212 - Designing Neutral Zone Guidelines and Implementation Plan to Increase Sharp Safety

Description: Clinical Problem/Significance and background

Sharps injuries among clinicians remain a persistent issue, despite the presence of national clinical standards and safety protocols. These incidents not only pose serious health risks due to potential exposure to bloodborne pathogens but also result in operational disruptions, including staff reassignment, occupational health reporting, and the financial burden of testing both patients and clinicians. To address this ongoing concern, a change in clinical practice is necessary. This project aims to implement and evaluate a hospital-approved guideline that includes staff education and the adoption of the neutral zone technique. The goal is to assess its effectiveness in reducing the frequency of sharps-related injuries.

Clinical Question

Can a hospital approved guideline, evidence based education plan, and the implementation of a neutral zone technique reduce sharps injuries among clinical staff and surgeons?

Description of Evidenced-Based Protocol

This protocol uses PDSA methodology and is grounded in recommendations from the American College of Surgeons (ACS), The Joint Commission (TJC), Association of Peri-Operative Registered Nurses (AORN) and the Occupational Safety and Health Administration (OSHA) regarding sharps safety. It outlines a standardized approach for implementing the neutral zone technique during General Operating Room surgical interventions at two campuses at the University of Maryland Medical Center. Key components include: (1) the implementation of a hospital approved guideline (2) identification and designation of a neutral zone on the sterile field; (3) staff education on the rationale, benefits, and correct use of the technique; and (4) ongoing monitoring and documentation of injury rates. The protocol was developed in collaboration with perioperative leadership and frontline staff to ensure feasibility and alignment with institutional safety goals.

Implementation of Evidenced-Based Protocol

We collected and organized baseline data on sharps injuries, using data sourced by our employee health office; then developed a tracking system to trend. Our organization has revised the data plan and is now using UMMSafe (Internal online reporting system) to enter sharp injury incidences. Education will help to encourage injured staff to get treatment and for staff to enter record of injuries.

A multidisciplinary team reviewed sharp injuries as a persistent safety concern. The evidence-based intervention included a two-week pilot of neutral zone products at both campuses in all OR cases. The first week was the use of a commercially available disposable mat. The second week was use of a commercially available disposable hands free transfer tray.

Perioperative Nursing Implications

Nurses have a critical role in maintain a high standard of patient and staff safety, ensuring guideline compliance and documentation. Clinical nurse educators are responsible for developing and implementing an education plan in using the neutral zone, including use guidance, reinforcing compliance and building this new practice as part of the clinical norm.