Hygiene Relating to Surgical Scalpel Blades


“The operating room is clearly one of the most hazardous environments in the healthcare delivery system”. By definition surgery is invasive. Instruments that are designed to penetrate patient’s tissue must be sterile and can just as easily injure the provider. Blood is everywhere, speed is essential and emergencies can occur at any time and interrupt routines and protocols. Preventing exposure and injuries under these circumstances is indeed challenging!

In the past decade, awareness of the risk of exposure to blood and body fluids containing HIV,HBV,HCV and more recently SARS and Bird Flu have created a new era in surgical infection prevention practices. Just as patients must be protected from wound contamination and infections, so must providers be protected from intraoperative injuries and exposure to patient’s blood and other body fluids. South Africa like many other countries around the world have strict Occupational and Safety Acts in place that can make the employer or employee liable which includes infection by a HBA (Hazardous Biological Agent) e.g. HIV, HBV etc. where no adequate precautions have been deemed to take place.

We should not consider the cost of safety but rather the cost of not creating a safe and hygienic environment.

Specific techniques required to maintain surgical asepsis and a surgical safe environment include the following:

  • Patient considerations: skin cleaning pre-operatively, skin antisepsis and wound covering with sterile drapes

  • Surgical Staff considerations: hand hygiene, use of and removal of gloves, dropping of new sterile scalpel blade into a sterile area (avoid sharp edges which can blunt the blade) without contaminating the sterile area or the surgical blade. (Use a second person to open the foil around the sterile blade and to drop the  blade into the sterile area without contaminating the blade)

  • Equipment and room preparation and considerations: traffic flow and good housekeeping practices, cleaning and sterility of instruments including scalpel handle, gloves and other items

  • Environmental considerations: maintain a aseptic operating area, easy access to sharp’s disposal bin’s

  • Safety: Attaching the surgical blade to the handle – maintain the integrity of the blade and if you sustain an injury dispose of the blade and call for a new blade to protect the patient, removing a surgical blade from the handle – avoid an injury when removing a contaminated blade by using a blade remover tool (avoid a forceps as this may cause the blade to break or shoot into the air), create a safety zone when passing the scalpel so two people never touch the scalpel at the same time, when not in use scalpels should be visible and not in the immediate work area, scalpels should never be used with significant force which could cause the blade to slip and cause a injury, never use a blade to point to things of interest, only one scalpel blade to be used at any one time, a used blade must be dropped not pushed into a sharp’s container, safety awareness is a priority!


When do sharp’s injuries occur?

  • Putting on or taking off the disposable scalpel blade

  • Passing the scalpel between team members

  • Cutting (e.g., in using fingers to hold or spread tissue or cutting toward the fingers of the surgeon or assistant

  • Before and after using the scalpel: leaving it on the operating table, dropping it on your own or assistant’s foot, reaching to catch scalpels sliding off the drapes, poor disposal of blades ending up in the drapes or on the floor

  • Disposing of scalpel blade into an over-filled container or a poorly located container


Prevention:

  • Implement known hygiene and safety protocols

  • Ensure proper sterilisation of scalpel handle and other surgical items

  • Staff training

  • Do not re-use surgical scalpel blades or disposable scalpels

  • Avoid rotating staff – stick to a team

  • Use single use safety scalpels that are easy to use, blade is only exposed when in use and where the blade can be locked away permanently for safe disposal

  • Doctor’s rooms, paramedics and emergency care givers in the field are especially at risk as the infrastructure and environment is not as well geared towards best practice hygiene and safety protocols as is found in an operating theatre environment. These professionals will be best advised to review their protocols and to make use of single use safety scalpels that reduce their contact with and exposure to the surgical blade so as to ensure sterility and the safety of themselves and the patient.



by:

Trevor Milton