Needle injuries often not reported by med students

Medical students are commonly stuck by needles but often fail to report their injuries to employee health services, placing them at risk for hepatitis, HIV and other blood borne diseases, results of a survey show.

The problem, Dr. Martin A. Makary of Johns Hopkins University, Baltimore notes in a prepared statement, is that hospitals are not creating a culture of speaking up. If people are not speaking up regarding their own safety concerns, it's probably a surrogate marker of people not speaking up about patient safety concerns.

Dan Henderson, third year medical student and Health Justice Fellow at the American Medical Student Association, in Reston, Virginia told Reuters Health: When you are a medical student, new to a surgical or medical rotation, you are at the bottom of the totem pole. That totem pole really creates a lot of pressure not to speak up about safety issues, particularly things like needlesticks.

Makary and colleagues surveyed a group of surgical residents at 17 medical centers about needlestick injuries they sustained while in medical school or residency.

The report in the latest issue of Academic Medicine that 582 (83 percent) of 699 survey respondents experienced a needlestick injury as a resident and 415 (59 percent) as a medical student, with an average of 2 injuries per respondent in the student group.

Most of the needlestick injuries among medical students were self-inflicted, occurred in the operating room, or when the student felt rushed. It's definitely an issue for medical students; I haven't had any needle sticks myself, although I have been close, but I have several friends who have been stuck, Henderson said.

In the survey, among 89 residents who sustained their most recent needlestick injury during medical school, 42, or 47 percent, did not report the incident to the appropriate person. The most common reason cited for the lack of reporting was the amount of time required to file a report.

Reporting a mishap is a very cumbersome and emotional process that some students would rather not think about, Henderson said. Those medical students who don't report (a needlestick injury) are really gambling that their stick wasn't going to be the 1 out of 100 or 1 out of 1000 that actually spreads a disease.

In Makary's opinion, Medical schools are not doing enough to protect their students and hospitals are not doing enough to make medical school safe.

We, as a medical community, are putting our least skilled people on the front lines in the most high-risk situations. Most trainees are still forced to learn to sew and stitch on patients, which puts both providers and patients at risk, Makary warned.

Makary and colleagues would like to see medical school programs emphasize safe operating room techniques and promote the use of new safe-needle technologies. Video trainers, human patient simulators and virtual reality computer-based trainers, they point out, have all been shown to teach and improve surgical skill sets, and should be incorporated into the training curriculum for medical students.

Additionally, they call for medical centers to implement strategies aimed at improving reporting systems and creating a culture of reporting.

The culture is changing but it's very slow to change, Henderson said. Certainly, having a fast reporting system that is easy and doesn't punish people or make you feel like you made a mistake would be a good first step.

SOURCE: Academic Medicine, December 2009.