Needle-stick injuries are common but unreported by surgeons in training

A survey of nearly 700 surgical residents in 17 U.S. medical centers finds that more than half failed to report needle-stick injuries involving patients whose blood could be a source of HIV, hepatitis and other infections.

Authors of the report — appearing in the June 28 issue of The New England Journal of Medicine — say most residents in the survey falsely believe that reporting and getting timely medical attention won’t prevent infection. Residents also say reporting takes “too much time” and interrupts their work.

“The fact that we have so many residents who fail to understand the importance of timely reporting of needle-stick exposures in order to protect themselves from serious medical consequences clearly illustrates the breadth of this problem and the need for hospitals to develop systems to address it,” says contributing author Mark S. Sulkowski, M.D., of the Division of Infectious Diseases at Johns Hopkins.

Lead author Martin Makary, M.D., M.P.H., a surgeon at The Johns Hopkins Hospital, says that while residents must take more responsibility, it’s also up to hospitals to take “immediate steps to improve safety and care for health care workers to reduce the spread of HIV and hepatitis infection.”

Makary says injuries could be greatly reduced by hospitals’ increasing the use of nurse practitioners and physicians assistants to reduce surgical workloads and adopting sharpless surgical techniques such as electric scalpels, clips and glues.

“Twenty percent of all general surgery operations could be done without using any sharp instruments,” he says. Furthermore, Makary says, residents would more likely report exposures if hospitals used timely reporting mechanisms (e.g., internal hotlines and response teams), routine prompts (e.g., postoperative checklists that monitor exposures), and peer-to-peer education to create a local culture that encourages speaking up.

“We know also that many residents resist reporting because the training culture suggests that needle sticks ‘go with the territory’ and reporting them may lower peer esteem,” Makary notes.

The survey, which took place in 2003, revealed that 99 percent of surgeons-in-training suffered an average of eight needle-stick injuries in their first five years. Of these surgeons, only 49 percent reported injuries to an employee health service. Of those who reported, 53 percent had experienced an injury involving a patient with a history of intravenous drug use and/or infected with HIV, hepatitis B (HBV) or hepatitis C (HCV).

“We did not realize the extent to which health care workers are at risk — a risk that is preventable,” says Makary, a surgeon who studies medical errors and health care quality. Makary says improved techniques that reduce the number of needle sticks and timely treatment for those who are injured could all but eliminate the risk of getting infected with disease.

Makary says 57 percent of surgical residents reported a feeling of being “rushed” as the primary cause of the injury. He adds that 42 percent said they did not report the injury because it took “too much time” and 28 percent said there was “no utility in reporting.”

In fact, says Sulkowski, early reporting and treatment with antivirals can prevent the establishment of infection in people exposed to HIV and HBV and can eradicate evidence of virus in more than 90 percent of people with acute HCV infection.

Previous studies suggest that an estimated 600,000 to 800,000 needle-stick injuries are reported each year by U.S. health care workers. Furthermore, a recent study of a general surgical service in an urban academic hospital revealed that 20 percent to 38 percent of all procedures involved patients with bloodborne pathogens.

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