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The reporting of needlestick injuries sustained in theatre by surgeons: are we under-reporting?
Journal of Hospital Infection (2008) 70, 66e70
Available online at www.sciencedirect.com
www.elsevierhealth.com/journals/jhin
The reporting of needlestick injuries sustained in theatre by surgeons: are we under-reporting? E. Au, J.A. Gossage*, S.R. Bailey Maidstone Hospital, Maidstone, Kent, UK Received 21 November 2007; accepted 17 April 2008 Available online 3 July 2008
KEYWORDS Needlestick; Sharps; Bloodborne; Gloves; Reporting
Summary Surgeons frequently sustain needlestick injuries when operating. The aim of this study was to evaluate the incidence and reporting rate of needlestick injuries at one institution. A questionnaire was distributed anonymously to 69 surgeons of all grades and specialties in a district general hospital in the UK. The questionnaire was returned by 42 surgeons (60.9%). There were 840 needlestick injuries over two years, of which 126 caused bleeding. Senior surgeons who spent more hours operating per week had a higher rate of needlestick injuries compared with junior surgeons (29.1 vs 6.59 injuries per surgeon over two years). Of the total number of injuries, 19 (2.26%) were reported to Occupational Health according to the surgeons questioned, but only six reported incidents were found in the Occupational Health records. Junior surgeons were significantly more likely to report needlestick injuries than senior surgeons (9.82% vs 1.10% of injuries reported, P ¼ 0.0000045). The main reasons for failure to report needlestick injuries were due to the lack of time and excessive paperwork. Seventy-three percent of surgeons did not routinely use double gloves when operating, mainly because of decreased hand sensation. The rate of needlestick injury reporting by surgeons at this institution is extremely low. Previous studies have shown a higher reporting rate suggesting that, despite awareness of bloodborne infections, surgeons are still not following recommended protocols. ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
Introduction * Corresponding author. Address: Department of General Surgery, Maidstone Hospital, Maidstone, UK. Tel.: þ44 7803 726641. E-mail address: [email protected]
Surgical procedures are the most common cause of needlestick injuries in hospitals, with reported occupational exposures increasing significantly
0195-6701/$ - see front matter ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2008.04.025
Needlestick injuries in surgeons since 2002.1,2 These figures are thought to be an underestimation, as a proportion of injuries are still not reported, with surgeons being the least likely to attend Occupational Health out of all healthcare workers.3,4 Surgeons suffering from needlestick injuries carry a significant risk of exposure to bloodborne pathogens, such as hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV).5 The risk of transmission depends on the amount of patient’s blood transferred to the doctor and the infected patient’s viral load. The risk of transmission for HBV ranges from 22 to 31%, HCV from 2 to 3% and HIV ~0.3%.5,6 Following the UK Department of Health guidelines published in 2006, all surgeons should receive a full HBV vaccination course.7 In addition, the use of gloves when conducting invasive procedures and the reporting of needlestick injuries are recommended. This study reports the results of a survey conducted amongst surgeons in a district general hospital. The aim was to determine the actual incidence of sharps injuries over the last two years compared with the number of injuries reported to Occupational Health. The differences between specialties, age groups and the reasons for failure to follow reporting guidelines were also assessed.
Methods Questionnaire An 18-item questionnaire was used to determine the number of needlestick injuries within the last two years, the reporting rate of injuries and reasons for failure to report. In addition the survey also aimed to determine views on behavioural methods of protection against occupational exposures (e.g. double glove), HBV immunisation status and the compliance with post-exposure protocols.
Subject sample Sixty-nine questionnaires were distributed anonymously to surgeons of all grades who carried out surgical procedures in general surgery, obstetrics and gynaecology, urology and orthopaedics at a district general hospital in the UK.
67 associations between specialties and age groups regarding number of needlestick injuries, reported needlestick injuries and double glove usage were evaluated using two-sided Fisher’s exact test. To account for the difference in response rates, the data were normalised by calculating the number of injuries per surgeon within the last two years when comparing between specialties and age groups. Surgeons who did not respond to a specific question were excluded from that analysis.
