title: Use of safety scalpels and other safety practices to reduce sharps injury in the operating room: what is the evidence?
abstract: BACKGROUND
  The occupational hazard associated with percutaneous injury in the operating room (OR) has encouraged harm reduction through behaviour change and the use of safety-engineered surgical sharps. Some Canadian regulatory agencies have mandated the use of "safety scalpels." Our primary objective was to determine whether safety scalpels reduce the risk of percutaneous injury in the OR, while a secondary objective was to evaluate risk reduction associated with other safety practices.
  
  
  METHODS
  We used evidence review methods described by the International Liaison Committee on Resuscitation and conducted a systematic, English-language search of Ovid, MEDLINE and EMBASE using the following search terms: "safety-engineered scalpel," "mistake proofing device," "retractable/removable blade/scalpel," "pass tray," "hands free passing," "neutral zone," "sharpless surgery," "double/cutproof gloving" and "blunt suture needles." Included articles were scored according to level of evidence; quality; and whether they were supportive, opposed or neutral to the study question(s).
  
  
  RESULTS
  Of 72 included citations, none was supportive of the use of safety scalpels. There was high-level/quality evidence (Cochrane reviews) in support of risk reduction through double-gloving and use of blunt suture needles, with additional evidence supporting a pass tray/neutral zone for sharps handling (4 of 5 articles supportive) and use of suturing adjuncts (1 article supportive).
  
  
  CONCLUSIONS
  There is insufficient evidence to support regulated use of safety scalpels. Injury-reduction strategies should emphasize proven methods, including double-gloving, blunt suture needles and use of hands-free sharps transfer.
authors.affiliation: Department of Surgery, University of British Columbia, Vancouver, BC.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: DeGirolamo
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Courtemanche
authors.forename: Warren D
authors.initials: WD
authors.lastname: Hill
authors.forename: Angie
authors.initials: A
authors.lastname: Kennedy
authors.forename: Erik D
authors.initials: ED
authors.lastname: Skarsgard
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control*; D004867:Equipment Design; D005932:Gloves, Surgical; D006801:Humans; D009339:Needles; D016602:Needlestick Injuries / Q000517:prevention & control*; D009873:Operating Rooms; D011482:Protective Devices; D040242:Risk Reduction Behavior; D013525:Surgical Instruments