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404 | The Surgical Technologist | APRIL 2015 safety scalpel feature should be intuitive and not require the repositioning of the scalpel within the surgeon’s hand. 15 In addition, the surgeon should be able to easily activate the safety feature without looking at the scalpel. The rapid and safe activation of the safety feature during passing in the neutral zone would make many of the injuries during surgi- cal steps most likely preventable. There are a number of entrenched objections to the use of safety scalpels. Some clinicians argue that safety scal- pels feel too light (even though light electrocautery pens are commonly used), don’t fit in their hands well and feel clumsy to use. Others note that retractable shields and other safety mechanisms often obstruct the view of the blade dur- ing use and make the safety scalpel unsuitable for deeper incisions. 16 Other surgeons have indicated that some safety scalpel blades cut poorly or wear out quickly. The first-gen- eration safety scalpels were of poorer designs and resulted in many objections, whereas some of the newer ones incorpo- rate some of the features that make them more desirable – or less objectionable – to surgeons. Another frequent objection is the fact that safety scal- pels are active devices, meaning that a clinician has to consciously activate the products’ safety features. Unlike some passive blood collection devices, whose spring-loaded mechanisms simply require needle insertion to automati- cally activate the retracting feature, safety scalpels require the proactive retracting or shielding of the blade between uses. This adds steps to a surgical procedure, and some sur- geons even fear injuries may accidentally occur while these steps are being taken. Some surgeons have complained that some safety scalpels require both hands to activate the safety SEPTEMBER 2015 feature, which places the hands in jeopardy of being cut by the scalpel during the activation process. 17 Despite these objections, a small but definite minority of surgeons seems to have no problem using the more user-friendly versions of safety scalpels. R E A L C OS T S OF US I NG S A F E T Y S C A L P E L S A ND C ON V EN T I ON A L S C A L P E L S One of the most common objections concerning why an institution or surgeon does not use a safety scalpel is the cost of the safety scalpel. OSHA answers this question in an interpretation letter dated November 21, 2002, stating that “selecting a safer device based solely on the lowest cost is not appropriate. Selection must be based on employee feedback and device effectiveness. OSHA compliance offi- cers have issued citations to employers that have facilities that were not using effective engineering controls because of the product availability limits of their purchasing con- tracts.” 18 If during an OSHA inspection it is determined that an employer did not evaluate and select appropriate and effective devices, the employer may be cited. Since many health institutions are using costs to deter- mine whether they use safety scalpels, it may be instructive to take an in-depth look at the costs of scalpel injuries: • Costs of baseline and follow-up laboratory testing of healthcare worker and testing of the source patient • Cost of diagnostic testing • Cost of post-exposure prophylaxis and other treatment that might need to be provided • Cost of treatment (stitches, microsurgery, etc) • Cost of lost time in a procedure • Cost of reprocessing scalpel handles • Cost of replacement staff • Workers’ compensation claims • Time spent investigating and reporting • Increase in a facility’s insurance premium • Increase in liability reserves • Attorney’s fees • Cost of a settlement • Cost of unreported injuries (51%-90%) In certain circumstances, other direct costs may need to be considered. For example, if occupational exposures are managed through a contract with another provider, there may be a fee for each patient visit. To come up with a true economic cost for the non-use of safety scalpels, we used data cited in the previous portion of this paper in the following calculations: According to an OSHA Interpretation Letter, 13 the revised OSHA bloodborne pathogen standard requires employ- ers to evaluate safer medical devices to eliminate or minimize employee expo- sure to blood or other potentially infec- tiousmaterials (OPIM).