Results Out of the 69 questionnaires, 42 were returned (60.9%). The response rate varied according to specialty and hospital post. The response rate was highest for general surgery and specialist registrars, and lowest in obstetrics and gynaecology and senior house officers. Of the respondents, 15 (35.7%) were consultants, 18 (42.9%) were specialist registrars and nine were senior house officers. Twenty-five (59.5%) respondents were older than 35 years and 17 (40.5%) were younger.
Double glove use Only 11 of 42 (26.2%) surgeons reported that they always use double gloves when operating, nine were orthopaedic surgeons and two were general surgeons. Double glove usage was 100% in orthopaedics compared with 11.1% in general surgery and 0% for both urology and obstetrics and gynaecology. In general surgery, junior surgeons aged <35 years had a higher double glove usage rate than senior surgeons aged >35 years (20 vs 7.7%). The majority of surgeons who did not use double gloves (71%) responded that doing so decreased hand sensation.
Special precautions with high-risk patients When operating on high-risk patients, most surgeons (52.4%) reported using three methods of protection: double gloves, eye protection and instrument-only suturing (Table I). Fewer senior surgeons and surgeons in obstetrics and gynaecology reported using more than two methods of protection in high-risk patients.
Compliance with post-exposure procedures and hepatitis vaccination
Data analysis Demographic data and frequency tables were compiled from the returned questionnaires. The
Only 23.9% of surgeons reported having complied with hospital post-exposure procedures after a needlestick injury. However, 85.7% were aware
68
E. Au et al.
Table I Extra methods of protection used by surgeons when operating on high-risk patients Special precautions with high-risk patients
Surgeons (%)
Double gloves, eye protection AND instrument-only suturing Double gloves AND eye protection Double gloves OR eye protection OR instrument-only suturing
52.4 31.0 16.6
of the existence of post-exposure protocols. All surgeons reported having been vaccinated against hepatitis B and 90.5% had had their antibodies checked in the last two years.
Table II Number of needlestick injuries reported in the questionnaire by surgeons in different specialties and age groups Category of surgeons
No. of needlestick injuries (% of total)
Specialty General surgery 60% (504/840) Urology 21.8% (183/840) Orthopaedics 10.6% (89/840) O&G 7.62% (64/840) Age group <35 years >35 years
No. of needlestick injuries per surgeon 28 26.1% 9.89% 8%
(504/18) (183/7) (89/9) (64/8)
13.3% (12/840) 6.59% (112/17) 86.7% (728/840) 29/1% (728/25)
O&G, obstetrics and gynaecology.
Incidence of needlestick injuries over two years There were 840 needlestick injuries over two years, of which 126 caused bleeding. The rate of needlestick injuries varied between specialties, being highest in general surgery (Table II). Junior surgeons also had a lower rate of needlestick injuries compared with senior surgeons who spent more hours operating per week (6.59 vs 29.1 injuries/surgeon).
Reported needlestick injuries
Reasons for failure to report needlestick injuries In all, 57.7% of surgeons responded that lack of time and excessive paperwork were the main reasons for not reporting an injury. A small percentage felt that Occupational Health did not provide adequate support for reporting procedures, such as out-of-hours access.
Discussion
Of the 840 needlestick injuries, 19 (2.26%) were reported according to the surgeons questioned. However, only six reported incidents were found in Occupational Health records. The survey showed that only 33.3% of surgeons reported their needlestick injuries. The reporting rate varied between grades of surgeons and specialties (Table III). Surgeons aged <35 years were significantly more likely to report their injuries than those >35 years (9.82% vs 1.10% of needlestick injuries reported, P ¼ 0.0000045). Overall, the reporting rate is extremely low in all specialties (Table IV, Figure 1).
