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Surgical Students Fail to Report Needle Stick Injuries

Most of the surgical students stick themselves with needles and sharp instruments while in training. Most of the resulting injuries could be infectious and very often they are unreported.

This is according to a new study by reported Martin Makary, M.D., a surgeon at the Johns Hopkins Hospital, and colleagues, in the June 28 issue of the New England Journal of Medicine.

These doctors are risking their health and that of their families and patients to the threat of transmitting the diseases including AIDS, hepatitis and many other blood-borne illnesses.

The study of almost 700 surgeons-in-training at 17 U.S. medical centers found that 582 had experienced a needle stick 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.

A survey by Dr. Makary and colleagues revealed that young surgeons didn't report such injuries for a range of reasons, their being rushed was the chief reason the surgical residents cited for the injuries, which were mostly self-inflicted. Other reasons included being too busy and believing that reporting and getting timely medical attention would not prevent infection. Many a times surgeons feel the reason for not reporting injuries, was, that doing so would take too much time, could jeopardize career opportunities and might cause a loss of face among peers.

"It's been long suspected, but no one truly appreciated the magnitude of the problem," said Martin Makary, "Every surgeon is destined to be on anti-HIV medications and is at risk for contracting HIV and hepatitis at far higher rates than we suspected."

"Part of the surgical culture has been maintaining the patient first at all cost, and when an accide nt 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 also been seen that that residents who know their patient is a likely carrier of certain diseases are more likely to report the injury.

I think a lot of it is really a person's perception of risk," said Dr. Jim Kelaher, director of Occupational Health Programs at Baylor College of Medicine.

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 findings highlight the need for "immediate steps to improve safety and care for health care workers to reduce the spread of HIV and hepatitis infection," he said .The hospitals could adopt so-called sharp less technologies where possible, including electric scalpels, clips and glues.

He and colleagues also called for better reporting mechanisms, such as internal hotlines and response teams; routine prompts, such as postoperative checklists; and "peer-to-peer education" to encourage reporting.

These 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.

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."

Early treatment with antiretroviral medications and administration of the HBV vaccine containing hepatitis B immune globulin can prevent infection in those exposed to HIV and HBV respectively. Treatment with interferon can eradicate HCV in more than 90% of cases of acute infection.


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