A Twitter follower wrote me this: "hospital making me use 'safety scalpel' w/retractable sheath. I've almost cut myself x 2. Do you know of any data about it?"
That got me interested because I like to question things. Was this going to be yet another rule without evidence?
I thought I would have to do an exhaustive search to see if anyone had ever studied the question of whether so-called 'safety scalpels' really are safer than standard scalpels.
I was pleasantly surprised to find a 2013 paper in the Canadian Journal of Surgery which reviewed the literature on the subject. The authors, from the University of British Columbia, found no studies that addressed harm reduction and the use of safety scalpels. A previous paper from Australia in 2009 also found no randomized trials of safety scalpel use.
In their discussion, the authors point out that the introduction of safety scalpels might have the opposite effect on safety due to factors such as personnel not being familiar with how they work and that safety scalpels have never been subjected to rigorous evaluation by failure mode and effects analysis. And they noted that injuries related to the use of safety scalpels have been reported.
Since there is no proof that safety scalpels are effective in reducing injuries, there seems to be no rationale for regulatory agencies or hospitals to mandate their use.
The paper noted that at least 24 different safety scalpels have been developed and approved for use in the United States. An Internet search confirmed that there are at least that many types of safety scalpels on the market.
I attempted to find a specific mandate about scalpels in the Needlestick Safety and Prevention Act of 2001 but was unable to do so. If the act says anything about scalpels, perhaps someone could let me know.
Among the issues with safety scalpels are that surgeons complain that they do not have the correct feel, quality or precision of standard scalpels.
The use of devices that allow for safer removal and replacement of scalpel blades may be a better alternative than using safety scalpels.
In 2011, the magazine Outpatient Surgery and the International Sharps Injury Prevention Society surveyed 186 operating room clinicians and found that 60% of respondents were not using safety scalpels at their hospitals. OSHA is not fining many institutions since 95% of those who answered said they had never been fined.
Meanwhile, safety scalpel use is far less than expected. The use of safety scalpels appears to have been based on an unwarranted assumption that safety scalpels are safer.
It is certainly possible that safety scalpels do reduce the incidence of injuries, but it is equally possible that the rate of injuries in the same or even worse with the use of safety scalpels.
As a byproduct of their investigation, the authors mention that the use of hands free passing techniques for sharps, double-gloving and avoidance of using hands as retractors have been shown to be effective in reducing sharps-related injuries.
But not safety scalpels. So why are they being used at all?