Dr. Fuentes, Collier, Sinnott and Whitby reviewed clinical charts of 137 scalpel injury reports of a 550 bed hospital and shared their findings in an issue of International Journal of Risk & Safety Medicine1.
Injuries were classified as not preventable and preventable.
Not Preventable Injuries
Nearly 50% of the reported injuries were sustained while the scalpel was in use and were classified as not preventable.
Preventable Injuries
The remaining preventable injuries occurred during:
Loading (2%), Passing (18%) Removing (13%), Disposal
(10%) Cleaning (3%) Downstream (4%).
These findings are significant because they reveal that 50% of scalpel blade injuries cannot be prevented by safety scalpels currently available on the market, because these scalpels are loaded with a sharp-tipped blade.
The focus, so far, has been on the prevention of preventable injures that may occur, for example, during passing with the use of engineering controls2 such as retractable safety scalpels or retractable shield scalpels. These mechanisms are an attempt to control the risk that a sharp-tipped scalpel blade poses.
It is estimated that 95% of surgeons continue to use conventional scalpels as surgeons prefer the weight and feel of a conventional metal handle and argue that the active parts of many safety scalpels on the market today, create additional risks. Therefore a very high percentage of risk remains without an acceptable solution.
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REFERENCES: 1Hector Fuentes , James Collier , Michael Sinnott , and Michael Whitby “Scalpel safety”: Modeling the effectiveness of different safety devices’ ability to reduce scalpel blade injuries. International Journal of Risk & Safety in Medicine 20 (2008) 83–89. DOI 10.3233/JRS-2008-0428. IOS Press.
2Engineering controls are defined in OSHA’s Bloodborne Pathogens standard as controls that isolate or remove the bloodborne pathogens hazard from the workplace [29 CFR 1910.1030(b)]. The standard states “Engineering and work practice controls shall be used to eliminate or minimize employee exposure” [29 CFR 1910.1030(d)(2)(i)]. This means that if an effective and clinically appropriate safety-engineered sharp exists, an employer must evaluate and implement it. However, if using a safer device compromises either patient safety or medical integrity its use would not be required. |
