Medical residents often fail to report needlestick incidents, which can put them at risk for blood-borne diseases, a recent study shows.
Of 699 surgery residents surveyed, 59% reported they had been stuck by a needle more than once, according to the report that was published in this month's issue of Academic Medicine. However, about half of those residents failed to report the incident to hospital officials. Not reporting such incidents means that the residents do not receive treatment to prevent infections, such as HIV or hepatitis C.
Study authors said residents do not report the incidents because they are embarrassed and are afraid that they will receive negative evaluations from faculty. It's up to hospital and GME administrators to work together to create a culture in which residents and other healthcare workers feel comfortable speaking up. One way to transmit that message is through a robust IC training program.
Emphasizing the importance of IC training, principles, and expectations from day one is critical to helping residents form good IC habits, says Bruce Polsky, MD, chief of the division of infectious diseases at St. Luke's-Roosevelt Hospital Center in New York City. "If you do not do that, then you're in the position of having to break bad habits."
Although residents at many hospitals receive IC training during orientation, they tend to become lax about certain practices overtime. For example, residents understand the importance of hand hygiene, but it is difficult to get them to put it to practice consistently, he adds.
Tackle this problem by enlisting IC department employees, nurse managers, and unit receptionists to monitor the ward and report residents or veterans who violate hand-hygiene procedures. When a breach occurs, the observer intervenes and corrects the resident. If the monitor does not feel comfortable interceding, he or she can report the issue to an attending physician who then speaks with the resident.
When noncompliance becomes a chronic problem, the information is relayed to the resident's immediate supervisor and then up the chain of command to the program director.
Residents also become lax about wearing personal protective equipment (PPE) because putting it on and discarding it can be an arduous process that adds several minutes to seeing a patient. "They have a heavy workload … and this just adds another layer of complexity," Polsky says.
Instructing residents on the proper way to wear gloves and gowns is critical, and involving program leadership in the training will make the lesson resonate more with residents. At St. Luke's-Roosevelt, program directors demonstrate how to correctly wear gear, conveying that wearing PPE is important.
In a situation where a resident does not follow hand-hygiene or PPE guidelines, Polsky says the punishment should not be punitive. "We want people to understand it is for their own protection and … this should be a standard part of taking care of patients."
Program directors should focus on remediation and coach the resident on the proper way to perform the technique, says Polsky.
Julie McCoy is associate editor for the Residency Department at HCPro, Inc. For more residency-related news, visit www.residencymanager.com.