Young Doctors Face Suture Needlestick Risk, Survey Says.

Business Editors/Health/Medical Writers

SAN DIEGO--(BUSINESS WIRE)--March 22, 2004

A new survey indicates America's young doctors are still at risk for potentially deadly injuries from suture needles. The survey is described in an article in the Winter 2004 issue of AOHP Journal, the publication of the Association of Occupational Health Professionals in Healthcare (AOHP).

Researchers found the great majority of suture needlesticks reported in teaching hospitals were suffered by young physicians in training (medical students, interns, residents and fellows). Such needlesticks can transmit Hepatitis B, Hepatitis C or HIV/AIDS to the injured clinician.

When all reported sharps injuries were considered, the number of attending physicians and physicians-in-training who reported needlesticks was approximately equal.

The new article and survey are joint projects of AOHP and the National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI), both of them non-profit organizations.

"There's a mistaken perception among some observers that federal and state regulations have solved the sharps safety problem," said MaryAnn Gruden, CRNP, MSN, NP-C, COHN-S/CM, the president emeritus of AOHP and one of two article authors. "Our preliminary survey demonstrates that these injuries are still occurring in troublingly high numbers among medical students and young physicians. The risk to these clinicians hasn't received much attention, and yet they face significant needlestick risk when they're assigned tasks such as suturing."

Gruden emphasized that solutions are readily available: "While there's been some progress, the tragedy is that needlestick injuries continue to occur, and that hundreds of thousands of them -- including many involving dangerous suture needles -- could be easily avoided by the adoption of new technologies."

The survey covered by the article was e-mailed to the roughly 75 percent of AOHP's 1,000 members for whom the organization had e-mail addresses. A total of 36 responses was received, with each response representing a separate sharps injury incident. Among other aspects of their jobs, AOHP members are generally responsible for tabulating needlestick injuries at their facilities.

The review of injuries to clinicians reported by AOHP members at hospitals around the country produced several notable results:

    -- Of patients involved in reported accidental needlesticks of a
       clinician, 17% of the patients were infected with Hepatitis C
       or HIV.

    -- Manual manipulation of suture needles caused a much larger
       proportion of reported injuries (33 percent) than any other
       root cause. This is consistent with previously published
       research showing 35 percent of injuries to interns and
       residents were caused by suture needles.

    -- Nearly all of the suture needlesticks (91 percent) were caused
       by curved suture needles, which some clinicians mistakenly
       consider to be effective safety devices.

    -- Physicians-in-training suffered 69 percent of suture
       needlesticks related to catheter securement at teaching
       hospitals.

Attending physicians (53 percent) and physicians-in-training (47 percent) reported approximately the same number of sharps injuries. This suggests that sharps accidents can happen to anyone, regardless of experience, the authors write.

"This survey underlines the value of primary prevention, eliminating the risk by eliminating the medical sharp," said co-author Steve Bierman, M.D., president of the National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI). "For example, it makes more sense to eliminate the possibility of injury by using sutureless technologies rather than using so-called safety devices like curved suture needles."

Sutureless technologies include catheter-securement devices (also known as adhesive anchors) as well as fibrin sealants and surgical glues. Adhesive anchors replace tape and suture for securing catheters and tubes. Based on industry estimates and published research, using these devices could annually prevent 60,000-120,000 needlesticks caused by suture securement of central venous catheters (CVCs) alone.

Fibrin sealants and surgical glues are relatively new primary-prevention products used to close certain wounds that are traditionally sutured.

Besides manual manipulation of suture needles, the survey found the other prominent causes of reported injuries to be hurrying (19 percent) and actions of a co-worker (17 percent). Of suture-related injuries, 81 percent occurred during wound closure. The next most common cause was suture securement of catheters (15 percent).

The authors write that the survey likely understates actual sharps injury risk. A previously published survey of 14,215 healthcare workers found that surgeons failed to report 73 percent of sharps injuries they suffered, with other healthcare workers neglecting to report 52 percent of their injuries.

Based on the survey's results, the authors make several recommendations:

    -- Medical residents and other young physicians should be targeted
       with a campaign that both educates them about sharps injury
       hazards and informs them of their rights to demand safer
       devices. NAPPSI has launched its own such campaign, called
       Protecting America's Interns and Residents from Suture-needle
       Sticks (PAIRSS). The campaign has the support of the American
       Medical Students Association and the National Association of
       Residents and Interns.

    -- Primary prevention should be utilized in all possible
       circumstances. This approach uses technologies and practices
       that reduce or eliminate sharp implements by replacing them
       with safer technologies and practices. Simply put, eliminate
       the sharp and you eliminate the risk.

    -- Work practice controls can also reduce risk. Physician training
       should stress the hazards of hurrying and the potentially
       dangerous nature of actions that can injure co-workers.

    -- Hospitals that purchase supplies through companies that don't
       stock safety devices need to develop more flexible purchasing
       arrangements that protect their workers.

    -- Physicians should be trained to manipulate suture needles with
       instruments to avoid the risk of manual manipulation.

The AOHP is dedicated to promoting the health and safety of workers in healthcare. This is accomplished through advocating for employee health and safety, providing opportunities for occupational health education and networking, advancing health and safety through best practices and research, and partnering with employers, regulatory agencies and related associations.

For more information, call 800-362-4347, e-mail [e-mail] or access http://www.aohp.org.

NAPPSI has created the most current and comprehensive list of needlestick-safety devices, available at www.NAPPSI.org/safety.shtml. The organization utilizes communications such as a monthly e-mail newsletter and a national speaker's bureau to inform decisionmakers, clinicians and the media about the value of primary prevention.

NAPPSI's membership encompasses more than 4,000 individual healthcare workers, as well as medical device manufacturers and many clinical associations concerned with needlestick safety. For NAPPSI membership and other information, call 858-350-8623, e-mail [e-mail] or access www.NAPPSI.org.