Comparison of Injuries From Sharps Among Resident Physicians Within Dermatology and Other Medical and Surgical Specialties | Dermatology | JAMA Dermatology | JAMA Network
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Figure 1.  Proportion of Injuries by Device
Proportion of Injuries by Device

Error bars indicate 95% CIs.

aSignificant difference from the combined nondermatology medical and surgical values.

bSignificant difference from the dermatology value.

Figure 2:  Proportion of Injuries by Context
Proportion of Injuries by Context

Error bars indicate 95% CIs.

aSignificant difference from the combined nondermatology medical and surgical values.

bSignificant difference from the dermatology value.

1.
Mannocci  A, De Carli  G, Di Bari  V,  et al.  How much do needlestick injuries cost? a systematic review of the economic evaluations of needlestick and sharps injuries among healthcare personnel.  Infect Control Hosp Epidemiol. 2016;37(6):635-646. doi:10.1017/ice.2016.48PubMedGoogle ScholarCrossref
2.
International Safety Center. EPINet report for needlestick and sharp object injuries. https://internationalsafetycenter.org/wp-content/uploads/2018/06/Official-2016-NeedleSummary.pdf. Published July 19, 2017. Accessed May 21, 2018.
3.
U.S. Public Health Service.  Updated US Public Health Service Guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis.  MMWR Recomm Rep. 2001;50(RR-11):1-52.PubMedGoogle Scholar
4.
Nambudiri  VE, Qureshi  AA, Vleugels  RA.  Sharps injuries among US dermatology trainees: a cross-sectional study.  J Am Acad Dermatol. 2016;74(4):756-758. doi:10.1016/j.jaad.2015.11.027PubMedGoogle ScholarCrossref
5.
Marnejon  T, Gemmel  D, Mulhern  K.  Patterns of needlestick and sharps injuries among training residents.  JAMA Intern Med. 2016;176(2):251-252. doi:10.1001/jamainternmed.2015.6828PubMedGoogle ScholarCrossref
6.
Bakaeen  F, Awad  S, Albo  D,  et al.  Epidemiology of exposure to blood borne pathogens on a surgical service.  Am J Surg. 2006;192(5):e18-e21. doi:10.1016/j.amjsurg.2006.08.013PubMedGoogle ScholarCrossref
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Research Letter
January 2019

Comparison of Injuries From Sharps Among Resident Physicians Within Dermatology and Other Medical and Surgical Specialties

Author Affiliations
  • 1Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
JAMA Dermatol. 2019;155(1):116-118. doi:10.1001/jamadermatol.2018.4468

Injuries from sharps represent a safety concern in the form of exposure to bloodborne pathogens, as well as a financial burden on health care systems, with a mean cost per injury of $750 in 2015.1-3 About 18% of the approximate 385 000 annual injuries from sharps in the United States are incurred by resident physicians, and it has been previously suggested that dermatology residents are at a particularly high risk of such injuries.2,4,5 There is currently a lack of published information concerning resident-specific data (aside from simple injury frequencies), data on how injuries from sharps vary between specialties (aside from total injury frequencies), and nonsurvey-based data.2,4-6 The goal of this study is to assess whether the nature of injuries from sharps among University of Oklahoma Health Sciences Center dermatology residents is demonstrably different compared with injuries from sharps among residents in other medical and surgical specialties.

Methods

Records for this study, conducted from January 29 to May 15, 2018, were based on optional incident reports that residents are asked to complete after sustaining injuries from sharps. Data were stratified by type of specialty (dermatology, nondermatology medical specialty, or nondermatology surgical specialty), injury situation (eg, passing instruments between employees), and type of device involved. Specialties within the nondermatology medical category were cardiology, family medicine, neurology, nuclear medicine, pathology, pediatrics, pulmonology, radiology, and rheumatology. Surgical specialties included anesthesia, dentistry, general surgery, neurosurgery, obstetrics and gynecology, ophthalmology, otorhinolaryngology, orthopedic surgery, plastic surgery, and urology. Reports for which the specialty was unclear were excluded from analysis. This study was approved by the University of Oklahoma Institutional Review Board. Deidentified University of Oklahoma Health Sciences Center records of injuries from sharps were obtained from the environmental health and safety office.

Group statistics are presented as rates expressed as percentage of total injuries within a specialty type (number of injuries of interest/total number of injuries in group). Rates were compared between and among groups using χ2 tests or Fisher exact test if injury frequencies were low (expected injuries <5). All P values were from 2-sided tests and results were deemed statistically significant at P < .05.

