Resident Hours Reduction Provides Little Benefit to Improve Needlestick and Eyesplash Injuries

Presentation 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

Disclosures
Colen Publishing & Ventures
Family Hobby

Travel

Pre-Conventional

Conventional

Post Conventional

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 the phenomenon persists

History
2011 Model-stricter national regulations
reduce the continuous-duty hours of resident physicians from 30 to 16 hours

Goal
To study whether there exists reduced occupational injuries
needle stick eye splash

before and after 2011.

Survey
Respondents: 212 (17.67% of neurosurgery residents)

Characteristics of Survey Respondents

Variable Female sex Age < 25 25-27 28-31 32-35 35-40 > 40 Postgraduate year PGY-1 PGY-2 PGY-3 PGY-4 > PGY-5 Practice Type Academic Private Residency/Practice Location West South Midwest Northeast Respondents 17.42% 1.12% 13.41% 43.02% 27.37% 11.73% 3.35% 21.23% 10.06% 12.85% 15.08% 30.17% 98.86% 1.14%

22.16% 28.41% 23.30% 26.14%

Percent Incurred or Witnessed a Needlestick or Eyesplash Injury

10.67% Yes

No

89.33%

Survey Results, Needlestick Injuries

Variable Total number of percutaneous injuries incurred/witnessed Respondents

Before July 2011 After July 2011 Total number of percutaneous injuries incurred/witnessed during an emergency procedure Before July 2011 After July 2011 Location of needlestick Injury Index finger, non-dominant Index finger, dominant Other finger, non-dominant Other finger, dominant Device or Instrument associated with injury Suture Needle Scalpel Blade Skin/Bone Hook Monopolar Wire Scissors Other

78.23% 91.40%

46.40% 51.2% 48.82% 32.28% 39.37% 33.86% 87.6% 14.73% 9.30% 7.75% 3.10% 1.55% 27.13%

Hmmmm

Part of Hand Injured with Needlestick Injury

Index Finger, non-dominant hand Index Finger, dominant hand Other Finger, non-dominant hand Other Finger, dominant hand Other body part 16.54% 1.57% 32.28% 39.37% 33.86% 48.82%

I never had one nor witnessed one

Eyesplash Injuries

Survey Results, Eyesplash Injuries

Variable Number of eyesplash injuries incurred/witnessed Before July 2011 After July 2011 Number of eyesplash injuries incurred/witnessed during an emergency procedure Before July 2011 After July 2011 Personal Protective Equipment Prescription Glasses Loupes Disposable Plastic Glasses Eye shield Other Respondents

40.94% 51.94%

29.13% 33.33%

17.92% 37.74%
8.49% 9.43% 14.15%

Percent Experienced/Witnessed Injury Before and After July 2011

100 90 80 70

91.4%

78.23%

Percent of Respondants

60 50 40

51.94% 40.94%

Needlestick Injury Eyesplash Injury

30

20
10 0

Before July 2011

After July 2011

Percent of Injury Experienced/Witnessed During an Emergent Procedure Before and After July 2011
60

50

51.2% 46.4%

Percent of Respondents

40

30

33.33% 29.13%

Needlestick Eyesplash

20

10

Before July 2011

After July 2011

Ouch! So, what do we do now?

Preventative Measures After an Injury

4.03%
12.90%
Formal Discussion with Attending Informal Discussion with Attending

5.65%
No measures were taken

62.90%
18.55%

Resident to Resident Discussion Formal Lecture on OR Safety Other

6.45%

Institutional Testing Policy After Injury

Immediate and Delayed Testing Immediate Testing Delayed Testing No Testing Required I have no idea and it was never discussed

48.78% 38.21% 1.63% 7.32% 12.20%

Future: Interesting recommendations by residents to improve practices:

Interesting recommendations by residents to improve practices:

"There should be a nationwide policy that allows testing of patients without their consent when a needle stick or exposure occurs. Have OR nurses report - they will be the most reliable. "The process to be tested and receive medication should be faster, as to not interfere with work and not be another reason not to go to receive treatment "Hastiness of the attending has been the highest cause of needle stick in our institution."

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't want to deal with it. Protocol should be at least mandatory reporting and testing but [the] process needs to take less than 30 minutes to encourage more people to report.

"It should be made as easy as possible for the resident or staff that was injured.
The troubling thing is the exposure source in my state has to consent to viral testing. Hospitals should require the use of protective disposable goggles for the safety of the staff... gloves should also be prick resistant

So does reduction of resident hours help prevent injury?

Handoffs Errors Continuity of care Medication Dangers Other treatment or communication errors

Limitations
Small sample size Recall bias Under reporting

Future Direction

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.

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.

Live Love and Leave a Legacy! Thank you!

chaim.colen@gmail.com