title: Cast-saw injuries: assessing blade-to-skin contact during cast removal. Does experience or education matter?
abstract: BACKGROUND
  Cast-saw injuries are sustained during cast removal or splitting of a cast when a hot cast-saw blade touches the patient's skin inadvertently during cast removal. Other studies have evaluated risk factors associated with saw-blade temperature, however, none have documented the number and duration of blade-to-skin contacts during cast removal.
  
  
  METHODS
  Using a pediatric long-arm model capable of detecting cast-saw blade contact, we tested the ability of health care providers to apply and remove casts before and after a brief education module. The total number and duration of "touches" between the saw and the model's "skin" were recorded. Correlations between user "touches," and experience and comparisons between pre- and post-education "touches" were performed.
  
  
  RESULTS
  Of the 18 study participants, 16 touched the model surface with the cast saw; 7 of the 18 participants maintained blade contact with the skin for > 1 second 22 times during the testing process. Participants with less experience averaged 20 (± 16) touches, whereas more experienced participants averaged 24 (± 19) touches (P = 0.7). Average number of touches was similar-before 22 (± 20) and after 25 (± 22); P = 0.5-participants completed an education module. No correlation between experience or participation in the education program was found with decreased number of blade-to-skin touches.
  
  
  CONCLUSIONS
  Nearly all clinicians inadvertently contacted the underlying skin with the cast-saw blade. In our limited sample size, experience and education did not prevent this; therefore, minimizing time of contact and blade temperature may be more important factors in minimizing cast-saw injuries.
authors.affiliation: Department of Surgery, University of Wisconsin-Madison, Madison, WI.
authors.forename: Kirstin C
authors.initials: KC
authors.lastname: Monroe
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Sund
authors.forename: Blaise A
authors.initials: BA
authors.lastname: Nemeth
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Noonan
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Halanski
mesh_terms: D000328:Adult; D001132:Arm / Q000033:anatomy & histology; D002370:Casts, Surgical; D002648:Child; D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D008297:Male; D008953:Models, Anatomic; D061214:Patient Safety; D011361:Professional Competence; D015203:Reproducibility of Results; D012867:Skin / Q000293:injuries*