Needlestick injuries in emergency medicine trainees

Clinical bottom line

Emergency medicine residents in their first four years of training have a high rate of exposure to blood.

Reference

CH Lee. Occupational exposures to blood among emergency medicine residents. Academic Emergency Medicine 1999 6: 1036-1043.

Study

The study was a survey of 3,239 participants in a national in-service examination to all emergency medicine residents in the USA. It was delivered on February 24 1998, and there were 2,995 (90%) responses. About 10% were in the fourth training year, with the remaining 90% slit about evenly between years 1-3.

The questionnaire was in two parts, with 39 multiple-choice questions, 29 about blood borne occupational exposure and nine about respiratory exposure to tuberculosis.

Results

Residents were often exposed, with 56% having at least one exposure, and one in 10 having four or more exposures (Table 1).

Table 1: Residents with occupational exposures

Number of exposures	Percent of residents
0	44
1	24
2	16
3	7
4 or more	9

The usual place of exposure was the emergency department (72%) rather than wards (15%). Solid needles or sharp objects accounted for 40% of latest exposures, with hollow bore needles accounting for 31%. Eye splashes made up 17%. At the time of exposure 92% were wearing gloves, 41% eye protection, and 30% masks.

Only 40% of patients involved in the exposure were known to be HIV negative. Six percent were definitely positive, and at least another 10% had risk factors, but with unknown status.

The circumstances relating to the exposures was interesting, and some of these are shown in Table 2. Recapping needles accounted for 13% of exposures.

Table 2: Circumstances of exposure

Circumstance (at least one exposure)	Percentage
Uncooperative or belligerent patient	32
Several people performing multiple procedures	52
Rushed for time	49
Recapping needle	13

Only 47% of exposures were reported to the appropriate health support systems, mostly because residents considered post-exposure counselling inadequate. Testing for HIV or hepatitis was done in about half of exposed residents, and HIV prophylaxis in only half residents exposed.

Effect of experience

Residents more advanced in training were more likely to report at least one exposure, and more likely to report a higher number of exposures. Residents always using universal precautions reported fewer exposures than all other groups (Figure 1).

Figure 1: Use of universal precautions

Comment

This is a particularly well done survey with a high participation rate. It shows that emergency medicine residents have a high rate of occupational exposure to blood.