Medical student needlestick injuries

Originally posted in MedPage Today

by Kristina Fiore, MedPage Today Staff Writer

Medical students are frequently stuck by needles, and few report their accidents, researchers say.

In a survey, about 60% of surgery residents reported being stuck with a needle while they were in medical school, Martin A. Makary, MD, MPH, of Johns Hopkins, and colleagues reported in the December issue of Academic Medicine.

“Needlestick injuries during medical school among students who go on to surgery residencies are highly prevalent and likely are under-reported,” the researchers wrote.

They noted that medical students have underdeveloped surgical skills and are at a high risk of needlestick injuries that can result in chronic infection, social stigma, long-term disability, and psychological stress.

Among all U.S. healthcare workers, researchers estimate about 600,000 to 800,000 needlestick and other percutaneous injuries are reported each year, and there’s evidence of “vast under-reporting.”

However, rates of such injuries have not been assessed among medical students.

So in January 2003, the researchers surveyed recent medical school graduates who had been enrolled in a surgery residency at one of 17 medical centers in the U.S.

A total of 699 responded, for a 95% response rate.

Among those, 83% reported sustaining a needlestick injury at some point during their surgical training, and 59% reported having been stuck as a medical school student.

For those who had the needlestick injury in medical school, their median number of injuries was two.

Young physicians who had been stuck in medical school were also more likely to be stuck during residency than those who hadn’t been stuck as medical students (OR 2.57, 95% CI 1.84 to 3.58).

They also had a 2.51-fold increased risk of needlestick injury involving a high-risk patient — one with a history of intravenous drug use or infection with HIV, HBV, or HCV (95% CI 1.73 to 3.65).

Most needlestick injuries that occurred during medical school were self-inflicted (72%), involved a solid-bore needle (78%), occurred in the operating room (67%), or occurred when the respondent felt rushed (57%), the researchers said.

The investigators found that 89 residents (21% of those who had been stuck) sustained their most recent needlestick injury during medical school. Among them, 47% did not report their injury to an employee health office.

The most common reason for not doing so was the amount of time involved in making a report (31%), Makary said.

However, a greater proportion of injuries involving high-risk patients — 92% — were reported.

In univariate logistic regression analyses, medical students were 12.5 times less likely to report a needlestick injury if it involved a low-risk patient (95% CI 1.54 to 101.84) and 21.5 times less likely to do so if no one else knew of the injury (95% CI 5.75 to 80.89).

“Prompt reporting of all needlestick injuries, not just those involving high-risk patients, is critical to ensuring proper medical prophylaxis, counseling, and legal precautions,” the researchers said.

Makary said medical schools don’t do enough to protect their students from such injuries, and hospitals don’t do enough to make medical school safe.

“We, as a medical community, are putting our least skilled people on the front lines in the most high-risk situations,” Makary said in a release. “Most trainees are still forced to learn to sew and stitch on patients, which puts both providers and patients at risk.”

He said strategies for improving reporting systems and creating a culture of reporting should be implemented by medical centers.

“Hospitals are not creating a culture of speaking up,” he said.

They wrote that possible causes of needlestick injuries are inferior manual dexterity and carelessness. They could also be attributed to varying levels of skills training at medical schools, or to psychological attributes of the respondent, such as confidence and efficacy.

Hospitals and educators should increase the education about needlestick reporting measures as well as the use of simulators for safe and controlled learning to master proper handling of needles, the researchers said. Double-gloving can also prevent risk of blood contamination.

Makary and colleagues also recommend “sharpless” surgery, which includes using nonsharp alternatives such as electrocautery cutting frequencies instead of a knife and applying skin glue rather than using suture closure.

“Medical centers should do more to implement novel prevention strategies and improved reporting systems for medical students,” they said.

The researchers said the study’s findings may not generalize to other specialities because surgery residents are more likely to have handled needles in medical school. They said the study was also limited by self-reporting.

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