Needlestick injuries are very common, especially in surgeons, but injury rates may be greatly underestimated due to under-reporting. This study demonstrated that the reporting rate of needlestick injuries at this institution was extremely low (2.26% of all needlestick injuries reported). More worryingly, there was a discrepancy between the number of needlestick injuries reported according to the survey and the actual number of incidents recorded by Occupational Health (19 versus six reports). Although the majority of surgeons were aware of the existence
Table III Percentage of surgeons who reported their needlestick injuries to Occupational Health within the last two years by specialty and hospital grade Total 33.3
Hospital post
Specialty
Cons.
SpR
SHO
Gen. Surg.
Urology
20
31.3
62.5
33.3
33.3
Ortho.
O&G
44.4
14.3
Cons., consultant; SpR, specialist registrar; SHO, senior house officer; Gen. Surg., general surgery; Ortho., orthopaedics; O&G, obstetrics and gynaecology.
Gen. Surg., general surgery; Ortho., orthopaedics; O&G, obstetrics and gynaecology. Surgeons aged <35 years were significantly more likely to report needlestick injuries than surgeons aged >35 years in the same specialties. There was no significant difference in reporting rates between specialties.
1.56% (1/64) 0 0.552% (1/181) 1.38% (6/435) 0 12.2% (5/41) P ¼ 0.018 100% (2/2) P ¼ 0.00018
Ortho. Urology O&G Ortho.
Surgeon <35 years
Urology Gen. Surg.
5.80% (4/69) P ¼ 0.036 No. of injuries reported (%)
Table IV
Number of needlestick injuries reported within the last two years by specialty
Gen. Surg.
Surgeon <35 years
O&G
Needlestick injuries in surgeons
69 of post-exposure protocols (85.7%), a very small proportion reported having actually complied with the guidelines (23.9%). Senior surgeons operating the most hours per week suffered a higher injury rate and were less likely to report compared with junior surgeons. There was a 100% hepatitis B vaccination rate in both junior and senior surgeons since this is a compulsory NHS Trust procedure for all doctors. The low reporting rate at our institution reflects surgeons’ perception of transmission risks. It has been shown that health beliefs affect a doctor’s compliance in reporting needlestick injuries.6 Compliers tend to perceive their susceptibility to contracting disease and the benefit of reporting more highly than non-compliers who emphasise the inconvenience of reporting such injuries. Overall, the results of this study suggest that surgeons at this institution failed to report the majority of needlestick injuries and only used double gloves when operating on high-risk patients. Although the reporting rate was very low at this institution, results may vary between hospitals according to the prevalence of bloodborne infection in the patient population. Future studies could compare the reporting rate in a central London hospital where there is a higher prevalence of bloodborne viruses and surgeons may be more compliant with needlestick injury protocols. The persistently low reporting rate raises particular concern, especially when cases of HIV and HVC transmission between surgeons and patients have been documented in the UK.2 Resources need to be targeted at training and educating surgeons on the importance of reporting such injuries. Contact numbers for the Occupational Health physician and microbiologist should be displayed in theatres for urgent advice after a high-risk exposure and theatre sisters should be trained to follow the sharps incident protocol. The efficiency of the reporting process, especially when out of hours, needs improvement. One way would be to introduce an electronic bloodborne virus evaluation form on the Trust intranet which can be submitted online to Occupational Health. Reports should be risk-stratified and surgeons who have sustained a high-risk injury should be followed up at the first opportunity. In conclusion, there is a high frequency of needlestick injuries among surgeons, and until we have an efficient sharps injury protocol in place, the lengthy process of reporting, with the possibility of postponing surgery, means that it is not always practical to report every incident to Occupational Health. A new and efficient reporting
70
E. Au et al. Surgeons aged <35 years
Number per surgeon
Gen. Surg. P = 0.036
Urol. P = 0.00018
Ortho. P = 0.018
Surgeons aged >35 years
B
Number per surgeon
A 16 14 12 10 8 6 4 2 0
O&G
60 50 40 30 20 10 0
Gen. Surg.
