This article is a free, publicly accessible excerpt from ECRI's member-access
Evaluation Background: Scalpel Blade Removers. For membership inquiries, contact
clientservices@ecri.org.
Scalpel blade removers facilitate the safe removal of scalpel blades from reusable scalpel handles after use or during blade exchanges (e.g., during a sterile procedure).
Major components of a typical scalpel blade remover include:
1. A blade removal method that does not require the operator to come into contact with the blade. The removal mechanism typically bends up the blade's base to force it to slide out of its secure slit on the handle.
2. In many models, some form of blade containment. Either the device itself serves as a waste disposal unit or the device allows the operator to grip the blade such that it can be disposed of into a sharps container without coming into contact with the user.
Scalpel blade removers can be categorized as follows:
1. Nonsterile:
a) One-handed (passive) devices—Essentially a mounted sharps container with a removal mechanism that allows quick, one-handed blade removal. The user inserts the blade into the device, the mechanism removes the blade, and the user withdraws the handle from the device. Typically capable of storing 100 to 200 blades for disposal.
b) Two-handed (active/manual) devices—Possibly the most commonly available type, these blade removers consist of a small box into which users insert a scalpel. The user then presses a button on the area covering the blade (or otherwise maneuvers the handle so that the blade is trapped) and pulls the handle out, leaving the blade contained in the box. Typically capable of storing 100 blades for disposal.
Note: Healthcare workers who use nonsterile blade removers (nurse practitioners, physician assistants, and other nonsurgical staff) often do not regularly perform scalpel blade removal. For these staff, fully disposable scalpels (e.g., safety scalpels) may be a safer alternative. For more information on safety scalpels, including our product ratings, see
Safety Scalpels: Evaluation Background.
2. Sterile:
a) Disposable "one-handed" devices—Intended for use during surgery for intraoperative blade changes or in care areas where a larger containment unit is not necessary (e.g., in an ICU, where scalpels may be used to remove tracheotomy sutures). These devices can typically contain one to three blades in a chamber that is clear to aid in postprocedural sharps counts. While a user can often insert the blade and handle into the device one-handed, a second hand may be required to brace the device to remove the handle and contain the blade.
b) Disposable two-handed devices—Similar to the above but require two hands to insert the handle and then remove and contain the blade.
3. Sterilizable metallic devices—Reusable hemostat-like, pliers-like, or other metallic devices specifically designed for removing surgical blades and placing them in a separate sharps disposal container.
Dedicated scalpel blade removers have been available for decades, though they are not necessarily widely used. Without a dedicated removal device, clinicians tend to use hemostats to remove scalpel blades. However, hemostats are not designed or indicated for this purpose and leave the user exposed to risk of sharps injury.
Technological advances allow one-handed use, compatibility with a wider array of scalpel blade and handle sizes, sterile blade exchanges, and improved postprocedural counts (via a clear housing) and blade containment.
Facilities and clinical departments that use these products include:
1. Most surgical settings
2. Cardiac catheterization labs
3. Clinical pathology
4. Emergency medicine
5. Endoscopy
6. Gynecology
7. Labor and delivery
8. Otolaryngology
9. Podiatry
10. Urology
Typical users include surgeons, first assistants, circulating nurses, registered nurses, surgical technologists, coroners, forensic pathologists, doctors, and emergency technicians.
These products are referred to by a number of names. Common synonyms include sharps disposal units and blade removers.
ECRI has published Evaluation findings for the following products (member access only):
Other Currently Available Scalpel Blade Removers
The following products compete directly with one another and with the products listed above. Note that the listed and evaluated products are intended for medical use; several available products are indicated for research purposes only.
Anthony Products Inc. [451787]
- Scalpel Blade Remover (sterilizable metallic)
Aspen Surgical Products Inc. [378253]
- Bard-Parker Blade Remover (sterile, two-handed)
Delasco LLC [289891]
- Scalpel Blade Remover, Hemostat Type (sterilizable metallic)
Feather Safety Razor Co. [305463]
- Blade Pliers (sterilizable metallic)
- Blade Remover <S> (sterile, two-handed)
Helmut Zepf Medizintechnik GmbH [286094]
- Scalpel Blade Remover Klingex (sterilizable metallic)
Medesy srl [296810]
- Blade Remover (sterilizable metallic)
Technology Background
Principles of Operation
1. A scalpel blade remover is an engineered safety mechanism that removes a scalpel blade from a scalpel handle. Blade removal can be either passive (i.e., the mechanism removes and contains the blade itself automatically upon insertion) or active (i.e., the operator inserts the scalpel and, while pressing down on or otherwise engaging the remover with their other hand to trap the blade, pulls out the handle, leaving the blade behind).
