CSNS_Needlestick Apr 2014

8/12/2019 CSNS_Needlestick Apr 2014

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Resident Hours Reduction Provides

Little Benefit to Improve Needlestick

and Eyesplash InjuriesPresentation at the Council of State Neurosurgical Societies (CSNS) annual

meeting. San Francisco, CA.

Presenter: Chaim Ben-Joseph Colen, MD, Ph.D.

Drazin D, Al-Khouja L, Colen C

April 2014


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Disclosures

Hobby

Travel

Post ConventionalConventional

Family

Pre-Conventional

Colen Publishing & Ventures


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History

Medical and Surgical residencies traditionally

require lengthy hours of trainees.

The public and the medical education

establishment recognize that such long hours

are counter-productive, since sleep

deprivation increases rates of medical errors

and may affect learning, however thephenomenon persists


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History

2011 Model-stricter national regulations

reduce the continuous-duty hours of resident

physicians from 30 to 16 hours


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Goal

To study whether there exists reduced

occupational injuries

needle stick

eye splash

before and after 2011.


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Survey

Respondents: 212 (17.67% of neurosurgery

residents)


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Variable Respondents

Female sex 17.42%

Age

< 25 1.12%

25-27 13.41%28-31 43.02%

32-35 27.37%

35-40 11.73%

> 40 3.35%

Postgraduate year

PGY-1 21.23%PGY-2 10.06%

PGY-3 12.85%

PGY-4 15.08%

> PGY-5 30.17%

Practice Type

Academic 98.86%Private 1.14%

Residency/Practice

Location

West 22.16%

South 28.41%

Midwest 23.30%Northeast 26.14%

Characteristics of Survey Respondents


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89.33%

10.67%

Percent Incurred or Witnessed a Needlestick

or Eyesplash Injury

YesNo


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Variable Respondents

Total number of percutaneous injuries incurred/witnessed

Before July 2011 78.23%

After July 2011 91.40%

Total number of percutaneous injuries incurred/witnessed

during an emergency procedure

Before July 2011 46.40%

After July 2011 51.2%

Location of needlestick InjuryIndex finger, non-dominant 48.82%

Index finger, dominant 32.28%

Other finger, non-dominant 39.37%

Other finger, dominant 33.86%

Device or Instrument associated with injury

Suture Needle 87.6%

Scalpel Blade 14.73%

Skin/Bone Hook 9.30%

Monopolar 7.75%

Wire 3.10%

Scissors 1.55%Other 27.13%

Survey Results, Needlestick Injuries


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Hmmmm


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1.57%

16.54%

33.86%

39.37%

32.28%

48.82%

I never had one nor witnessed one

Other body part

Other Finger, dominant hand

Other Finger, non-dominant hand

Index Finger, dominant hand

Index Finger, non-dominant hand

Part of Hand Injured with Needlestick Injury


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Eyesplash Injuries


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Variable RespondentsNumber of eyesplash injuries

incurred/witnessedBefore July 2011 40.94%After July 2011 51.94%

Number of eyesplash injuriesincurred/witnessed during an

emergency procedureBefore July 2011 29.13%After July 2011 33.33%

Personal Protective

EquipmentPrescription Glasses 17.92%Loupes 37.74%Disposable Plastic

Glasses 8.49%Eye shield 9.43%Other 14.15%

Survey Results, Eyesplash Injuries


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78.23%

91.4%

40.94%

51.94%

0

10

20

30

40

50

60

70

80

90

100

Before July 2011 After July 2011

PercentofRespon

dants

Percent Experienced/Witnessed Injury

Before and After July 2011

Needlestick Injury

Eyesplash Injury


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46.4%

51.2%

29.13%

33.33%

0

10

20

30

40

50

60

Before July 2011 After July 2011

PercentofRespondents

Percent of Injury Experienced/Witnessed During an

EmergentProcedure

Before and After July 2011

Needlestick

Eyesplash


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Ouch! So, what do we do now?


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62.90%

6.45%

12.90%

4.03%5.65%

Preventative Measures After an Injury

No measures were taken

Formal Discussion withAttending

Informal Discussion withAttending

Resident to ResidentDiscussion

Formal Lecture on ORSafety

Other

18.55%


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12.20%

7.32%

1.63%

38.21%

48.78%

I have no idea and it was never

discussed

No Testing Required

Delayed Testing

Immediate Testing

Immediate and Delayed Testing

Institutional Testing Policy After Injury


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Future: Interesting recommendations

by residents to improve practices:


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Interesting recommendations by

residents to improve practices:

"There should be a nationwide policy that allows testing ofpatients without their consent when a needle stick orexposure occurs.

Have OR nurses report - they will be the most reliable.

"The process to be tested and receive medication should befaster, as to not interfere with work and not be anotherreason not to go to receive treatment

"Hastiness of the attending has been the highest cause ofneedle stick in our institution."


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Interesting recommendations by

residents to improve practices:

Currently required to report but [the] process is so arduous(2 hour wait in ED) that most residents and attendings don'twant to deal with it. Protocol should be at least mandatoryreporting and testing but [the] process needs to take lessthan 30 minutes to encourage more people to report.

"It should be made as easy as possible for the resident orstaff that was injured.

The troubling thing is the exposure source in my state hasto consent to viral testing.

Hospitals should require the use of protective disposablegoggles for the safety of the staff... gloves should also be

prick resistant


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So does reduction of resident hours

help prevent injury?

Handoffs Errors

Continuity of care

Medication Dangers Other treatment or communication errors


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Limitations

Small sample size

Recall bias

Under reporting


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Future Direction


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Future Direction

Develop protocols for easier reporting

Uniform protocols- ex. use of safety shields,

protection wear, easier reporting techniques,

etc

End goal: to discover the risk variables and

minimize the rates of injury by identifying and

altering modifiable factors.


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Conclusion

Incidence of needlestick and eyesplash

injuries did not decrease with decreased

length of work hours.

Further work is needed to suggest uniform

protocols to make our residents workplace

safe.


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Legacy!

Thank you!

[email protected]

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