Monthly Needlestick Rates Suggest a Steep Learning Curve

Laird Harrison

November 04, 2020

The rate of injuries with needles and other sharp instruments among hospital staff jumped sharply in July, suggesting the need for safety instruction early in the academic year, researchers say.

Dr Jonathan Zampella

"The reason this is important is it gives us an idea of when the best time to intervene might be," said Jonathan Zampella, MD, an assistant professor of dermatology at New York University (NYU) Grossman School of Medicine, New York City.

The findings were published online today in a research letter in JAMA Surgery.

Hundreds of thousands of healthcare workers incur injuries with needles and other sharp instruments every year, which places them at risk for bloodborne infections.

"Especially amongst dermatologists, it's not a question of if you get stuck, it's a question of when," Zampella told Medscape Medical News. "Most have been stuck at some point in their lives."

Until now, studies of these injuries have mostly depended on surveys, he said. By contrast, for the current study, Zampella and colleagues used a dataset of injuries reported to NYU Langone Health's Occupational Health Services.

They identified 5395 such injuries that occurred between January 2000 and February 2020. The total number was similar among surgical and nonsurgical specialists, but the mean incident rate was 4.7 for every 10 people among the nonsurgical staff vs 9.4 for every 10 people in the surgical staff.

Zampella and colleagues further found that the highest rate of injury, at 16.0 incidents for every 10 people, occurred among urology house staff, followed by orthopedic surgery staff, with 14.1, and general surgery staff, with 14.0. The lowest staff rates were among psychiatrists (0.3), radiation oncologists (1.1), and neurologists (2.4).

But even some nonsurgical specialties had high rates. For example, the rate was 11.5 for pathology house staff and 11.3 for dermatology house staff.

Zampella said his first reaction to the data was, "What the heck? What are pathologists doing that they are getting needlestick injuries?

"But it makes sense," he said. "Sometimes they do biopsies, and they do fine-needle aspirations ― these kinds of things that we might not be paying as much attention to as we should."

The finding suggests that nonsurgical specialists should receive more training in injury prevention, he said.

The training should be in person, and it should not just be for first-year residents. "Everybody needs to have refreshers on preventing needlesticks," he said. "And we have to make sure everyone in the hospital is playing for the same team. Residents are learning, and if they see poor technique by one of their attendings, that's something they may imitate."

The study's primary conclusion regards the importance of seasonality in needlestick and other injuries from sharp instruments.

Among house staff, 9.4% of the injuries occurred in July. The proportion then gradually rose to 10.5% in October before gradually going back down to a low of 6.2% in June.

The difference from one quarter to the next was statistically significant (P = .02).

July is when internships and residencies start, Zampella pointed out. Among the nonhouse staff, the rate was consistent throughout the year.

This suggests that the beginning of the academic year for trainees was the key factor driving the uptick in injuries, he said.

He believes that residents are receiving instruction in injury prevention, but perhaps not at the right time of year. For example, dermatology residents at NYU are given a lecture in needlestick injury prevention in February.

Zampella has received personal fees from X4 pharmaceuticals. The other authors disclosed no relevant financial relationships.

JAMA Surgery. Published online November 4, 2020. Abstract

Laird Harrison writes about science, health and culture. His work has appeared in magazines, newspapers , and online publications. He is at work on a novel about alternate realities in physics. Harrison has taught writing at San Francisco State University, UC Berkeley Extension and the Writers Grotto. Visit him at lairdharrison.comor follow him on Twitter: @LairdH .

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