Must needlesticks be a rite of passage for surgeons?

Survey: OR sharps injuries are universal

Virtually every surgical resident will have a needlestick before his or her training is complete, but only half of those needlesticks will be reported, according to a report in the New England Journal of Medicine.

A survey of about 600 surgeons in training at 17 medical centers around the country revealed that half of the exposures (53%) involved a high-risk patient, and only 16% of those high-risk exposures were reported. Surgical residents were six times more likely to suffer a needlestick than other medical residents.¹

The survey, by researchers at Johns Hopkins University, highlighted the need for better sharps safety and improved training among surgical residents.

Sharps safety for surgical residents should begin in medical school and continue through their residency, says William Schecter, MD, FACS, chairman of the American College of Surgeons (ACS) Committee on Perioperative Care and chief of surgery at San Francisco General Hospital.

The ACS has set up education centers around the country, with high-tech simulators, to enable surgeons and surgical teams to work on their technique, says Schecter. Meanwhile, training in bloodborne pathogen exposure and sharps safety is mandatory for surgical residents, he adds.

Creating a safe OR environment is a top priority for the ACS, he says. "In this case, what�s safe for the operating team is safe for the patient," says Schecter.

Timely reporting of sharps exposures in the OR is a particular problem for surgical residents, the Johns Hopkins study found. "[U]nderreporting may result in a substantial underestimation of the magnitude of the problem," the authors said.

There are many barriers to reporting in the OR. "Lack of time" was the primary reason that surgical residents failed to report injuries — which would prevent the physicians from receiving prompt post-exposure prophylaxis for HIV or HBV or baseline testing for HCV.

Employee health professionals need to make reporting easier for OR personnel, perhaps through hotlines or even postoperative checklists that include a question about needlesticks that occurred during the case, the Johns Hopkins researchers said.

Reporting and providing baseline blood samples need to be as convenient as possible, says Ramon Berguer, MD, FACS, clinical professor of surgery at the University of California Davis and chief of surgery at Contra Costa Regional Medical Center in Martinez, CA.

"If you�re in the middle of an eight-hour operating day, the idea that you�re going to drop your cases, go stand in line at employee health, and go through four hours of treatment is just unrealistic," he says. "They want to finish their obligations for the day."

Still, surgical leaders are optimistic that they can create a greater culture of safety in the OR —starting with the surgeons in training.

Reference

1. Makary MA, Al-Attar A, Holzmueller CG, et al. Needlestick injuries among surgeons in training. N Eng J Med 2007; 356:2,693-2,699.