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Occupational exposure in junior medical staff in New York

 

Clinical bottom line

Over six months there was an average of one exposure for each student or member of the house staff in a New York hospital. The majority of these were unreported.


Reference

F Resnic & MA Noerdlinger. Occupational exposure among medical students and house staff at a New York City medical center. Archives of Internal Medicine 1995 155: 75-80.

Study

The study was conducted over two months in 1992/3 at a 1200 bed hospital, with about 10% of inpatients being HIV positive. Subjects were third and fourth year medical students and medical and surgical house staff. All house staff members have training on use of universal precautions for handling body fluids on their first day. Hospital policy mandates reporting of all occupational exposures.

An anonymous questionnaire was sent to 650 students and house staff members, with 13 items some relating to occupational exposure. Responders were asked to give information about specialty and postgraduate years of training at the time of completing the questionnaire. Exposures were defined as needlestick, sharp object, mucous membrane or broken skin, and the period over which an exposure may have taken place was about six months.

Results

There were 388 responses (60%). There were more exposures in surgical house staff than medical house staff or students (Table 1). Overall 122 of 385 (32%) respondents had an exposure over the previous six months. One in 20 (4.6%) involved HIV positive or perceived high risk patients.

Table 1: Occupational exposure among students and house staff

 

Respondents

Exposures

Exposures/respondent

Percent exposed

Students

110

45

0.4

27

Medical house staff

158

55

0.4

20

Surgical house staff

117

230

2.0

52

TOTAL

385

330

0.9

32

Higher levels of exposure were associated with obstetrics & gynaecology, orthopaedics, urology and other surgical specialties. There was a tendency for fewer exposures with increased postgraduate years of training in medical specialties, and a trend for higher exposure with increased postgraduate years for surgical specialties.

Few students and house staff reported their exposures. Only 11% of exposures were reported and only 29% of exposed respondents reported an incident.

Reasons for not reporting included the source thought not to be infectious, insignificant exposure, too little time to report, already immunised for HBV, the outcome unchanged by reporting, the exposure was not an emergency and not knowing how to report an exposure. These reasons accounted for 83% of the reasons given for not reporting.

Reasons for reporting included that it was hospital policy, a significant exposure, to seek prophylactic treatment and because the patient was thought to be infectious.

Comment

This is a detailed study that is worth reading. It has clues about how to change things, emphasising, for instance, the importance of hospital policy and ignorance. Ignorance includes an estimate that at this hospital between 2% and 5% of patients thought not to be HIV positive in fact were HIV positive.