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News USA

Injuries caused by the use of surgical instruments or needles always carry the risk of acquiring a disease from a patient. (Photo: Ioan Sorin Ursu/Shutterstock)
Apr 16, 2013 | News USA

Researchers review potential impact of instrument-caused injuries

by Surgical Tribune

PHILADELPHIA, Pa., USA: Nearly 400,000 injuries caused by needles or sharp instruments occur each year in the U.S., according to a recent review in the Plastic and Reconstructive Surgery journal. About 25 percent of injured workers are surgeons. The main health concern with such injuries is the risk of acquiring a communicable disease from a patient.

Injuries caused by needles and other sharp instruments are a major occupational hazard for surgeons — with high costs related to the risk of contracting serious infectious diseases. "Despite health care policies designed to protect health care workers, injuries remain common," surgeon Dr. Kevin C. Chung, member of the American Society of Plastic Surgeons, and colleagues at the University of Michigan Health System, Ann Arbor, wrote in their review.

Nearly all surgeons will sustain a sharps injury sometime during their career. Medical students and residents are also at high risk; fatigue and inexperience are important risk factors.

The risk of acquiring a disease from a patient is always present. While contracting HIV is the most-feared situation, the risk of infection with the hepatitis B virus is indeed much higher. Additionally, sharps injuries can have a major psychological impact on the injured person and his or her family — particularly during the period in which it is established whether the injured worker is free of infection, which may take several weeks or months.

Once an injury occurs, there are standardized guidelines for post-exposure prevention, depending on whether the patient has any known transmissible infections. Recommendations include antiviral medication for health care workers exposed to HIV and the hepatitis B or C virus — ideally starting within hours after the injury.

High costs for tests

Owing to the need for testing and treatment, sharps injuries have a major economic impact. Average costs for testing, follow-up and preventive treatment range from $375 for needlestick exposure to a patient with no known bloodborne illness, up to nearly $2,500 for injuries from sharps contaminated with blood from a patient with HIV.

Post-exposure prevention can only be executed if the injury is reported. One study found that 70 percent of surgeons never or rarely report sharps injuries. They may feel that they have insufficient time to report, or may underestimate the risks involved.

"Fortunately, the majority of sharps injuries are preventable," according to Chung and his colleagues. Engineered safety devices can prevent many injuries, especially if surgeons and other workers are involved in the decision to use them. Other options include the use of nonsharp alternatives, establishing safe procedures for passing sharp instruments and wearing double gloves to reduce the risk of infection.

Success of regulations disputed

Over the years, regulations have been introduced to ensure that proper prevention and reporting strategies are in place. The introduction of the Needlestick Safety and Prevention Act of 2000 led to a 38 percent overall reduction in injuries in all care settings. However, one study reported that the rate of sharps injuries in the operating room had actually increased. "Although preventive strategies exist, their success ultimately relies on clinician compliance," Chung and co-authors write.

The authors hope their review will help to increase awareness of the risks and potential harms of sharps injuries among surgeons and operating room personnel, and to increase awareness of efforts to reduce the risk. They conclude: "Targeting educational initiatives during medical school and training may improve knowledge among surgeons of the safest ways to practice in the operating room, and ensuring compliance among all surgeons in practice can reduce the economic and psychosocial burden of these highly prevalent injuries."

The review, titled "Sharps Injuries: The Risks and Relevance to Plastic Surgeons," was published in the April issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons. It can be viewed free on the journal's website.

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