2. The device is intended to prevent healthcare worker injury during blade removal and disposal after use or during blade exchange (i.e., during a sterile procedure).
Normal Operating Procedure
Scalpels may be used in nearly any care area, from the emergency department to operating rooms to forensic pathology; different care areas require different levels of sterility. How a scalpel blade remover is used may differ depending on whether it is sterile, nonsterile, or sterilizable.
Disposable Sterile Blade Removers
Typical use case: The device is placed on a Mayo stand and used to exchange blades during a procedure—for example, if a blade dulls after initial incision.
1. The operator passes the blade—using a hands-free technique or a neutral zone—to a clinician within the sterile field.
2. The clinician safely inserts the scalpel's blade end into the blade remover containment chamber and manipulates the system until it produces an audible mechanical click, indicating the blade has been disengaged and contained. The clinician then removes the bare handle from the device.
3. The clinician attaches a new blade, which can be removed after use the same way.
4. The containment unit may be disposed of in a sharps container after postprocedural counts.
Nonsterile Blade Removers
Typical use case: The device is located in patient care areas and is either wall- or bench-mounted (in the case of one-handed units) or freestanding/portable (two-handed units).
1. After using the scalpel, the clinician inserts the blade end into the remover per the IFU and manipulates the device until it disengages—often with a mechanical click—and contains the blade. The clinician then removes the scalpel handle from the device.
2. The remover is disposed of per facility removal policy when full.
Sterilizable Metallic Blade Removers
Typical use case: The device is placed on a Mayo stand and used during a procedure. It is used and sterilized as part of the surgical instrument kit.
These are generally pliers- or forceps-like devices used to disengage the scalpel blade and place the sharp into a designated waste container; they do not contain the blade.
Safety Concerns
1. Users must be aware that blade removers provide protection only if used correctly and only during blade exchange and/or disposal. They do not protect users from all possible events that may result in scalpel injury.
2. Scalpel injuries, whether mechanical injuries or structural damage to the hand, also expose the injured worker and the patient to risk of bloodborne infection.(1) Approximately 40% of patients undergoing surgery have a potentially transmissible, bloodborne illness.(2)
3. Costs associated with a single sharps injury (not including litigation) range from approximately $70 to $5,000, depending on the potential exposure risk. These costs can compound across an institution and result in annual national expenditures of over $65 million.(3)
4. Approximately 600,000 sharps-related injuries occur in hospitals each year. Data shows that scalpels cause 8% of injuries to healthcare workers in hospital settings and 17% of worker injuries in the surgical setting, with OR nurses and technicians twice as likely as surgeons or surgical residents to be injured. The US Centers for Disease Control and Prevention estimates that 39% of scalpel injuries are inflicted by the user on the assistant. Underreporting of scalpel injuries is also suspected.(4-8)
5. In 2000, the US Occupational Safety and Health Administration signed the Needlestick Safety and Prevention Act into law, mandating employers to "identify, evaluate, and implement" safer medical devices, including devices used in the care of patients during surgery. Despite the law, adoption and use of safety scalpels in the United States has been estimated to be less than 10%.(9)
6. Though not directly related to the technology itself, another safety concern is that scalpel users who use a hemostat for blade removal may be unaware that alternative blade remover devices, including passive devices, exist.
Unfortunately, little independent peer-reviewed literature is available specific to scalpel blade removal devices. Most papers available are written by Dr. Michael Sinnott (Qlicksmart Staff and Patient Safety co-founder) and compare the use of passive blade removers to the use of safety scalpels requiring active engagement of the safety feature.
Estimating the Acquisition Cost for Scalpel Blade Removers
The following average cost information is based on either ECRI Supply Guide data associated with vendor catalog numbers or list prices found on product sites; if both Supply Guide and list price data are available, the lower of the two was used.
- Disposable sterile blade removers: $1
- Disposable nonsterile blade removers (one-handed, including mounting hardware): $27
- Disposable nonsterile blade removers (two-handed): $6
- Sterilizable: $29
Recalls and Hazards
These devices are intended to improve blade removal safety, so recalls and hazards may be unlikely. Searching for "blade" AND "remover" as well as searching individual manufacturer names yielded no records in the
ECRI Alerts database.