Needlestick injuries among medical students

doi:10.1067/mic.2003.44

American Journal of Infection Control

Volume 31, Issue 4, June 2003, Pages 226-230

https://doi.org/10.1067/mic.2003.44 Get rights and content

Abstract

Background: Concern about occupational exposure to bloodborne pathogens exists, and medical students, who lack in experience in patient care and surgical technique, may be at an increased exposure risk. Methods: This prospective cohort study evaluated needlestick injuries and practices regarding the use of protective strategies against bloodborne pathogens in medical students. A questionnaire was developed and sent to 224 medical students. Results: Of 224 students, 146 students (64%) returned questionnaires. Forty-three students (30%) reported needlestick injuries that most commonly occurred in the operating room; 86% of students reported always using double gloves in the operating room; 90% reported always wearing eye protection, and all but one student had been vaccinated against hepatitis B. A concern about contracting a bloodborne pathogen through work was noted in 125 students, although they usually reported that this concern only slightly influenced their decision regarding a career subspecialty. Conclusion: Medical students have a high risk for needlestick injuries, and attention should be directed to protection strategies against bloodborne pathogens. (Am J Infect Contol 2003;31:226-30.)

Section snippets

Questionnaire

A 53-item questionnaire concerning frequency and reporting of needlestick injuries, protection strategy education, double glove practices, knowledge of seroconversion rates, and concerns regarding bloodborne pathogens was developed. After approval by the Human Studies Committee at Washington University School of Medicine, mailing lists for third- and fourth-year medical students of the 1999 to 2000 academic year were compiled.

Subject sample

In October 1999, questionnaires and cover letters were mailed to all

Results

There were 143 surveys returned (64%), including 86 third-year (70%) and 57 fourth-year students (56%). Significantly more third-year than fourth-year students responded to the survey (P =.04). The response group included 78 women and 62 men; no sex response was given for 3 of the returned surveys. The average age of the students responding was 26 years (range, 23-29 years; SD, 3 years).

Discussion

Bloodborne pathogens may be transmitted by various methods including needlestick injuries. Medical students lack expertise in many procedures, and exposure to blood and body fluids has been documented at a high rate among medical students.22, 23, 24, 25, 26 Rosenthal et al²⁵ reported that 24% of students in their final years of training had sustained at least 1 blood exposure accident. Shen et al²² reported 33% of fourth-year medical students had at least 1 needlestick or sharp object injury.

