Needlestick Injuries Common Among Surgery Students

WEDNESDAY, June 27 (HealthDay News) -- American surgeons-in-training stick themselves far too often with needles that could carry infection, and they often fail to report that they've done so.

That's the conclusion of a new study in the June 28 issue of the New England Journal of Medicine.

"We were all alarmed at how great the magnitude of the problem appears to be," said lead author Dr. Martin A. Makary, director of the Johns Hopkins University Center for Surgical Outcomes Research.

The study of almost 700 surgeons-in-training at 17 U.S. medical centers found that 582 had experienced a needlestick injury. In more than half the cases, the needles were being used for high-risk patients -- those with particularly dangerous infections, such as hepatitis or HIV. And 297 of the 578 most recent incidents had not been reported to an employee health service, including 15 of the 91 cases involving high-risk patients.

That needlestick injuries occur in surgery and that many are not reported at once is not surprising, Makary said.

"Part of the surgical culture has been maintaining the patient first at all cost, and when an accident occurs in the operating room, the surgeon's first inclination is to continue with the operation," he said. "But the extent of the problem is much greater than we thought. Previous estimates of injuries understate the magnitude of the problem, because most of the injuries are not being recorded."

It has been estimated that one of every 50 needlesticks involving hepatitis B and one of every 100 involving HIV results in an infection, Makary said, making them "a significant public health problem." He assigned blame for the problem to both medical institutions and individual physicians.

"More hospitals need to do a better job in protection," Makary said. "They need more appropriate and more timely surgical systems so surgeons can get medical treatment immediately, not after a long bureaucratic process that takes them away from the patient."

The typical educational program about needlestick injuries "is practically worthless, it is just not working," Makary said. "What we advocate is peer-to-peer education on the topic, so it is not an outside administrator or occupational safety nurse saying that surgeons need to do a better job. Surgeons who have been stabbed should educate their fellow surgeons about what they should have done."

Needlestick incidents among surgeons could be reduced by having physician assistants and nurse practitioners do more of the work during surgery, by having hospitals require checklists of safer techniques and by using safer equipment, such as electric scalpels, clips and glues, Makary said.

In fact, up to 20 percent of surgical procedures could be done without using any sharp instruments at all, he said. However, an estimated 1 million needlestick injuries occur each year in the United States, Makary said.

Those injuries occur although the United States is the only nation that has a comprehensive needle safety program, said Ron Stoker, executive director of the International Sharps Injury Prevention Society, an organization devoted to reducing such injuries. The program came into existence when President Bill Clinton signed a bill passed by Congress in November 2000, Stoker said.

Under the law, the National Institute of Occupational Safety and Health reviews and updates safety measures, including the adoption of lower-risk equipment. Institutions that fail to use such equipment could be fined under the law, Stoker said, but "people don't use them, and now we have a lot of injuries."

"The biggest problem is that individual surgeons don't want to use safety equipment," Stoker said. Nurses are more likely to want to use such equipment, he said, and they are more likely to report accidents when they occur, he said.

Under current practices, the operating room will remain a high-risk area, with "sometimes hundreds of needles used and passed from surgeon to surgeon and from surgeon to nurse," Makary said. "We need to create an atmosphere of speaking up to ensure that no accident occurs."

More information

There's more on preventing needlestick injuries at the Centers for Disease Control and Prevention.

SOURCES: Martin A. Makary, M.D., director, Johns Hopkins Center for Surgical Outcomes Research, Baltimore; Ron Stoker, executive director, International Sharps Injury Prevention Society, South Jordan, Utah; June 28, 2007, New England Journal of Medicine