Urol.
Ortho.
O&G
Figure 1 Rates within previous two years for total needlestick injuries (solid bars), injuries causing bleeding (hatched bars) and injuries (hollow bars) reported per surgeon aged >35 years (A) and <35 years (B) by specialty. Surgeons aged <35 years in general surgery (Gen. Surg.), urology (Urol.) and orthpaedics (Ortho.) had a significantly higher reporting rate compared with surgeons aged >35 years in the same specialties (P ¼ 0.036, P ¼ 0.00018, P ¼ 0.018 respectively). There were no needlestick injuries reported from surgeons aged <35 years in obstetrics and gynaecology (O&G).
system should be developed and made available at all institutions.
Conflict of interest statement None declared. Funding sources None.
References 1. Astbury C, Baxter PJ. Infection risks in hospital staff from blood: hazardous injury rates and acceptance of hepatitis B immunization. J Soc Occup Med 1990;40:92e93.
2. Health Protection Agency. Surveillance of occupational exposure to bloodborne viruses in healthcare workers; 15 November 2006. 3. Hettiaratchy S, Hassall O, Watson C, Wallis D, Williams D. Glove usage and reporting of needlestick injuries by junior hospital medical staff. Ann R Coll Surg Engl 1998;80:439e441. 4. Elder A, Paterson C. Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices. Occup Med (Lond) 2006;56:566e574. 5. Deisenhammer S, Radon K, Nowak D, Reichert J. Needlestick injuries during medical training. J Hosp Infect 2006;63:263e267. 6. Tabak N, Shiaabana AM, Shasha S. The health beliefs of hospital staff and the reporting of needlestick injury. J Clin Nurs 2006;15:1228e1239. 7. UK Department of Health. Recommendations of the expert advisory group on AIDS and the advisory group on Hepatitis. Guidance for clinical healthcare workers: protection against infection with blood-borne viruses. London: UK Department of Health; 2006.
Available online at www.sciencedirect.com
www.elsevierhealth.com/journals/jhin
The reporting of needlestick injuries sustained in theatre by surgeons: are we under-reporting? E. Au, J.A. Gossage*, S.R. Bailey Maidstone Hospital, Maidstone, Kent, UK Received 21 November 2007; accepted 17 April 2008 Available online 3 July 2008
KEYWORDS Needlestick; Sharps; Bloodborne; Gloves; Reporting
Summary Surgeons frequently sustain needlestick injuries when operating. The aim of this study was to evaluate the incidence and reporting rate of needlestick injuries at one institution. A questionnaire was distributed anonymously to 69 surgeons of all grades and specialties in a district general hospital in the UK. The questionnaire was returned by 42 surgeons (60.9%). There were 840 needlestick injuries over two years, of which 126 caused bleeding. Senior surgeons who spent more hours operating per week had a higher rate of needlestick injuries compared with junior surgeons (29.1 vs 6.59 injuries per surgeon over two years). Of the total number of injuries, 19 (2.26%) were reported to Occupational Health according to the surgeons questioned, but only six reported incidents were found in the Occupational Health records. Junior surgeons were significantly more likely to report needlestick injuries than senior surgeons (9.82% vs 1.10% of injuries reported, P ¼ 0.0000045). The main reasons for failure to report needlestick injuries were due to the lack of time and excessive paperwork. Seventy-three percent of surgeons did not routinely use double gloves when operating, mainly because of decreased hand sensation. The rate of needlestick injury reporting by surgeons at this institution is extremely low. Previous studies have shown a higher reporting rate suggesting that, despite awareness of bloodborne infections, surgeons are still not following recommended protocols. ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.