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Accidental exposure to percutaneous needle stick and sharp injuries (NSSIs) and blood and other body fluids is the unintended contact with risky medical instruments or patient secretions during a medical intervention. During the COVID-19 pandemic, the significance of occupational injuries in healthcare professionals was revealed once again. To assess the occupational injuries, we compared rates, distribution and type of exposure to blood and body fluids and NSSIs of health care workers for 2019 (pre-pandemic era) and 2020 (pandemic era) years, respectively.
Our study included data collected by the ‘Hospital Infection Control Committee’ for the years 2019–2020. Data collected using the active surveillance method were analyzed retrospectively.
During 2019 (pre-pandemic period) and 2020 (pandemic period), 112 (27.65%₀) and 82 (21.4%₀) NSSIs reported, respectively. Of the exposed HCWs in 2019 (pre-pandemic period), 16.8%₀ (14) were doctor, 53.6%₀ (60) were nurse and 47.4%₀ (14) were intern doctors. In the 2020 (pandemic period), NSSIs were observed most frequently in nurses and cleaning staff, 50.24%₀ and 33.64%₀, respectively. Concerning the total percentage of exposure to blood and other body fluids, a slight increase was revealed from 1.48%₀ to 2.62%₀ in 2019 and 2020, respectively. A significant decrease in exposure rate was reported among the doctors between the pre-pandemic and pandemic era; 3.6%₀ and 1.19%₀ at 2019 and 2020, respectively. A significant increase in exposure rate was reported among the nurses between pre-pandemic and pandemic era; 0.8%₀ and 6.89%₀, respectively.
In conclusion, the exposure to NSSIs during the pandemic period decreased; however, there was no severe difference at pre-pandemic and pandemic periods concerning exposure to blood and body fluids. Well-designed training and awareness programs can be effective in preventing exposure to NSSIs and blood and other body fluids and exposure to respiratory acquired viruses.
Systematic Review of Blood-borne Pathogen Exposure Rates Among Medical Students
2020, Journal of Surgical Research
Blood-borne pathogen exposures (BBPEs) pose a risk to health care workers (HCWs). Needlestick injuries (NSIs) have declined overall, but not for surgical HCWs. There are limited data regarding BBPEs among medical students (MSs) in their clinical years. We aimed to quantify this risk for third- and fourth-year MSs.
A literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PUBMED database was searched to identify studies of third- and fourth-year MSs using the terms BBPE, NSI, and MS. Studies of other HCWs were excluded if MS data were not extractable. Additional studies were identified from references. Descriptive analysis was performed.
Seven of 171 articles published from 2002 to 2018 met study criteria. All used self-reported data from surveys/questionnaires. One-third of MSs reported BBPEs (n = 194/600, 32.3%) with a mean of 1 in 3.09 and a median of 1 in 3.53 (range: 1 in 1.9-8.3 students). Most events were NSIs (144/194, 74%) with a mean of 1 NSI per 4.05 MSs and median of 1 in 4.625 (range: 1 in 2.47-10.71). The remaining BBPEs reported included blood and bodily fluid splashes (n = 37, 19%), other mucocutaneous exposures (n = 7, 3.6%), and uncategorized injuries (n = 2, 1%).
One-third of senior MSs reported BBPEs during clinical rotations. Most BBPEs were NSIs. Quantifying this risk allows for anticipatory education and protocol development to protect students and other new HCWs. Educational efforts focused on NSI prevention before and during clinical rotations may help reduce BBPEs.
The State of Needlestick Training for Undergraduate Medical Students at Canadian Universities
2019, Journal of Obstetrics and Gynaecology Canada
Canadian undergraduate medical students sustain needlestick injuries, which have adverse implications, including blood-borne illnesses and personal anxiety. This study sought to determine students’ needle handling efficacy and to examine the prevalence of formal training around needlestick safety and reporting procedures both nationally and, specifically, within the University of Toronto in Toronto, Ontario (U of T). A seven-question survey electronic survey was distributed to 116 undergraduate medical education (UME) leaders practising in high-risk rotations at 13 Canadian universities. Additionally, an eight-question survey was delivered electronically to 428 residents, fellows, and faculty in the Department of Obstetrics and Gynaecology at the U of T. A total of 34% of UME leaders and 36% from the U of T responded. Of UME respondents, 53% reported that their institution lacks needlestick training, and 35% were unsure whether their institution provides reporting instruction. At the U of T, 53% were “concerned” or “very concerned” that students pose a risk to themselves, and 27% “disagreed” or “strongly disagreed” that students handle instruments correctly. Our findings suggest that needlestick safety training for medical students across Canadian universities is insufficient. It is concerning that students are frequently exposed to patients in high-risk and surgically intensive rotations, despite their inexperience with needles. Furthermore, non-reporting among students may prevent them from receiving early prophylaxis or treatment. There is a need for the national implementation of a standardized and formalized needlestick safety curriculum for medical students before and during clerkship.
