Needles Sticky Issue For Surgical Residents

BALTIMORE, June 27 -- A needle stick injures more than four of every five surgical residents during their training, researchers here said.

About half of the injuries go unreported, reported Martin Makary, M.D., a surgeon at the Johns Hopkins Hospital, and colleagues, in the June 28 issue of the New England Journal of Medicine.

A survey by Dr. Makary and colleagues revealed that young surgeons didn't report such injuries for a range of reasons, including being too busy and believing that reporting and getting timely medical attention would not prevent infection.

The findings highlight the need for "immediate steps to improve safety and care for health care workers to reduce the spread of HIV and hepatitis infection," Dr. Makary said.

Among other things, he said, hospitals could adopt so-called sharpless technologies where possible, including electric scalpels, clips and glues.

"Twenty percent of all general surgery operations could be done without using any sharp instruments," Dr. Makary said.

He and colleagues also called for better reporting mechanisms, such as internal hotlines and response teams; routine prompts, such as postoperative checklists; and "peer-to-peer education" to encourage reporting.

"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," Dr. Makary said.

The survey was aimed at 17 medical centers across the country with 741 surgical trainees, and 702 (or 95%) of them returned the survey form. Three were excluded from the analysis, including one who reported about 100 needlestick injuries and two who did not report the number of such incidents.

By the fifth post-graduate year, 99% of the surgeons had had at least one needlestick, the researchers found, and 53% of the incidents involved a high-risk patient - one with a history of intravenous drug use and/or infection with HIV, hepatitis B (HBV) or hepatitis C (HCV) with a history of intravenous drug use and/or HIV, hepatitis B, or hepatitis C.

Of the most recent injuries, only 49% were reported to an employee health service, Dr, Makary and colleagues reported.

The most common reason for not reporting was a feeling of being rushed, with 42% of respondents saying it would take too much time. Another 28% said they saw "no utility" in reporting the injury.

In a multivariate analysis, the researchers found five factors that predicted failure to report injuries, including:

• Being male, which was significant at P=0.03.
• Lack of involvement of a high-risk patient, significant at P