Needlestick and Sharps Injuries Among Resident Physicians

Needlestick and other sharps injuries (NSI) are an important occupational hazard, and approximately 600 000 to 800 000 NSI events were reported annually in US hospital settings as of 1999.¹ These events carry risk of bloodborne pathogen transmission, as well as psychosocial and financial burdens. The cost associated with an NSI could range from $500 to $3000 (as of 2000), depending on the treatment provided.² Protecting health care workers against NSIs is an important component of workplace safety, and resident physicians are among those at risk. Physicians in training, particularly surgical residents, frequently report NSIs.³

Current epidemiology reports of NSIs among resident physicians are predominantly from survey-based studies. In contrast, studies sourcing data from occupational health offices are few in number and have small sample sizes.⁴ This study reviews reported NSIs to more comprehensively evaluate differences in NSI incidence rates among house staff across medical and surgical specialties. To develop targeted approaches to NSI prevention, we evaluated the influence of the academic calendar by calculating rates of NSIs per month.

A deidentified data set of NSIs reported to New York University Langone Health’s Occupational Health Services by employees following injury between January 2000 and February 2020 was analyzed by employee type, specialty, and month of injury. House staff were defined as either surgical, based on the American College of Surgeons classification,⁵ or medical/nonsurgical (Table). The study was submitted to the New York University Grossman School of Medicine institutional review board and designated as not human subjects research, given that all data were provided in a deidentified data set and contained no protected health information.

Incidence rates were calculated using mean house staff program size data by specialty from July 2012 to July 2019. Statistical analysis was performed using χ² tests, Fisher exact tests, and linear regression. All P values were deemed statistically significant at P < .05. Odds ratios were reported with 95% CIs. Statistical analysis was performed with Excel version 16.32 (Microsoft).

There were 5395 injuries reported to Occupational Health Services. Of these, 715 (13.3%) were reported by house staff and 4680 injuries by non–house staff health care workers. Of the 715 injuries among house staff, 367 (51.3%) were reported among staff in medical/nonsurgical specialties and 348 (48.7%) were reported among staff in surgical specialties. The mean NSI incidence rates were 4.7 and 9.4 events per 10 individuals for medical/nonsurgical and surgical specialties, respectively. The highest NSI incidence rates were seen among house staff in urology (16.0 events per 10 individuals), orthopedic surgery (14.1 events per 10 individuals), and general surgery (14.0 events per 10 individuals) (Table).

Among house staff, the greatest number of injuries occurred in October (75 of 715 events [10.5%]), with an overall downward trend thereafter. June to July demonstrated the largest month-to-month increase, from 44 reported injuries (6.2%) to 67 reported injuries (9.4%). This month-to-month change was not observed among the non–house staff cohort (Figure). The proportion of injuries by calendar quarter among non-house staff remained relatively stable throughout the year (first quarter, 1199 [25.6%]; second quarter, 1171 [25.0%]; third quarter, 1153 [24.6%]; fourth quarter, 1157 [24.7%]; total, 4680 injuries). In comparison, the distribution of injuries among house staff was significantly different, with a notable increase between the second and third quarter (first quarter, 173 [24.2%]; second quarter, 148 [20.7%]; third quarter, 205 [28.7%]; fourth quarter, 189 [26.4%[; total, 715 injuries; P = .02). The third quarter corresponds to the first 3 months of residency training, from July to September. The annual NSI incidence rate did not significantly change among house staff from July 2012 to July 2019.

We report what is, to our knowledge, the largest non–survey-based study of NSI events among house staff. We build on prior studies, which suggest that NSIs occur most often during the first 6 months of training,⁴ and further characterize this risk to be highest in the first 3 months of the academic year, with the transition from June to July representing a pivotal point for intervention. Our data suggest that there is a learning curve over which house staff acquire procedural skills, since July coincides with the onboarding of new resident physicians. This trend is unique to house staff in training, in that NSI frequency among non–house staff remained stable during the same period.

Postgraduate year information was not captured in our data set. Attributing the NSI risk to first-year residents may not explain the entirety of the observed increase, in that non–first-year residents may have new responsibilities resulting in increased fatigue, anxiety, or longer hours, leading to more injuries.⁶ Our findings suggest that preventive and educational strategies should target residents during onboarding and potentially be repeated annually between postgraduate years.

Accepted for Publication: July 18, 2020.

Corresponding Author: John G. Zampella, MD, The Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 E 38th St, 11th Floor, New York, NY 10016 (john.zampella@nyulangone.org).

Published Online: November 4, 2020. doi:10.1001/jamasurg.2020.4112

Author Contributions: Dr Ugonabo and Ms Shah had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ugonabo, Adotama, Zampella.

Acquisition, analysis, or interpretation of data: Ugonabo, Shah, Zampella.

Drafting of the manuscript: Ugonabo, Adotama, Zampella.

Critical revision of the manuscript for important intellectual content: Ugonabo, Shah, Adotama.

Statistical analysis:Shah, Zampella.

Administrative, technical, or material support: Ugonabo, Adotama, Zampella.

Supervision: Ugonabo, Adotama, Zampella.

Conflict of Interest Disclosures: Dr Zampella reported personal fees from X4 pharmaceuticals outside the submitted work. No other disclosures were reported.