Les étudiants canadiens de premier cycle en médecine subissent des blessures par piqûres d'aiguille, qui entraînent des effets indésirables comme la transmission de maladies à diffusion hématogène et l'anxiété. Cette étude visait à établir l'efficacité des techniques de manipulation d'aiguilles des étudiants et à examiner la prévalence de mesures d'éducation formelle sur la sécurité lors de l'utilisation d'aiguilles et de procédures de signalement d'incident, à l'échelle nationale et plus particulièrement à l'Université de Toronto, à Toronto (Ontario). Un sondage en ligne comportant sept questions a été envoyé à 116 leaders de la formation de premier cycle en médecine exerçant en contexte de stages à haut risque dans 13 universités canadiennes. De plus, un sondage en ligne comportant huit questions a été envoyé à 428 résidents, boursiers et membres du corps professoral du département d'obstétrique et de gynécologie de l'Université de Toronto. Au total, 34% des leaders de la formation et 36 % des sondés de l'Université ont répondu au sondage. Parmi les leaders de la formation ayant répondu, 53% ont déclaré que leur établissement n'offrait pas de formation liée à l'utilisation d'aiguilles, et 35% d'entre eux n'étaient pas certains si leur établissement avait des consignes de signalement d'incidents. À l'Université de Toronto, 53% des répondants se disaient « préoccupés » ou « très préoccupés » du risque que présentaient les étudiants pour eux-mêmes, et 27% étaient « en désaccord » ou « fortement en désaccord » avec l'énoncé selon lequel les étudiants manipulaient les instruments adéquatement. Les résultats montrent que la formation sur l'utilisation sécuritaire des aiguilles par les étudiants en médecine des universités canadiennes est lacunaire. Il est donc inquiétant que les étudiants soient fréquemment exposés à des patients dans le cadre de stages à haut risque et de stages comportant un volet chirurgical important, malgré leur inexpérience avec les aiguilles. Par ailleurs, le non-signalement d'incidents par les étudiants pourrait les empêcher de recevoir rapidement un traitement prophylactique ou curatif. Il faudrait mettre en place une formation normalisée sur l'utilisation sécuritaire des aiguilles par les étudiants en médecine, à la fois avant et pendant leurs stages cliniques.
Evaluating the Effectiveness of a Continuing Education Program for Prevention of Occupational Exposure to Needle Stick Injuries in Nursing Staff Based on Kirkpatrick's Model
2018, Journal of the National Medical Association
Nurses are the most vulnerable group that are faced with occupational injuries caused by exposure to needle stick injuries. This study evaluated the effectiveness of a continuing education program about the prevention of occupational exposure to needle stick injuries in the nursing staff, based on the Kirkpatrick model.
In this study, 120 nurses were selected in the experimental and control groups. A continuing education program for experimental group was performed. After the education program, its effectiveness has been evaluated across four levels (Reaction, Learning, Behavior, Results) of the Kirkpatrick model. Data analysis was conducted using Pearson's correlation coefficient, chi-square test, paired t-test, independent samples t-test, and descriptive statistics. The data were analyzed using the SPSS statistical software (V. 22).
The mean score for knowledge in the experimental group improved significantly from 8.32 ± 2.17 to 13.98 ± 1.2 (p < 0.05). The experimental group of 24 nurses (40%) were exposed to needle stick injury before education, but this number was reduced to 9 (15%) after intervention. The chi-square test showed a significant difference (P = 0.013). However in the experimental group, 15 nurses (25%) were exposed to blood and body fluids before intervention, but again it was reduced to 6 (10%) after education. The chi-square test showed a significant difference (P = 0.002).
The results from the execution of continuing education program showed that through designing training programs and raising awareness in nursing personnel, we can reduce occupation exposure to needle stick injuries.
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Meticulous observance of standard infection control precautions by health care providers is strongly recommended for every patient encounter. Assessment of nursing students’ compliance should be carried out regularly in order to ensure adherence to protocols. Thus, this study was conducted to assess self-reported compliance with standard precautions among baccalaureates in nursing students in a Saudi university. A convenience sample of 236 nursing students was surveyed in this cross-sectional, self-reported study, using the Compliance with Standard Precaution Scale Arabic version (CSPS-A). Independent t-test and one-way analyses of variance (ANOVA) were performed to examine the differences on compliance. A multiple regression analysis was performed to identify the factors affecting compliance. The overall compliance rate was 61.0%. The students reported highest compliance in disposing used sharp instruments and other sharp objects into sharps-only boxes, while the lowest compliance rate in using water only for hand washing. Significant differences in compliance were observed when respondents were grouped according to their demographic characteristics. Cultivating a supportive culture of adherence to infection control precautions among nursing students is of paramount importance. The clinical environment should be supportive of a culture where strict compliance with the control and prevention of infection is of prime importance.
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^*: Reprint requests: Susan E. Mackinnon, MD, FACS, Division of Plastic and Reconstructive Surgery, Ste 17424, East Pavilion, One Barnes-Jewish Hospital Plaza, St Louis, MO 63110.

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Major ArticlesNeedlestick injuries among medical students*

Abstract

Section snippets

Questionnaire

Subject sample

Results

Discussion

Am J Infect Control

AORN J

J Hosp Infect

Prev Med

Am J Infect Control

Am J Infect Control

Am J Infect Control

Am J Infect Control

Am J Infect Control

Am J Med

Am J Infect Control

Ann Emerg Med

Am J Infect Control

Am J Obstet Gynecol

Surgeons' concern and practices of protection against bloodborne pathogens

Ann Surg

Practical precautions for avoiding sharp injuries and blood exposure

Plast Reconstr Surg

Reported use of strategies by surgeons to prevent transmission of bloodborne diseases

Can Med Assoc J

Assessment of hepatitis B virus immunization status among North American surgeons

Arch Surg

Surgical gloves as a mechanical barrier against human immunodeficiency viruses

Br J Surg

Efficacy of double versus single gloving in protecting the operating team

Aust N Z J Surg

Management of occupational exposures to blood-borne viruses

N Engl J Med

Universal precautions: an update

Heart Lung

Universal precautions: an update

Occup Environ Med

Risk to surgeons: a survey of accidental injuries during operations

Br J Surg

Major Articles
Needlestick injuries among medical students*