Introduction * Corresponding author. Address: Department of General Surgery, Maidstone Hospital, Maidstone, UK. Tel.: þ44 7803 726641. E-mail address: [email protected]
Surgical procedures are the most common cause of needlestick injuries in hospitals, with reported occupational exposures increasing significantly
0195-6701/$ - see front matter ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2008.04.025
Needlestick injuries in surgeons since 2002.1,2 These figures are thought to be an underestimation, as a proportion of injuries are still not reported, with surgeons being the least likely to attend Occupational Health out of all healthcare workers.3,4 Surgeons suffering from needlestick injuries carry a significant risk of exposure to bloodborne pathogens, such as hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency virus (HIV).5 The risk of transmission depends on the amount of patient’s blood transferred to the doctor and the infected patient’s viral load. The risk of transmission for HBV ranges from 22 to 31%, HCV from 2 to 3% and HIV ~0.3%.5,6 Following the UK Department of Health guidelines published in 2006, all surgeons should receive a full HBV vaccination course.7 In addition, the use of gloves when conducting invasive procedures and the reporting of needlestick injuries are recommended. This study reports the results of a survey conducted amongst surgeons in a district general hospital. The aim was to determine the actual incidence of sharps injuries over the last two years compared with the number of injuries reported to Occupational Health. The differences between specialties, age groups and the reasons for failure to follow reporting guidelines were also assessed.
Methods Questionnaire An 18-item questionnaire was used to determine the number of needlestick injuries within the last two years, the reporting rate of injuries and reasons for failure to report. In addition the survey also aimed to determine views on behavioural methods of protection against occupational exposures (e.g. double glove), HBV immunisation status and the compliance with post-exposure protocols.
Subject sample Sixty-nine questionnaires were distributed anonymously to surgeons of all grades who carried out surgical procedures in general surgery, obstetrics and gynaecology, urology and orthopaedics at a district general hospital in the UK.
67 associations between specialties and age groups regarding number of needlestick injuries, reported needlestick injuries and double glove usage were evaluated using two-sided Fisher’s exact test. To account for the difference in response rates, the data were normalised by calculating the number of injuries per surgeon within the last two years when comparing between specialties and age groups. Surgeons who did not respond to a specific question were excluded from that analysis.
Results Out of the 69 questionnaires, 42 were returned (60.9%). The response rate varied according to specialty and hospital post. The response rate was highest for general surgery and specialist registrars, and lowest in obstetrics and gynaecology and senior house officers. Of the respondents, 15 (35.7%) were consultants, 18 (42.9%) were specialist registrars and nine were senior house officers. Twenty-five (59.5%) respondents were older than 35 years and 17 (40.5%) were younger.
Double glove use Only 11 of 42 (26.2%) surgeons reported that they always use double gloves when operating, nine were orthopaedic surgeons and two were general surgeons. Double glove usage was 100% in orthopaedics compared with 11.1% in general surgery and 0% for both urology and obstetrics and gynaecology. In general surgery, junior surgeons aged <35 years had a higher double glove usage rate than senior surgeons aged >35 years (20 vs 7.7%). The majority of surgeons who did not use double gloves (71%) responded that doing so decreased hand sensation.
Special precautions with high-risk patients When operating on high-risk patients, most surgeons (52.4%) reported using three methods of protection: double gloves, eye protection and instrument-only suturing (Table I). Fewer senior surgeons and surgeons in obstetrics and gynaecology reported using more than two methods of protection in high-risk patients.
Compliance with post-exposure procedures and hepatitis vaccination
Data analysis Demographic data and frequency tables were compiled from the returned questionnaires. The
Only 23.9% of surgeons reported having complied with hospital post-exposure procedures after a needlestick injury. However, 85.7% were aware
68
E. Au et al.
Table I Extra methods of protection used by surgeons when operating on high-risk patients Special precautions with high-risk patients
Surgeons (%)
Double gloves, eye protection AND instrument-only suturing Double gloves AND eye protection Double gloves OR eye protection OR instrument-only suturing
52.4 31.0 16.6
of the existence of post-exposure protocols. All surgeons reported having been vaccinated against hepatitis B and 90.5% had had their antibodies checked in the last two years.
