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?”
I got interested because I like to question things. I wondered, “Is this yet another rule without foundation?”
I thought I would have to do an exhaustive search to find any studies on whether so-called safety scalpels (scalpels with retractable or otherwise protected blades) really are safer than standard scalpels.
To my surprise, a 2013 paper in the Canadian Journal of Surgery reviewed the literature on the subject. The authors, from the University of British Columbia, found no studies that addressed the use of safety scalpels and harm reduction.
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 safety scalpels work and that they have never been subjected to rigorous evaluation by failure mode and effects analysis. And injuries related to the use of safety scalpels have been reported.
In his book Normal Accidents, Yale sociology professor Charles Perrow mentioned a concept called “risk homeostasis,” which says that instituting safety measures may lead to people becoming overconfident and taking risks in other ways. For example, some skiers and bicyclists wearing helmets may take more chances, and serious injuries in these sports have not decreased.
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.
Surgeons complain that safety scalpels do not have the correct feel, quality, or precision of standard scalpels.
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.
As a byproduct of their investigation, the Canadian authors found 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. Devices that allow for safer removal and replacement of scalpel blades may also be of value.
I attempted to find a specific directive 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.
Safety scalpel use is far less than expected. 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 apparently not fining many institutions since 95% of those who answered said they had never been fined.
The use of safety scalpels appears to have been based on an unwarranted assumption that safety scalpels are safer.
It is 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 than with standard scalpel use.
So, to paraphrase Rod Tidwell, show me the evidence.
Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel. His blog averages 1400 page views per day, and he has over 9100 followers on Twitter.