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| The Surgical Technologist | SEPTEMBER 2015 402 standard conventional scalpels rather than adopting the use of safety scalpels. A 2005 estimate indicated that fewer than 5% of reusable scalpels were safety scalpels. A 2010 estimate indicated that fewer than 15% of the acute-care market had converted to the use of safety devices. 1 In a survey conducted in 2011, 60% of respondents reported that safety scalpels were not being used at their facility. 1 Scalpel injuries, although less common than needlestick injuries, present a serious risk to surgical technologists, surgical assistants, nurses and surgeons in the OR and in other departments in the hospital. 2 The OR department is one of close collaboration where individuals work under intense pressure, continually in the presence of sharp instru- ments and potentially infectious blood and bodily fluids. Scalpel injuries are typically more severe than a needle- stick injury. In both cases, there is the concern about sero- conversion to HIV, hepatitis B or hepatitis C, but with scalpel injuries, concerns about damage to workers’ con- nective tissue, including tendons, rises. Most scalpel inju- ries occur during either assembly or disassembly, transfer between personnel, use of the scalpel or disposal of the scalpel. 3 The largest proportion of scalpel injuries occurred “between steps of a multi-step procedure.” Most often this occurs during the passing of the scalpel between steps. The hectic pace in the operating room puts everyone at risk for needlestick injuries and scalpel injuries due to the prolonged exposure to open surgical sites and the frequent handling of sharp instruments. 4 Scalpel injuries represent an estimated 7% to 8% of all sharps injuries. They are different and more dramatic, however, than needlestick injuries, and can cause life- changing and life-threatening injuries. The rate of inci- dence of sharps injuries for scalpels is much higher than for needlesticks. Eisenstein and Smith reported that 3.2 syringe and needle injuries occurred for every 100,000 devices used. However, there were 662 incidences of sharps injury for every 100,000 scalpels used. Therefore, the dangers of using conventional scalpels is more than 200 times that of conventional needles. 2 The 2003 EPINet analysis indicates that scalpel blades were more likely than needles to be involved in deep or oth- erwise severe injuries. 5 A breakdown of scalpel and needle injuries revealed that 58% of scalpel injuries were classified as moderate (ie, surface cut, some bleeding) and 11% as severe (ie, deep cut, profuse bleeding), compared with 39% and 2%, respectively, for suture needles. Wound severity also correlates directly with a higher risk of mutual infectious fluid transmission between the healthcare worker and the patient because deep wounds produce a larger quantity of blood and exposed tissues than shallow ones. In most cases, surgeons and surgical residents were the original users of devices causing their injuries (81.9% and 67.3% of injuries, respectively). Conversely, nurses and surgical technologists were most often injured by devices originally used by others (77.2% and 85.1% of injuries, respectively). Most injuries to surgeons (71%) and surgi- cal residents (66%) occurred during the use of the device. By contrast, injuries to nurses (75.3%) and surgical technologists (73.4%) occurred when passing or dissembling devices, either during or after their disposal. Regardless the origin of the injury, scalpels are a major threat to healthcare workers. 6 E C O N O M I C B U R D E N O F S C A L P E L I N J U R I E S In one study, Hatcher describes that a single sharps injury without infection costs healthcare facilities anywhere from $2,234 to $3,832. 7,8 In the case of a transferred blood-borne disease after a sharps injury, the overall long-term financial cost is calculated to be as high as $1.1 million. 9 In another study, it was estimated that the cost of non- infecting sharps exposure to a staff member runs between $500 (low risk) to $3000 (high risk) 10 to pay for reporting, medical testing, precautionary antiviral drug treatment and lost work hours. In yet another study, the direct cost of man- aging a sharps injury (estimated in 2003) had increased to $4,800 per injury. 11 The average direct costs, including labo- ratory costs for tests of both patients and exposed employ- ees, labor costs associated with testing and counseling and the costs of post-exposure prophylaxis, were estimated to be Scalpel injuries represent an estimated 7% to 8%of all sharps injuries. They are different and more dramat- ic, however, than needlestick injuries, and can cause lifechanging and life-threatening injuries.