Encouraging Needlestick Reporting

Abstract & Commentary

Editor’s Note: Please see the Rapid Reference Card, "Determining the Need for HIV Postexposure Prophylaxis (PEP) After an Occupational Exposure," enclosed with this issue of Internal Medicine Alert.

Synopsis: While educational interventions regarding actual risk may enhance reporting behaviors, establishing user-friendly mechanisms by which needlestick injuries can be dealt with quickly and appropriately, as well as adequate follow-up, is essential.

Source: Haiduven DJ, et al. Hosp Infect 1999;41:151-154.

Failure to report needlestick injuries is remarkably common, especially among physicians and medical students (Osborn EH, et al. Ann Intern Med 1999;130:45-51). Haiduven and colleagues distributed confidential surveys to healthcare personnel at a public teaching hospital in San Jose between 1992 and 1995. A total of 549 individuals responded to the survey, 83% of whom were nurses and 7% of whom were physicians. The remaining subjects included operating room technicians, dentists, and other hospital personnel.

Comment by Carol A. Kemper, MD

About one-half of the nurses and physicians and 84% of the remaining personnel reported at least one percutaneous needlestick injury within the previous five years. However, 46% failed to report all of their injuries, including 80% of the physicians and 45% of registered nurses. Reasons for nonreporting included the perception that the stick was sterile or clean (39%), or represented no risk (26%), too busy (9%), and dissatisfaction with follow-up (8%).

While educational interventions regarding actual risk may enhance reporting behaviors, establishing user-friendly mechanisms by which needlestick injuries can be dealt with quickly and appropriately, as well as adequate follow-up, are essential. The use of the ER for after-hours injuries is, in my experience, inadequate in that patients are often required to wait longer than that recommended for the administration of post-exposure prophylaxis (< 1 hour), and the management is often inconsistent and occasionally incorrect. This is despite the availability of approved hospital protocols. A designated 24-hour hotline, such as the one established at the San Francisco General Hospital (which, after-hours, usually rings a knowledgeable fellow or faculty member), appears to more consistently meet the needs of hospital personnel. The hotline number is prominently posted in blazing colors throughout the hospital to encourage reporting. (Dr. Kemper is Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center.)