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1st
appeared 6 January 1999
Accidental Needlesticks Still a Concern in
Medical School Training
While health workers' risk of exposure to infectious disease through accidental
needlesticks has been greatly reduced through comprehensive training programs and the
introduction of new safety devices, a new study by researchers at UCSF finds that medical
students remain at high risk of exposure.
In the first comprehensive, long-term study of medical students' risk of needlesticks and
other exposures to blood, the UCSF team found that 11.7 percent of the students studied
over a seven-year period sustained possible exposure to blood-borne diseases such as HIV
and hepatitis. None of the students in the study reported contracting a disease as a
result of an accidental exposure.
The study, reported in an article in the January 5 edition of the Annals of Internal
Medicine, included 1,022 third and fourth-year medical students from the classes of
1990-1996 who trained at UCSF-affiliated hospitals.
Emilie H. Osborn, the lead author of the study, noted that students in these classes
benefited from UCSF's leadership in training and occupational safety programs designed to
prevent needlestick injuries. But, the study reveals that they continue to face a higher
risk than expected, said Osborn, a physician with the Palo Alto Medical Foundation and
former associate dean of student affairs at UCSF.
The results of the study demonstrate the need for greater supervision of medical students,
Osborn said.
"We have to protect medical students from their own eagerness to learn new things and
from pressure from others not to ask for assistance," Osborn said. "Students
have to be encouraged to say to their supervisors, 'I can't do that. I want to watch you
do it.'"
In an editorial accompanying the study, Daniel D. Federman of the Harvard Medical School,
notes that there is inherent risk in the practice of medicine and, in turn, in the study
of medicine. Medical education demands that students participate actively and importantly
in the care of patients and, as a result, incur some of the risks of experienced
physicians, Federman writes.
The editorial praises UCSF's leadership in developing programs to prevent needlestick
exposures. Federman cites as "outstanding" a week-long course in needle safety
required of all UCSF students and praises UCSF's creation of a confidential hotline for
reporting needlestick exposures and obtaining preventive treatment. Despite these efforts,
the rate of possible exposure remained at more than 10 percent over the length of the
study, a signal that medical students in schools across the country run the same or
greater risk of exposure. The rate of exposures reported in specific years of the study
dropped to 6.5 percent of the students in 1996 from a high of 18 percent of the students
in 1993.
Most (82 percent) of the needlestick exposures in the study occurred while students worked
in one of four services -- obstetrics-gynecology, surgery, medicine, and emergency
medicine. The study found no other relationship linked to an increased likelihood of
possible exposure.
The availability of needle safety devices -- designed to shield the needle after it
punctures the skin -- did not prevent injuries in all cases, the study found. In the cases
where it was possible to use a safety device, one quarter of the injuries were inflicted
by needles equipped with safety devices. Half of the injuries involving needle safety
devices occurred before the procedure and half occurred after the needle was used but
before the safety shield was put in place.
The authors also noted that in subsequent surveys many students reported that they failed
to report possible exposures because they believed them to be too trivial, because they
occurred before the hotline was implemented, or because they reported them only to the
student health service. Fifty percent or more of possible exposures may go unreported by
medical students.
"Supervising attending physicians and senior housestaff [residents] must be charged
with the responsibility for ensuring that students are capable of performing procedures
safely before expecting them to do so without supervision," the article concludes.
"It is our responsibility as medical educators to provide a safe learning environment
for students before they face the risks of direct patient care. The era of 'see one, do
one, teach one' is long past."
Links:
Full press release
Annals of Internal
Medicine
PEPLine
New Hotline for Advice on
Occupational Exposures to HIV and Other Blood-Borne Diseases
SFGH Sets National Model for
HIV Prevention Intervention
Source: Bill Gordon, News
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