Needlestick injuries most common in first six months of residency

1. Dental, obstetric and gynecology and surgical residents were more likely to incur needlestick injuries.

2. First-year residents in the first 6 months of training were at highest risk for needlestick injuries.

Evidence Rating Level: 2 (Good)

Study Rundown: Healthcare professionals are at risk for needlestick injuries (NSI), putting them at risk for highly infectious diseases, such as HIV or hepatitis. It is important to understand the risk factors associated with NSIs in order to decrease their frequency. This study systematically examined whether NSIs varied by postgraduate year (PGY) level, and described NSIs among hospital house staff of different subspecialties.

Over half of all NSIs occurred in the PGY1, of which, 63% occurred within the first 6 months of residency. Needlestick injuries were highest among dental, obstetrics and gynecology, and surgical residents. Family medicine residents were least likely to be injured. The most prevalent instrument for NSIs was the suture needle. Other mechanisms include scalpels and blood gas syringes. Of the few cases where patients had hepatitis, no residents incurred seroconversion. Strengths of this study include systematic examination to NSIs as previous studies were based on self-report. It was also important to include dental residents, as they are an often missed but high-risk resident population. Limitations include only examining residents from a single training hospital. Further studies powered to analyze risk of seroconversion in patients with hepatitis and HIV would be of interest.

Click to read the study in JAMA Internal Medicine

Relevant Reading: Risk of needlesticks and occupational exposures among residents and medical students

In-Depth [cross-sectional study]: This study completed a cross-sectional study of all NSIs by residents between January 2000 to June 2014 in Mercy Health Youngstown Hospital. During this time, NSIs were analyzed to look for incidence across different programs, PGY level, anatomical sites of common NSIs, and prevalent instruments in NSIs. Statistical analysis included X2 goodness-of-fit testing with a significance level of 0.05.

Over the 14-year study period, 129 NSIs were reported in residents – 67 in PGY-1, 37 in PGY-2, 16 in PGY-3, 7 in PGY-4, and 2 in PGY-5. The incidence of NSIs was higher than expected (X2 goodness-of-fit statistic = 15.889, p = 0.003). Of those 67 NSIs in PGY-1, 62.7% occurred within the first 6 months of training. Dental residents had the highest rate of NSIs at 30.6% (22 of 72 residents), followed by obstetrics and gynecology at 28.9% (13 of 45 residents) and surgical residents at 18.5% (41 of 222 residents). Internal, transitional, and family medicine exhibited the lowest rates of NSI. Common sites for NSIs were the left index finger and the left middle finger. Instruments used during NSIs included suture needles (43.4%, n = 53), scalpels (11.6%, n = 15) and blood gas syringes (10.1%, n = 13).

Image: PD

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