Results

Incident report data were available for the years 2010 to 2017. A total of 464 injuries were recorded by University of Oklahoma Health Sciences Center residents. Of these 464 injuries, 19 were incurred by dermatology residents, 122 were incurred by nondermatology medical residents, 322 were incurred by nondermatology surgical residents, and 1 was excluded from the comparative analysis owing to our inability to determine the relevant residency department. Analytical results are illustrated in Figure 1 and Figure 2.

Statistically significant findings included the increased mean (95% CI) proportion of suture-needle injuries among dermatology compared with nondermatology specialties (63.2% [95% CI, 41.5%-84.9%] vs 40.1% [95% CI, 36.0%-44.5%]; P = .045) and compared with nondermatology medical specialties (63.2% [95% CI, 41.5%-84.9%] vs 21.3% [95% CI, 14.0%-28.6%]; P ≤ .001), as well as the decreased proportion of hollow-needle and bladed instrument injuries among dermatology compared with nondermatology medical specialties (hollow needles, 15.8% [95% CI, 0.0%-32.2%] vs 39.3% [95% CI, 30.6%-48.0%]; P = .047; and bladed instruments, 5.3% [95% CI, 0.0%-15.3%] vs 32.0% [95% CI, 23.7%-40.3%] P = .02). No significant differences were seen for proportion of electrical instrument injuries or contextual factors leading to injury (eg, recapping needles).

Discussion

Further research is necessary to confirm the external validity of this single-institution study. In addition, the data source for this study, optional incident reports, represents a potential weakness of nonresponse and voluntary response bias. Because records were deidentified prior to analysis, confounding factors, such as residents with repeated injuries, could not be evaluated.

Previous studies have suggested that resident physicians, and particularly dermatology residents, may be at increased risk of injuries from sharps.2,4,5 Our study represents the largest nonsurvey-based analysis of injuries from sharps among residents to date, to our knowledge. We demonstrated that dermatology residents, in comparison with residents of other medical specialties, incur a higher proportion of injuries involving suture needles and a lower proportion of injuries involving bladed instruments or hollow needles. This finding provides nonsurvey-based support for the recommendation of future research on injuries from sharps and education being targeted specifically toward prevention of suture-needle injuries.

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Article Information

Accepted for Publication: October 10, 2018.

Corresponding Author: Thomas Stasko, MD, Department of Dermatology, University of Oklahoma Health Sciences Center, 619 NE 13th St, Oklahoma City, OK 73104 (thomas-stasko@ouhsc.edu).

Published Online: December 5, 2018. doi:10.1001/jamadermatol.2018.4468

Author Contributions: Mr Morris and Ms Li had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Morris, Adotama, Stasko.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Morris.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Morris, Li.

Administrative, technical, or material support: Adotama.

Supervision: Adotama, Stasko.

Conflict of Interest Disclosures: None reported.

References
1.
Mannocci  A, De Carli  G, Di Bari  V,  et al.  How much do needlestick injuries cost? a systematic review of the economic evaluations of needlestick and sharps injuries among healthcare personnel.  Infect Control Hosp Epidemiol. 2016;37(6):635-646. doi:10.1017/ice.2016.48PubMedGoogle ScholarCrossref
2.
International Safety Center. EPINet report for needlestick and sharp object injuries. https://internationalsafetycenter.org/wp-content/uploads/2018/06/Official-2016-NeedleSummary.pdf. Published July 19, 2017. Accessed May 21, 2018.
3.
U.S. Public Health Service.  Updated US Public Health Service Guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis.  MMWR Recomm Rep. 2001;50(RR-11):1-52.PubMedGoogle Scholar
4.
Nambudiri  VE, Qureshi  AA, Vleugels  RA.  Sharps injuries among US dermatology trainees: a cross-sectional study.  J Am Acad Dermatol. 2016;74(4):756-758. doi:10.1016/j.jaad.2015.11.027PubMedGoogle ScholarCrossref
5.
Marnejon  T, Gemmel  D, Mulhern  K.  Patterns of needlestick and sharps injuries among training residents.  JAMA Intern Med. 2016;176(2):251-252. doi:10.1001/jamainternmed.2015.6828PubMedGoogle ScholarCrossref
6.
Bakaeen  F, Awad  S, Albo  D,  et al.  Epidemiology of exposure to blood borne pathogens on a surgical service.  Am J Surg. 2006;192(5):e18-e21. doi:10.1016/j.amjsurg.2006.08.013PubMedGoogle ScholarCrossref
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