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NEWS: New York Most US surgeons in training get needlestick injuries, few report them BMJ 2007; 335: 10-a-11-a [Full text]

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Under-reporting of needlestick injuries is a universal problem

Chidi C Ekwobi, Dilnath A. Gurusinghe   (12 July 2007)

Under-reporting of needlestick injuries is a universal problem 12 July 2007
Chidi C Ekwobi, Clinical Fellow in Plastic Surgery The Royal Preston Hospital, Sharoe Green Lane, Preston, PR2 9HT, Dilnath A. Gurusinghe Send response to journal: Re: Under-reporting of needlestick injuries is a universal problem	Needle-stick injuries within surgical specialties remains and intractable occupational hazard and most of the issues in New York are applicable in the UK. Trends in the levels of reporting seem similar to those in previously published studies (1,2). Many factors surrounding the circumstances in which the injuries occur, contribute to the low reporting rate. Often junior colleagues can find themselves working alone on lists when they experience a needle-stick injury. In such situations there is a pressure to complete operations as frequently it is not practical to find a replacement. As mentioned most of these injuries occur during the procedure – what is one to do with a patient on the table? Incident reporting forms can take a significant time to complete when needle-stick injuries occur. When a patient is involved as a donor in such incidents, consent needs to be obtained so that they can be screened. Not only that but they have to be counselled with regard to the viruses being tested for and as good practice dictates this should be by personnel who are not involved. The process is made more difficult that in a proportion of cases the donor is a patient who has had general anaesthesia. We have observed that mental risk assessment with regard to the background of the patient involved, surgeons can at times perform before embarking on such a course. It is not a replacement for proper reporting. Out of hours another barrier to prompt management is that there is often no access to occupational health services. Yes good advice is readily available over the phone - but over half of affected healthcare personnel will be forced to attend the Emergency Department (3). Increasingly and possibly rightly so no preferential treatment is given to staff to receive immediate treatment. Long waits in Emergency Departments, in addition to the time it takes to get there, means that the window for treatment in terms of HIV prophylaxis can be missed. The situation will not change until there is greater compulsion for surgeons to report needle-stick injuries with parallel improvements in the ease of access to hospital services. 1. Elmiyeh B, Whitaker IS, James MJ, Chahal CA, Galea A, Alshafi K. Needle-stick injuries in the National Health Service: a culture of silence. J R Soc Med. 2004 Jul;97(7):326-7 2. Wallis GC, Kim WY, Chaudhary BR, Henderson JJ. Perceptions of orthopaedic surgeons regarding hepatitis C viral transmission: a questionnaire survey. Ann R Coll Surg Engl. 2007 Apr;89(3):276-80 3. Johnston JJ, O'Conor E. Needlestick injuries, management and education: a role for emergency medicine? Eur J Emerg Med. 2005 Feb;12(1):10-2. Competing interests: None declared