June 29, 2007
Almost all surgical residents accidentally stick themselves with needles or other sharp medical instruments but most fail to report the injury, increasing their risk of contracting HIV, hepatitis or other bloodborne diseases from infected patients, according to a study published Thursday in the New England Journal of Medicine, the New York Times reports.
For the study, researchers at Georgetown University and Johns Hopkins University questioned 699 physicians who in 2003 were residents at 17 medical centers nationwide. They found that 99% of participants had experienced at least one needle-stick injury by the final year of residency, with an average of eight such injuries per resident. The study found that 51% of residents did not report the injuries to an employee health service, which is required at some hospitals. Of the residents who reported their injuries, 53% were stuck while working with a patient at high risk for common, potentially fatal bloodborne diseases, the Times reports (Altman, New York Times, 6/28).
The National Institute for Occupational Safety and Health estimates that one in 300 health care workers who are stuck with a needle while working with an HIV-positive person will contract the virus. In addition, NIOSH estimates that two in 100 health care workers who are stuck while treating people with hepatitis C will develop the infection. The researchers noted that although the risk of disease is low, it would be virtually nonexistent if health care workers reported the injuries and sought treatment immediately, the Baltimore Sun reports.
According to the Sun, surgical residents are prone to needle sticks because they are inexperienced. In addition, residents often work with high-risk patients and conduct procedures in which needle sticks are common. About 800,000 needle sticks occur annually. CDC between 1985 and 1999 documented 55 cases of health care workers contracting HIV, the Sun reports (Emery, Baltimore Sun, 6/28).
According to the Times, being rushed at work was the No. 1 reason residents did not report needle-stick injuries. The study found that residents believed reporting their injuries would take too much time, could jeopardize career opportunities and might cause them to lose face among peers, the Times reports. In addition, some residents believed that timely medical treatment would not prevent them from contracting HIV or another illness.
The study's findings are "further evidence" that protection measures recommended by CDC to prevent such injuries and provide treatment should be strengthened, the Times reports. Researchers urged surgeons to provide residents with specific instruction on safe techniques and what to do if an injury occurs. Other preventive measures include wearing two sets of surgical gloves; using electric scalpels, clips and glue rather than sharp instruments; improving techniques for passing instruments between health care workers; using postoperative check lists; and increasing the use of nurse practitioners and physician assistants to reduce workloads. In addition, infection control experts are urging physicians to use the same precautions in treating all patients and not only those at high risk of HIV and other infections, according to the Times.
Martin Makary, a surgeon at Johns Hopkins who led the survey, said that surgeons have made "little progress in the last 20 years" in preventing needle-stick injuries and that hospitals "are not doing what they should" to prevent such injuries (New York Times, 6/28). Makary added that attending physicians should insist that injuries be reported to the hospital, adding that if treatment is sought immediately, HIV is "almost 100% preventable" (Baltimore Sun, 6/28).
The study is available online.
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2007 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.