Karl B. Hille, The Examiner
2007-06-29 07:00:00.0
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BALTIMORE -

Working too fast can be deadly.

Johns Hopkins researchers found that while only 1 in 100 surgical residents does not get accidentally stuck by a needle during his residency, only half those injured are reporting incidents.

The main reason for the failure to report the incident appeared many times in surgeons’ survey responses. It takes “too much time,” even when the needle-stick injury involves a patient whose blood may be a source of HIV, hepatitis or other infectious virus.

Resolving the issue may require new procedures, training and a change of the culture of the emergency room, said Dr. Martin Makary, the lead author of the study and a surgeon at Johns Hopkins Hospital.

“There’s no quick fix to cultural problems,” Makary said. “Surgeons accept a certain amount of personal risk in going into this field.”

Published on Thursday in the New England Journal of Medicine, the study contacted about 700 surgical residents spread throughout 17 U.S. medical centers.

Makary recommends a multitiered approach, including education about infection prevention, less dangerous equipment and procedures, and getting champions in the medical field to try to turn around opinions and attitudes about reporting even minor injuries.

“Approximately 20 percent of general surgical techniques are suitable for sharpless techniques,” Makaray said. Tools like electric scalpels, and using clips and glues instead of stitches, especially with infected patients, can help cut down the level of risk.

Establishing standards for handling “sharps” in the operating room would help, he said. Suggestions include establishing a standard “safe zone” or procedure for disposing of used needles and sharp instruments, including spoken communication, double-gloving and blunt-tip needles for stitching some tissues.

In the study, Makary reports that about 57 percent of the surgical residents felt “rushed” as the primary cause of injury and that about 42 percent said they didn’t report the injury because the process was too involved and “took too much time.” Another 28 percent said that there was “no utility in reporting.”

Examiner staff writer Dave Carey contributed to this report

khillle@baltimoreexaminer.com