let staff members who perform the audits step outside of their typical roles and observe interactions between their colleagues from a different vantage point. Watching sharps exchanges as an outside observer instead of an active participant provides a fresh perspective on ways to make sure daily repetition doesn't dull the safety-minded focus that every team member must have. Peer-to-peer critiquing also creates accountability among the staff.

Make sure every member of the team gets a chance to conduct an audit, because it provides a global perspective of what's going on the OR. In addition, each team member has a unique viewpoint, so, for example, a tech might pick up on something a nurse would have missed.

PRE-OP PRECAUTION
One Last Check on Sharps Safety

Use this checklist before procedures begin to ensure sharps are properly managed during surgery.

• Is the surgeon right- or left-handed?
• Is the neutral zone selected and identified?
• Are safety scalpels available?
• Are appropriate retractors available?
• Have unnecessary sharps been eliminated from the field?
• Are team members aware of the sharps to be used during the case?
• Will team members communicate about the location of sharps?
• Are alternative wound closure devices such as blunt-tip sutures available?

Source: AORN Sharps Safety Toolkit (osmag.net/tfhyt5)

5Learning from mistakes
Encourage healthy dialogue among staff. Members who witness actions during visual audits that put their colleagues or patients in immediate jeopardy should announce their concerns in a collegial way. Report other more minor infractions to the surgical department manager, a safety officer or facility administrator, who can conduct formal coaching or require staff members to complete online sharps safety-training modules.

The point is to learn from the real-time observations of your team's sharps-handling practices and use the opportunities to improve your safety efforts. Our audits revealed surgeons often retracted anatomy manually during open procedures instead of using instruments designed to do the job. That practice put their hands in harm's way and increased their risk of getting stuck. It took a great deal of coaching and reminders to change that dangerous habit. OSM