Needle-stick and other percutaneous and mucocutaneous exposures are frequent, and underreporting is common. The EPINet hospital-based surveillance system in the United States has estimated that there were approximately 590 164 percutaneous and 196 721 mucocutaneous exposures to blood or risky biologic substances in 1996, with 39% of incidents not having been reported.9
The estimates of the CDC are 30% higher.10
National estimates of exposures in Canada are not currently available, although a national surveillance system is being developed (Sharon Onno, Health Canada, Ottawa, Ont.: personal communication, 2001). Initial investigations in Montreal in 1991/92 found that the overall exposure rate for all job titles was 12.1 per 100 full-time equivalent positions (FTEs) per year in hospitals11
and 11.7 per 100 FTEs per year in CLSCs (centres locaux de services communautaires).12
Hospital nurses were the most exposed group averaging 18.1 exposures per 100 FTEs per year, with operating room nurses experiencing the highest rates (39.7 exposures/100 FTEs per year). The researchers estimated that half of all exposures were not reported, with physicians tending not to report their exposures. As of 1997/98, hospital rates of exposure to BBPs decreased to 7.5 exposures per 100 FTEs per year.13
Surveys of hospital-based nurses in British Columbia, Alberta and Ontario were conducted in 1998/99. Nurses who worked in the operating room/recovery room were the most likely ever to have been stuck with a needle or sharp (70%–78%) and had the highest average number of injuries during their career (3.1–3.6) (Dr. Heather Clarke, Health and Nursing, Policy, Research and Evaluation Consulting, Vancouver, BC: personal communication, 2000. Dr. Phyllis Giovannetti, University of Alberta, Edmonton, Alta.: personal communication, 2000. Dr. Judith Shamian, WHO Centre for International Nursing Research, Toronto, Ont.: personal communication, 2000).
About 75% of US residents in emergency medicine14
and Canadian residents in family medicine and internal medicine15
experience needle-stick injuries during training, with most exposures not being reported. In a study in Toronto of medical students, interns and residents, surgical residents had the highest rates of injury, experiencing an average of 5.4 needle-stick injuries per year with less than 5% of injuries being reported.16
Surgeons have high rates of exposure to BBPs that are similar to those of OR nurses and surgical residents. A survey of orthopedic surgeons found that 39.2% had had a percutaneous blood contact in the preceding month.17
A survey of surgeons from the United States and the University of Toronto found that respondents averaged 11 needle-stick injuries over a 3-year period.18
Most respondents (70%) rarely or never reported needle-stick injuries.
A CDC review of 9 prospective studies conducted since 1990 reported that a surgical team member sustained at least one percutaneous injury during 1.3%–15.4% of procedures.19
Possible patient exposures to a sharp object that had previously injured the surgeon occurred in 1.7%–2.5% of operations and 0.1% of deliveries. shows the percentage of procedures with injuries and recontact by surgical specialty from a study based in 4 US university teaching hospitals.20
Recontact was defined as contact of a sharp object that has penetrated an HCW's skin with a patient's open wound or injury of an HCW by a bone fragment or surgical wire fixed in the patient's body. Data from a survey of surgeons at a teaching hospital in London, England, are shown in .21
Cardiac and gynecologic surgeries involved the highest frequency of injuries.