Table II Number of needlestick injuries reported in the questionnaire by surgeons in different specialties and age groups Category of surgeons
No. of needlestick injuries (% of total)
Specialty General surgery 60% (504/840) Urology 21.8% (183/840) Orthopaedics 10.6% (89/840) O&G 7.62% (64/840) Age group <35 years >35 years
No. of needlestick injuries per surgeon 28 26.1% 9.89% 8%
(504/18) (183/7) (89/9) (64/8)
13.3% (12/840) 6.59% (112/17) 86.7% (728/840) 29/1% (728/25)
O&G, obstetrics and gynaecology.
Incidence of needlestick injuries over two years There were 840 needlestick injuries over two years, of which 126 caused bleeding. The rate of needlestick injuries varied between specialties, being highest in general surgery (Table II). Junior surgeons also had a lower rate of needlestick injuries compared with senior surgeons who spent more hours operating per week (6.59 vs 29.1 injuries/surgeon).
Reported needlestick injuries
Reasons for failure to report needlestick injuries In all, 57.7% of surgeons responded that lack of time and excessive paperwork were the main reasons for not reporting an injury. A small percentage felt that Occupational Health did not provide adequate support for reporting procedures, such as out-of-hours access.
Discussion
Of the 840 needlestick injuries, 19 (2.26%) were reported according to the surgeons questioned. However, only six reported incidents were found in Occupational Health records. The survey showed that only 33.3% of surgeons reported their needlestick injuries. The reporting rate varied between grades of surgeons and specialties (Table III). Surgeons aged <35 years were significantly more likely to report their injuries than those >35 years (9.82% vs 1.10% of needlestick injuries reported, P ¼ 0.0000045). Overall, the reporting rate is extremely low in all specialties (Table IV, Figure 1).
Needlestick injuries are very common, especially in surgeons, but injury rates may be greatly underestimated due to under-reporting. This study demonstrated that the reporting rate of needlestick injuries at this institution was extremely low (2.26% of all needlestick injuries reported). More worryingly, there was a discrepancy between the number of needlestick injuries reported according to the survey and the actual number of incidents recorded by Occupational Health (19 versus six reports). Although the majority of surgeons were aware of the existence
Table III Percentage of surgeons who reported their needlestick injuries to Occupational Health within the last two years by specialty and hospital grade Total 33.3
Hospital post
Specialty
Cons.
SpR
SHO
Gen. Surg.
Urology
20
31.3
62.5
33.3
33.3
Ortho.
O&G
44.4
14.3
Cons., consultant; SpR, specialist registrar; SHO, senior house officer; Gen. Surg., general surgery; Ortho., orthopaedics; O&G, obstetrics and gynaecology.
Gen. Surg., general surgery; Ortho., orthopaedics; O&G, obstetrics and gynaecology. Surgeons aged <35 years were significantly more likely to report needlestick injuries than surgeons aged >35 years in the same specialties. There was no significant difference in reporting rates between specialties.
1.56% (1/64) 0 0.552% (1/181) 1.38% (6/435) 0 12.2% (5/41) P ¼ 0.018 100% (2/2) P ¼ 0.00018
Ortho. Urology O&G Ortho.
Surgeon <35 years
Urology Gen. Surg.
5.80% (4/69) P ¼ 0.036 No. of injuries reported (%)
Table IV
Number of needlestick injuries reported within the last two years by specialty
Gen. Surg.
