Study Finds Many Injuries to Surgeons Go Unreported

By LAWRENCE K. ALTMAN
Nearly all surgeons accidentally stick themselves with needles and sharp instruments while in training. But most fail to report the injuries, risking their health and that of their families and patients to the threat of diseases including AIDS, hepatitis and many other blood-borne illnesses, according to a survey being published today.
Their being rushed was the chief reason the surgical residents cited for the injuries, which were mostly self-inflicted. Among the reasons they cited for not reporting the potentially fatal injuries was that doing so would take too much time, could jeopardize career opportunities and might cause a loss of face among peers.
In addition, there was a false belief that getting even timely medical attention would not prevent infection. In fact, immediate treatment with antiviral drugs can prevent infection among those stuck with needles while caring for patients with the viruses that cause AIDS and hepatitis B. Immediate treatment can also prevent chronic infection among those infected with hepatitis C virus.
The survey, being published in The New England Journal of Medicine, was conducted by researchers at Georgetown University and Johns Hopkins University, and involved 699 doctors who in 2003 were surgical residents at 17 medical centers in the United States.
The findings are further evidence of a need to strengthen protection measures recommended by experts like Dr. Julie L. Gerberding, now director of the Centers for Disease Control and Prevention, from the many studies they began conducting in the 1980s, soon after the discovery of AIDS.
Surgeons have been urged to provide more specific instruction to trainees about safe techniques and what to do if injured. Other infection-reducing measures directed at surgeons include: wearing two sets of surgical gloves; substituting electric scalpels, clips and glues for sharp instruments; improving techniques for handing instruments from one health care professional to another; using postoperative checklists; and increasing the use of nurse practitioners and physician assistants to reduce surgical workloads. For those who experience needle stick injuries, additional steps include use of internal hot lines to summon response teams.
“Every operating room and training program should insist on the use of these techniques,” said Dr. William Schaffner, chairman of preventive medicine at Vanderbilt University, who was not involved with the new study.
In addition, infection control experts have urged doctors to apply the same precautions in caring for all patients rather than make judgments about the risks of infection in a particular case. Studies have shown that doctors underestimate the likelihood that one of their patients may be silently infected with a blood-borne virus.
But “this concept of standard precautions has not yet been deeply rooted in many trainees,” Dr. Schaffner said.
The survey’s senior author, Dr. Martin A. Makary, a surgeon at Johns Hopkins, said in an interview that surgeons had made “little progress in the last 20 years” in preventing needle stick injuries. And hospitals, he said, “are not doing what they should to care for their own providers, their families and patients.”
Dr. Makary said he had undertaken the study in part because two friends of his, both surgeons, had experienced serious emotional trauma after being stuck by needles while treating patients who had documented cases of AIDS and hepatitis C.
Such an experience among surgeons in training “traumatizes their psyche on top of the stress of residency,” Dr. Makary said.
“They do not know whether to tell their significant other,” he said, “and if they do report it to hospital officials, they worry about being stigmatized.”
An estimated 800,000 needle stick injuries occur each year among health care workers in this country. Of the participants in Dr. Makary’s confidential survey, 99 percent had experienced at least one needle stick injury by the end of the fifth and last year of surgical training (the average was eight such injuries). Of these, 51 percent failed to report their injuries to an employee health service as some hospitals require.
Of those who did report, 53 percent had been stuck while working on a patient at high risk for common, potentially fatal infections. The strongest predictor for reporting was someone else’s knowledge about the injury.