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Surgery. 2010 Jan;147(1):98-106. doi: 10.1016/j.surg.2009.08.001. Epub 2009 Oct 13.

Scalpel safety in the operative setting: a systematic review.

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Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, Australia.



The complex environment of the operative setting provides multiple opportunities for health care workers to sustain scalpel injuries; scalpels are the second most frequent source of sharps injuries in this setting. Little evidence has been published detailing the effectiveness of proposed safety procedures and devices.


A systematic search strategy was used to identify relevant studies. Studies were included based on the application of a predetermined protocol, an independent assessment by 2 reviewers, and a consensus decision. Nineteen articles formed the evidence base for this review.


Little high-level evidence was available. The results of studies reporting on 5 different devices/procedures were identified: the use of cut-resistant gloves/liners decreased the number of glove perforations in comparison with double latex gloves alone but lessened the wearer's dexterity and tactile sensation; the benefit derived from the use of the hands-free passing technique seemed equivocal; "sharpless surgery" was found to be feasible; a single-handed blade remover prevented at least as many injuries as a safety scalpel; and some shoe materials provided superior foot protection.


The lack of available evidence highlights the need for the generation of a methodologically rigorous, clinically relevant, and statistically valid body of primary research in this area to support appropriate and effective safety interventions.

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