Needle-stick injuries among surgical residents

AORN Journal, Sept, 2007 by George Allen

New England Journal of Medicine

June 2007

Approximately 800,000 needle-stick and other percutaneous injuries are reported annually among health care workers in the United States. Indeed, all health care workers who perform invasive procedures with sharp instruments are at risk for percutaneous injury. Individuals who work in the OR, however, are at the greatest risk not only for injury, but also for exposure to bloodborne pathogens such as HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), which have a high prevalence among surgical patients. Prompt reporting of occupational exposures to an employee health service is required to ensure appropriate health counseling, facilitate prophylaxis or early treatment, and establish the legal prerequisites for workers compensation.

Because of their numerous encounters with sharp instruments and the increased propensity for injury while learning new technical skill sets, surgeons in training have the greatest risk for exposure to bloodborne pathogens. Information from this group, however, is limited regarding the prevalence of, circumstances surrounding, and barriers to reporting needle-stick injuries. The purpose of this study was to investigate the prevalence and context of needle-stick injuries and the behavior associated with reporting such injuries among surgeons in training.

Study participants included surgeons in training in general surgery residency programs certified by the Accreditation Council for Graduate Medical Education in the United States. Of the 19 training programs involving 741 surgeons in training who were invited to participate in the study, 17 programs involving 702 surgeons in training agreed to participate. Participants were surveyed after completing the January 2003 American Board of Surgery Inservice Training Examination, a standardized nationwide examination administered to all general surgery residents.

The survey instrument included questions on

* the postgraduate year of clinical training,

* gender,

* number of past needle-stick injuries during training, and

* needle-stick injuries involving a high-risk patient.

It also included an expanded set of questions about the most recent needle-stick event.

A high-risk patient was defined as one with a history of infection with HIV, HBV, or HCV or a history of illicit IV drug use. The expanded questions about the most recent needle-stick event included questions on

* whether the event involved a high-risk patient,

* the perceived causes and circumstances,

* whether it was reported,

* reasons for not reporting if applicable, and

* whether anyone else knew of the injury.

Common statistical techniques, including univariate, multivariate, and logistic regression analysis; the Mantel-Haenszel test; and the Kruskal-Wallis test, were used to analyze the data.

FINDINGS. Of the 741 surgical residents invited to participate, 702 (95%) returned completed survey forms. Three respondents were excluded from the analysis, one as an outlier for reporting more than 100 injuries and two for not reporting the number of needle-stick injuries. A large number of the respondents (ie, 83%) reported that they had sustained a needle-stick injury during their residency. The mean total number of needle-stick injuries increased according to the postgraduate year (PGY) of training; the mean number of injuries for residents in

* PGY-1 was 1.5,

* PGY-2 was 3.7,

* PGY-3 was 4.1,

* PGY-4 was 5.3, and

* PGY-5 was 7.7.

By the final year, almost all of the residents (ie, 99%) reported having had a needle-stick injury, and for 53% of these respondents, the injury involved a high-risk patient.

Of respondents' most recent injuries, 51% were not reported to an employee health service and 16% were not reported at all. Lack of time was the most common reason given for not reporting such injuries. Multivariate analysis revealed the following five factors to be significantly associated with not reporting needle-stick injuries to the employee health service:

* male gender (P = .03),

* lack of involvement of a high-risk patient (P < .001),

* occurrence in the OR (P = .008),

* lack of knowledge of the injury by another person (P < .001), and

* total number of needle-stick injuries during training (P = .002).

CLINICAL IMPLICATIONS. The results of this study revealed that needle-stick injuries pose a significant occupational risk for surgical trainees with virtually all the trainees (ie, 99%) having had a needle-stick injury by their final year of training. The results also revealed that only 49% of surgical residents report these injuries. Perioperative managers should understand the critical importance of prompt reporting of any exposure event in the perioperative setting for all personnel, and they should develop mechanisms to facilitate such reporting.

Makary MA, Al-Attar A, Holzmueller CG, et al. Needlestick injuries among surgeons in training. N Engl J Med. 2007;356(26):2693-2699.

GEORGE ALLEN, PHD, RN, CNOR, CIC

GEORGE ALLEN

PHD, RN, CNOR, CIC

DIRECTOR OF INFECTION CONTROL