Nearly every trainee surgeon has experienced a needlestick injury by their final year of postgraduate education, according to a US study published in the June 28th edition of the New England Journal of Medicine. The study also showed that over 50% of all needlestick injuries were not reported, including 16% of injuries that involved a source patient who was infected with HIV, hepatitis B, or hepatitis C.
Feeling too busy was the main reason why trainee surgeons failed to report needlestick injuries, but over a quarter of those who had failed to report an injury said that they did not believe that treatment they may be offered would do any good.
Approximately 600,000 to 800,000 needle-stick injuries are reported annually by healthcare workers in the US. Such injuries can involve a risk of infection with serious blood-borne infections, such as HIV, hepatitis B and hepatitis C and the worry about the potential risk of infection after an injury can be psychologically traumatic.
Although any healthcare worker who performs an invasive procedure is potentially at risk of a needle-stick injury, the group most at risk is trainee surgeons. This is because of the number of procedures they are required to perform and their still-developing surgical skills.
The risk of exposure to a serious blood-borne infection for trainee surgeons is high: one recent study conducted at a general surgical service suggested that 20 – 38% of all procedures involved a patient who was infected with HIV, hepatitis B, or hepatitis C.
Prompt reporting of needlestick injuries is important so the healthcare worker’s risk of infection with a pathogen can be assessed. If appropriate, post-exposure prophylaxis (PEP) with antiretroviral drugs can be initiated in cases of possible exposure to HIV. If started soon after exposure to HIV, PEP can significantly reduce the risk of infection with the virus. Healthcare workers exposed to hepatitis B can be vaccinated (if they have not already been so); and those exposed to hepatitis C virus can be monitored for infection and commence therapy for acute hepatitis C infection if necessary. Such treatment can have a 90% success rate.
Investigators wished to determine the prevalence of needle-stick injuries and the circumstances in which they occurred. They also wished to see if these injuries were reported and to establish the reasons why trainee surgeons failed to notify the appropriate personnel about their injuries.
The study was conducted in 2003 and included 699 medical postgraduates in surgical training at 17 US institutions. The investigators established that, by the fifth year of postgraduate education, 99% of surgical trainees had experienced a needlestick injury. The medium number of injuries reported during these five years of training was eight – 1.7 per year. Over half (53%) of needlestick injuries involved a patient with HIV, hepatitis B or hepatitis C.
A feeling of being “rushed” was the most frequently reported reason for the injuries (53%), and a fifth of trainee surgeons did not think that their injury could have been prevented.
Over half (51%) of injuries were not reported to occupational health services. This included 16% of injuries where the source patient was infected with HIV, hepatitis B, or hepatitis C.
Although the main reason given for not reporting a needlestick injury was “it takes too much time” (42%), over a quarter (28%) of surgical trainees said there was “no utility in reporting” their injuries.
Factors significantly associated with failure to report needlestick injuries were: the patient was low-risk (p
The investigators suggest that the risk of needlestick injuries could be reduced by the wider use of “sharpless” invasive procedures. They suggest that 20% of all surgery could be conducted without the use of sharp instruments.
Greater use of nurse practitioners and physicians’ assistants could, it is also suggested, help reduce the pressure on surgeons. Reporting of injuries could also be increased by better education about occupational health procedures and by challenging a “macho” culture that may encourage trainee surgeons to accept needlestick injuries as a risk of the job and to discount the value of interventions to protect their health in the event of an incident.
Makary MA et al. Needlestick injuries among surgeons in training. N Eng J Med 356: 2693 – 2699, 2007.