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By the end of their five years of training in general surgery almost every US surgeon has received at least one needlestick injury. The average is about eight, according to an anonymous survey of 699 residents at 17 medical centres published in the New England Journal of Medicine (2007;356:2695-9).
Surgeons in training have more needlestick injuries than attending surgeons, scrub nurses, anaesthetists, and other operating room personnel. They have six times as many needlestick injuries as medical residents.
More than half of the injuries (53%) involved a high risk patient—one with HIV or hepatitis B or C infection or one with a history of injecting drugs. More than half of the residents (51%) did not report the injury to the employee health service at their institution.
The coauthor, Mark Sulkowski, associate professor of medicine and medical director of the viral hepatitis centre at Johns Hopkins University School of Medicine, told the BMJ that the paper was a “a major step to increasing awareness” of the problem. He said that it was up to medical centres and training programmes to prevent needlestick injuries through safer surgical techniques and occupational safety programmes to help surgeons who had needlestick injuries.
Medical centres do have systems for reporting needlestick and similar injuries, but most surgeons in training did not report injuries because it was too time consuming (42%), they didn't see the usefulness of reporting (28%), they didn't want to know the results (6%), or they perceived a stigma in having a needlestick injury (5%).
Suturing was the most common task resulting in injury (52%). Trainee surgeons said common causes of injury were being rushed (57%), being tired (15%), a lack of skill (12%), and lack of help (9%).
Surgeons in training often incur the injury while they are in the middle of a procedure. Hospitals have “a well defined pathway” for reporting, usually by telephone helpline, Dr Sulkowski said. The call connects the injured surgeon to an expert, who counsels about the risks of acquiring infection, makes recommendations for treatment, and directs the surgeon to the hospital's occupational health clinic for testing and prophylaxis. Injuries often occur after regular hours and getting to the clinic may be time consuming, so procedures need to be streamlined, he said.
Surgeons underestimate their risk of infection with HIV and hepatitis B and C after exposure. Education about reporting, counselling, and treatment is important, the authors say, because it benefits the surgeon, future patients, and partners.
For HIV exposure, treatment with antiretroviral drugs within 24 to 36 hours after exposure reduces HIV infection by 81%. For surgeons not immunised against hepatitis B, use of immunoglobulin after exposure reduces risk. For hepatitis C, early detection of infection can lead to treatment to prevent chronic infection, Dr Sulkowski said.
The authors say that hospitals should try to prevent exposure by using techniques such as “sharpless” methods for passing instruments and needles in the operating room; “sharpless” surgery, using non-sharp alternatives; blunt needles; and wearing two pairs of gloves.