Makary Martin A, Al-Attar Ali, Holzmueller Christine G, Sexton J Bryan, Syin Dora, Gilson Marta M, Sulkowski Mark S, Pronovost Peter J
Center for Outcomes Research, Department of Surgery, Health Policy and Management, Johns Hopkins University School of Medicine, Quality and Safety Research Group, Baltimore 21231, USA.
N Engl J Med. 2007 Jun 28;356(26):2693-9. doi: 10.1056/NEJMoa070378.
Surgeons in training are at high risk for needlestick injuries. The reporting of such injuries is a critical step in initiating early prophylaxis or treatment.
We surveyed surgeons in training at 17 medical centers about previous needlestick injuries. Survey items inquired about whether the most recent injury was reported to an employee health service or involved a "high-risk" patient (i.e., one with a history of infection with human immunodeficiency virus, hepatitis B or hepatitis C, or injection-drug use); we also asked about the perceived cause of the injury and the surrounding circumstances.
The overall response rate was 95%. Of 699 respondents, 582 (83%) had had a needlestick injury during training; the mean number of needlestick injuries during residency increased according to the postgraduate year (PGY): PGY-1, 1.5 injuries; PGY-2, 3.7; PGY-3, 4.1; PGY-4, 5.3; and PGY-5, 7.7. By their final year of training, 99% of residents had had a needlestick injury; for 53%, the injury had involved a high-risk patient. Of the most recent injuries, 297 of 578 (51%) were not reported to an employee health service, and 15 of 91 of those involving high-risk patients (16%) were not reported. Lack of time was the most common reason given for not reporting such injuries among 126 of 297 respondents (42%). If someone other than the respondent knew about an unreported injury, that person was most frequently the attending physician (51%) and least frequently a "significant other" (13%).
Needlestick injuries are common among surgeons in training and are often not reported. Improved prevention and reporting strategies are needed to increase occupational safety for surgical providers.
实习外科医生面临针刺伤的高风险。报告此类损伤是启动早期预防或治疗的关键步骤。
我们对17家医疗中心的实习外科医生进行了关于既往针刺伤情况的调查。调查项目询问了最近一次损伤是否报告给了员工健康服务部门，或者是否涉及“高危”患者（即有人类免疫缺陷病毒、乙型肝炎或丙型肝炎感染史或注射吸毒史的患者）；我们还询问了损伤的感知原因和周围情况。
总体回复率为95%。在699名受访者中，582人（83%）在培训期间有过针刺伤；住院医师培训期间针刺伤的平均次数根据研究生年级（PGY）增加：PGY-1为1.5次损伤；PGY-2为3.7次；PGY-3为4.1次；PGY-4为5.3次；PGY-5为7.7次。到培训的最后一年，99%的住院医师有过针刺伤；其中53%的损伤涉及高危患者。在最近的损伤中，578例中有297例（51%）未报告给员工健康服务部门，91例涉及高危患者的损伤中有15例（16%）未报告。在297名受访者中的126人（42%）中，缺乏时间是未报告此类损伤的最常见原因。如果除受访者之外的其他人知道未报告的损伤，那个人最常是主治医师（51%），最不常是“重要他人”（13%）。
针刺伤在实习外科医生中很常见，且往往未被报告。需要改进预防和报告策略以提高外科医护人员的职业安全性。
