What is the difference between Engineering Controls, Sharps with Engineered Sharps Injury Protections and Work Practice Controls?
16 April, 2012

...A combination of the three, Engineering Controls, Sharps with Engineered Sharps Injury and Work Practice Controls/Safe Systems of Work combined with Training, will provide the maximum protection against the risk of scalpel blade injuries. In order to design an optimum Sharps Injury Prevention programme it is important to understand the difference between the three terms so as to identify sharps injury prevention solutions.

US OSHA's Bloodborne Pathogens standards - 29CFR defines them as :

Engineering Controls means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or remove the bloodborne pathogens hazard from the workplace. 

Sharps with Engineered Sharps Injury Protections means a nonneedle sharp or a needle device used for withdrawing body fluids, accessing a vein or artery, or administering medications or other fluids, with a built-in safety feature or mechanism that effectively reduces the risk of an exposure incident.

Work Practice Controls means controls that reduce the likelihood of exposure by altering the manner in which a task is performed (e.g., prohibiting recapping of needles by a two-handed technique). Or as the Europeans define it- Safe Systems of Work - specifying and implementing safe procedures for using and disposing of sharp medical instruments and contaminated waste.  These procedures shall be regularly reassessed and shall form an integral part of the measures for the information and training of workers.

Since 2001 the revised OSHA Bloodborne Pathogen includes Sharps with engineered sharps Injury protections as part of Engineering Controls, but it is important to know the difference in order to design an optimum Sharps Injury Prevention programme and to identify the risks, and therefore the opportunities, for sharps injury prevention.  This is especially true from a European standpoint where the distinctions are not as clearly made.

Examples of Engineering Controls relating to prevention of scalpel blade injuries would include the use of sharps disposal containers ( yes, scalpels with engineered sharps injury protections should also be disposed off in sharps disposal container) and the use of ultrasonic cleaners for cleaning reusable scalpel handles.

Examples of Sharps with Engineered Sharps Injury Protections are Round-tip scalpel blades, reusable scalpel handles that allow touch-free removal of blade as well as disposable scalpels with retractable blades or protective guards. Please see SAFhandleTM Safety Scalpel Product Evaluation Form

Examples of Work Practice Controls/Safe Systems of Work would be- not recapping the plastic guard of a disposable scalpel or storing or reprocessing reusable scalpel handles in a manner that does not require the employee to reach by hand into containers. Studies have shown that no-hands-pass work practice control procedure  incorporating the use of a passing tray or neutral zone have been very effective in reducing sharps injuires.

A combination of the three, Engineering Controls, Sharps with Engineered Sharps Injury and Work Practice Controls/Safe Systems of Work combined with Training, will provide the maximum protection against the risk of scalpel blade injuries.



Sharps Injury Data- The problem with
currently available safety scalpels
14 November, 2011

A recent study published by the American College of Surgeons titled, ‘Increase in Sharps Injuries in Sur gical Settings Versus Nonsurgical Settings After Passage of National Needlestick Legislation’ reported the following data relating to sharps injuries:

...scalpel blade injuries cannot be prevented by safety scalpels currently available on the market, because these scalpels are loaded with a sharp-tipped blade.’ Of the top three devices that cause sharps injuries, suture needles, scalpels, and disposable syringes , the majority of injuries occur near the beginning of the use-disposal cycle—that is, during use, while passing the device, or between steps of a multi- step procedure. Injuries during these early phases accounted for 83.5% of suture needle injuries, 69.8% of scalpel blade injuries, and 51.9% of injuries from disposable syringes.

These findings are significant because they reveal that scalpel blade injuries cannot be prevented by safety scalpels currently available on the market, because these scalpels are loaded with a sharp-tipped blade.

The focus, so far, has been on the prevention of preventable injures that may occur, for example, during passing with the use of engineering controls such as retractable safety scalpels or retractable shield scalpels. These mechanisms are an attempt to control the risk that a sharp-tipped scalpel blade poses.



Scalpel Injury Prevention Guidance
ENGINEERING CONTROLS- ROUND TIP SCALPEL BLADES AS A SOLUTION FOR PREVENTING SHARPS INJURIES.
08 November, 2011

The use of engineering controls is an integral part of any Exposure Control Plan.

Blunt-tip suture needles have been identified by OSHA as an example of an engineering control to reduce percutaneous injuries.

CDC has identified round tip scalpel blades as an example of an engineering control to reduce percutaneous injuries. OSHA, NIOSH, and CDC have jointly released a safety and health information bulletin
“Use of Blunt-Tip Suture Needles to Decrease Percutaneous Injuires to Surgical Personnel” presenting evidence of the effectiveness of blunt-tip in decreasing percutaneous injuires and strongly encourage the use of blunt tip suture needles.

Scalpel blades: The CDC and the AORN in their workbook and guidance statement have identified round-tip scalpel blades as an example of an engineering control to reduce percutaneous injuries. The Exposure Prevention and Information Network (EPINET) of the University of Virginia’s International Healthcare Worker Safety Center, in its Checklist for Sharps Injury Prevention asks, “Are scalpel blades with safety features used such as round-tipped scalpel blades…?”



Scalpel Injury Prevention Guidance
Recommended Practices for Cleaning and Care of Surgical Instruments and Powered
06 November, 2011

As per AORN’s “Recommended Practices for Cleaning and Care of Surgical Instruments and Powered Equipment,” reusable metal scalpel handles should be considered sharp. Considering a reusable scalpel handle to be sharp minimizes the risk of injury, if a blade has been left on the handle. Visually check that the blade has not been left on the handle.

Reusable metal scalpel handles should be considered sharp. Visually check that the blade has not been left on the handle. OSHA’s BBP standard requires that where engineering and work practice controls will reduce employee exposure either by removing, eliminating or isolating the hazard, they must be used. This would include the use of ultrasonic cleaners and washer-disinfector as a form of engineering control.

Work practice controls require reusable sharp to be segregated from other instruments and placed in a separate puncture proof container for transportation until properly reprocessed. AORN recommends establishing a separate area to place a reusable sharp for safe handling during the procedure. CDC and OSHA also recommend the use of long-handled brushes (to keep the hand as far away as possible from sharp instruments) for cleaning reusable sharps, to reduce the potential for employee exposure to blood or other potentially infectious materials.

Employees should wear personal protective equipment according to regulations. Employees should not reach into trays, containers or sinks holding sharp instruments that cannot be seen.