The scalpel is a small, exceptionally sharp surgical instrument used to make precise incisions during an operation. While necessary in the operating room (OR), its design makes it a source of percutaneous injury, exposing healthcare workers to bloodborne pathogens like Hepatitis B, Hepatitis C, and HIV. Scalpel injuries are high-risk, often resulting in deep lacerations. Up to 15% of OR-related sharps injuries involve scalpels, mostly occurring during handling or passing, making strict safety protocols for transfer necessary.
Fundamental Principles of Sharps Safety
The first layer of defense against accidental injury is “sharps awareness,” a universal mindset governing all handling of bladed instruments. This protocol requires clear, verbal communication, ensuring the receiver is ready for the transfer. The person handling the sharp must announce the action, often using a phrase like, “Passing scalpel.” During any transfer, the blade must be kept visible and oriented away from the hands of both the giver and the receiver, minimizing accidental contact.
Once a blade has been used, a strict rule prohibits manually re-capping or manipulating the used scalpel blade with two hands, as this is a frequent cause of injury. Instead, specialized engineering controls, such as single-handed scalpel blade removers, are used to safely detach and contain the used blade.
The Traditional Hand-to-Hand Method
The traditional method for transferring a scalpel involves the direct manual exchange between the scrub person and the surgeon. The scrub person presents the scalpel by the handle, ensuring the blade is oriented away from the surgeon’s hand. The surgeon grasps the handle firmly before the scrub person releases their grip. This technique requires coordination to avoid the simultaneous movement of both hands on the instrument, known as “two-handed passing.”
Despite its tradition, this direct exchange is a major contributor to sharps-related injuries; some data suggests more than 50% of scalpel blade injuries occur during this passing process. Because of this elevated risk, modern surgical safety standards discourage the hand-to-hand pass in favor of techniques that eliminate direct manual contact between personnel.
The Safer Alternative Neutral Zone
The Neutral Zone (NZ) technique, also known as the hands-free technique (HFT), is the current best practice for transferring sharps in the operating room. The NZ is a small, predetermined area on the sterile field where sharp instruments are placed and retrieved without direct hand-to-hand contact.
The designated zone is typically a specialized transfer device, such as a magnetic mat or a small puncture-resistant tray. The entire surgical team must agree upon the exact location of the NZ before the procedure begins, often during the pre-operative briefing or Time Out. A strict protocol allows only a single sharp instrument in the zone at any moment.
When the scrub person is ready to pass the scalpel, they place it safely within the NZ and issue a mandatory verbal announcement, such as, “Scalpel is in the zone.” The surgeon then retrieves the instrument. The process is reversed when the surgeon is finished, placing the sharp back in the NZ and announcing, “Scalpel is in the zone,” for the scrub person to retrieve. Studies show that implementing the hands-free technique can dramatically reduce sharps injury rates, sometimes by close to 60%.