Ask the expert: Do we have to use safety scalpels?

OSHA Healthcare Connection, August 14, 2012

Q: I'm a safety office at a urologic institute and I am conducting my sharps review for this year. Does our practice have to use safety scalpels? The safety scalpels are quite costly and some brands seem more dangerous to activate the safety features then to just use a regular blade. Also, it is my understanding that it is not common for hospitals to use safety scalpels, so I am wondering what the law states for private practices of about 100 employees?

A: OSHA recognizes that no one medical device is appropriate for use in all circumstances and that it is important to safeguard both patients and employees during medical and surgical procedures. If the use of a particular engineering control, such as a safety scalpel, compromises patient safety, its use would not be considered feasible.

However, the employer must determine what engineering and work practice controls effectively minimize hazards without unduly interfering with medical procedures. Each employer must determine where and when bloodborne pathogen exposures can occur. They must also have evaluated on a frequent basis what engineering controls are available and feasible. These evaluations must be documented in the Exposure Control Plan, which must be updated on, at least, an annual basis.

Failure to be compliant with these regulations can be very expensive. A willful or repeated violation may result in a penalty of up to $70,000. There is a minimum penalty of $5,000 for willful violations. Serious violations can be fined a penalty of up to $7,000. If an employer fails to correct the violation set forth in a citation, the employer may be assessed a penalty of up to $7,000 for each day during which the violation continues.

As I have reviewed available safety scalpels and compared them to the complaints from surgeons and other clinicians, I believe there are some times when a safety scalpel would not be appropriate because it compromises patient safety. For example, if the surgeon is making a deep incision and the safety scalpel's shield blocks the surgeon's view of the tip of the scalpel, this would be compromising the patient's safety. Medical institutions should document this challenge and why they have chosen not to use a safety scalpel for this procedure. The institution should then outline the appropriate engineering controls that would be used to help protect healthcare workers during this type of procedure including the use of a neutral zone. The decision to use a conventional scalpel in a particular procedure does not give the institution carte blanche to use conventional scalpels in all procedures.

Ron Stoker
Executive Director
International Sharps Injury Prevention Society

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