“Scalpel safety”: Modeling the effectiveness of different safety devices’ ability to reduce scalpel blade injuries

Background: The objective of this study was to analyse and compare the potential effectiveness of two safety strategies in reducing scalpel blade injuries. The two strategies examined were safety scalpel vs. a single-handed scalpel blade remover combined with a hands free passing technique (HFPT) (e.g. passing tray or neutral zone). Methods: This was a retrospective study involving review of a 550-bed adult metropolitan tertiary referral hospital’s sharps injuries database, chart review, and hypothetical modelling of the data to determine potential preventable injuries. The modelling was done twice, firstly assuming 100% effectiveness of each safety device and secondly using previously published activation rates for “active” safety devices which were considered to be a more accurate reflection of real-life work practices. Results: A total of 141 scalpel injuries were reported between 1987 and 2003. Clinical charts were reviewed for 137 of these injuries. Just under 50% of injuries were sustained while the scalpel was in use and these were assumed to be not preventable. Assuming 100% effectiveness for each safety device resulted in 72 injuries being prevented by safety scalpels and 69 injuries being prevented by a combination of a single-handed scalpel blade remover and an HFPT. When injury prevention was calculated using published data on activation rates for “active” safety devices, the number fell to as low as 12 for safety scalpel and to 61 for the combination of a single-handed scalpel blade remover and an HFPT. Conclusion: Both safety strategies are potentially effective in reducing scalpel blade injuries. However the safety scalpels are active devices and as such are subject to widely variable activation rates. We recommend use of a single-handed scalpel blade remover in combination with an HFPT as this can potentially prevent 5 times as many injuries as safety scalpels.