Surgeon <35 years
O&G
Needlestick injuries in surgeons
69 of post-exposure protocols (85.7%), a very small proportion reported having actually complied with the guidelines (23.9%). Senior surgeons operating the most hours per week suffered a higher injury rate and were less likely to report compared with junior surgeons. There was a 100% hepatitis B vaccination rate in both junior and senior surgeons since this is a compulsory NHS Trust procedure for all doctors. The low reporting rate at our institution reflects surgeons’ perception of transmission risks. It has been shown that health beliefs affect a doctor’s compliance in reporting needlestick injuries.6 Compliers tend to perceive their susceptibility to contracting disease and the benefit of reporting more highly than non-compliers who emphasise the inconvenience of reporting such injuries. Overall, the results of this study suggest that surgeons at this institution failed to report the majority of needlestick injuries and only used double gloves when operating on high-risk patients. Although the reporting rate was very low at this institution, results may vary between hospitals according to the prevalence of bloodborne infection in the patient population. Future studies could compare the reporting rate in a central London hospital where there is a higher prevalence of bloodborne viruses and surgeons may be more compliant with needlestick injury protocols. The persistently low reporting rate raises particular concern, especially when cases of HIV and HVC transmission between surgeons and patients have been documented in the UK.2 Resources need to be targeted at training and educating surgeons on the importance of reporting such injuries. Contact numbers for the Occupational Health physician and microbiologist should be displayed in theatres for urgent advice after a high-risk exposure and theatre sisters should be trained to follow the sharps incident protocol. The efficiency of the reporting process, especially when out of hours, needs improvement. One way would be to introduce an electronic bloodborne virus evaluation form on the Trust intranet which can be submitted online to Occupational Health. Reports should be risk-stratified and surgeons who have sustained a high-risk injury should be followed up at the first opportunity. In conclusion, there is a high frequency of needlestick injuries among surgeons, and until we have an efficient sharps injury protocol in place, the lengthy process of reporting, with the possibility of postponing surgery, means that it is not always practical to report every incident to Occupational Health. A new and efficient reporting
70
E. Au et al. Surgeons aged <35 years
Number per surgeon
Gen. Surg. P = 0.036
Urol. P = 0.00018
Ortho. P = 0.018
Surgeons aged >35 years
B
Number per surgeon
A 16 14 12 10 8 6 4 2 0
O&G
60 50 40 30 20 10 0
Gen. Surg.
Urol.
Ortho.
O&G
Figure 1 Rates within previous two years for total needlestick injuries (solid bars), injuries causing bleeding (hatched bars) and injuries (hollow bars) reported per surgeon aged >35 years (A) and <35 years (B) by specialty. Surgeons aged <35 years in general surgery (Gen. Surg.), urology (Urol.) and orthpaedics (Ortho.) had a significantly higher reporting rate compared with surgeons aged >35 years in the same specialties (P ¼ 0.036, P ¼ 0.00018, P ¼ 0.018 respectively). There were no needlestick injuries reported from surgeons aged <35 years in obstetrics and gynaecology (O&G).
system should be developed and made available at all institutions.
Conflict of interest statement None declared. Funding sources None.
References 1. Astbury C, Baxter PJ. Infection risks in hospital staff from blood: hazardous injury rates and acceptance of hepatitis B immunization. J Soc Occup Med 1990;40:92e93.
2. Health Protection Agency. Surveillance of occupational exposure to bloodborne viruses in healthcare workers; 15 November 2006. 3. Hettiaratchy S, Hassall O, Watson C, Wallis D, Williams D. Glove usage and reporting of needlestick injuries by junior hospital medical staff. Ann R Coll Surg Engl 1998;80:439e441. 4. Elder A, Paterson C. Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices. Occup Med (Lond) 2006;56:566e574. 5. Deisenhammer S, Radon K, Nowak D, Reichert J. Needlestick injuries during medical training. J Hosp Infect 2006;63:263e267. 6. Tabak N, Shiaabana AM, Shasha S. The health beliefs of hospital staff and the reporting of needlestick injury. J Clin Nurs 2006;15:1228e1239. 7. UK Department of Health. Recommendations of the expert advisory group on AIDS and the advisory group on Hepatitis. Guidance for clinical healthcare workers: protection against infection with blood-borne viruses. London: UK Department of Health; 2006.