|Year : 2019 | Volume
| Issue : 3 | Page : 113-118
The prevalence of sharp injuries in the operative room among surgical residents and their behavior to them in the southern region of Saudi Arabia
Saad Mohammed Abdullah Alqahtani, Shaker Hassan Al-Shehri, Turki Khalid Alshehri, Salah Saad Al-Zahrani, Sameer Marei Alqahtani
Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
|Date of Web Publication||4-Nov-2019|
Saad Mohammed Abdullah Alqahtani
Department of Surgery, College of Medicine, King Khalid University, Abha
Source of Support: None, Conflict of Interest: None
Background: Residents of surgical specialties have a high risk of sharp injuries. The reporting behaviors have a critical step in prophylaxis and early treatment.
Aim: The aim of this study is to assess the prevalence of sharp injuries in the operative room among surgical residents and their behavior.
Methodology: A descriptive cross-sectional study was conducted including 166 surgical specialty residents who involved in operating procedures from seven hospitals in the southern region of Saudi Arabia. A self-administrating questionnaire about sharp injuries, predisposing factors for sharp injuries, and practice of universal precautions during the surgical procedures was used for data collection. The study questionnaire was developed by the researchers after intensive literature review and another research tool from a previous similar study which was conducted in King Abdul-Aziz University Hospital in Jeddah city of Saudi Arabia.
Results: About 64% of the residents have had at least one sharp injury in the last year. Most of these injuries (53.3%) occurred while suturing and 76.6% claimed the reason was due to fatigue. Most of the recent injuries (86%) were self-induced injuries caused with a solid needle (65.4%). The most common action post the injury was replacing the gloves and the needle (36.7%). Only 9% of them have reported all of their injuries to the concerned authorities, and 56% claimed the reason that they were not bothered. About 75.3% of them were aware of their local policies.
Conclusion: Sharp injuries and needlestick are common among surgical residents, but they have weak reporting behavior. More educational training program about the sharp-related safety program may improve their attitude and behavior regarding sharp injuries.
Keywords: Awareness, behavior, needlestick injury, operative room, sharp injuries, surgical resident
|How to cite this article:|
Alqahtani SM, Al-Shehri SH, Alshehri TK, Al-Zahrani SS, Alqahtani SM. The prevalence of sharp injuries in the operative room among surgical residents and their behavior to them in the southern region of Saudi Arabia. Saudi Surg J 2019;7:113-8
|How to cite this URL:|
Alqahtani SM, Al-Shehri SH, Alshehri TK, Al-Zahrani SS, Alqahtani SM. The prevalence of sharp injuries in the operative room among surgical residents and their behavior to them in the southern region of Saudi Arabia. Saudi Surg J [serial online] 2019 [cited 2019 Nov 12];7:113-8. Available from: http://www.saudisurgj.org/text.asp?2019/7/3/113/270236
| Introduction|| |
Surgical practice is mostly at high risk for sharp injuries with the probability of transmitting infections, especially blood-borne viruses. The risk of infection for healthcare personnel depends on the prevalence of disease in their patients and the nature and frequency of exposures. Surgeons and surgical trainees are at higher risk as they do these surgical interventions frequently.,,
As most of the sharp injuries happened in the operating room where the surgical residents mostly work, a great risk to the healthcare providers as well as the patient's health is recorded. These risks include getting infected by different pathogens such as hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) which can infect the human body by needlestick and sharp injuries. About 600,000–800,000 percutaneous injuries among healthcare providers have been reported annually. Although most surgeons are now adequately vaccinated against hepatitis B, there is no vaccine for HIV or HCV. Blood-borne viruses represent a global pandemic.
Reporting of the injuries to the concerned authorities has great advantages in minimizing the rate of the injuries and improving the practices as well as behaviors to avoid the risk of repeating those injuries. Initial risk assessment and early postexposure prophylaxis can be performed if needed., Specific measures should be applied to minimize the incidence and improve the behavior of residents toward the intra-operative injuries which we will not achieve without knowing the problem magnitude and determinants.
The current study aimed to understand the prevalence, risk factors, and the behavior of the residents regarding the sharp injuries and its local policies.
| Methodology|| |
A descriptive cross-sectional approach was used including all accessible residents in different surgical specialties at seven hospitals of the southern region of Saudi Arabia which contain residency programs with high work pressure due to the high rate of cases as a result of the current war in the southern borders of Saudi Arabia. The hospitals vary from tertiary to secondary hospitals. The data were collected by manual anonymous self-administrating questionnaire to maintain confidentiality. A total number of 259 questionnaires were distributed and 166 were returned with a 56% response rate. The study questionnaire was developed by the researchers after intensive literature review and another research tool from a previous similar study which conducted in King Abdul-Aziz University Hospital in Jeddah city of Saudi Arabia. The first part of the questionnaire was about the demographic information, including gender, nationality, specialty, residency level, and city of the residency program. The second section covered data regarding sharp injury in the last year and how many needlesticks have had in the last year, the common action they did regarding their injuries and did they get injured in a high-risk patient (patient with a history of HBV, HCV, or HIV). The third section covered injury reporting to the concern authorities, the causes of nonreporting, residents' knowledge about the policies where they work, and how friendly they are with. Another question regarding the causes of the recent needlestick injury, the type of the needle, and was it induced by themselves or someone else were covered in the fourth section. The last question in the first part is about what were they doing in the most recent sharp injury or needlestick injury. Second part had yes-no answered questions regarding the precautions which they usually take as double gloving, Visor/other eye protection, non-touch technique for needle and if they ever participated in any sharps-related safety training.
The official ethical clearance was obtained from Aseer Central Hospital Ethical committee before conducting the research, and the questionnaire included a brief introduction about the aim and importance of the research and clarification to the participant that their confidentiality will be protected.
After the data were extracted, it were revised, coded, and fed to statistical software IBM SPSS (released 2017, version 25.0. Armonk, NY, IBM Corp.). All statistical analyses were done using two-tailed tests and the alpha error was 0.05. A value of P ≤ 0.05 was considered to be statistically significant. Descriptive statistics based on the frequency and percentage for categorical data was used, while the mean and standard deviation displayed quantitative data. The Pearson's Chi-square test was used to test the association between resident data and sharp injury history.
| Results|| |
A total sample of 166 residents have completed the questionnaire; among them, 64.5% have had a sharp injury in the past 12 months [Figure 1] and 15% of them were injured for at least one time during their career involving high-risk patients.
|Figure 1: Prevalence of sharp injuries in the operating room among residents in surgical specialties in the Aseer region, Saudi Arabia|
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[Table 1] shows a pattern of injuries among the sampled residents. About 79.5% of residents had been injured for 1–3 times in the last year. Self-induced injuries were recorded among 86% of the injured residents and 65.4% of these injuries were by solid needles. As for conditions of injuries, 53.3% of residents were injured during suturing and 16.8% during replacing the needle. High-risk injuries due to dealing with high-risk patients were recorded among 15% of injured residents.
|Table 1: Patterns of sharp injuries in the operating room among residents in surgical specialties in the Aseer region, Saudi Arabia (n=107)|
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With regard to causes of sharp injuries in the operative room among residents in surgical specialties, fatigue (76.6%) and rushed (65.4%) were the most common causes of injuries among surgical residents in training [Figure 2].
|Figure 2: Causes of sharp injuries in the operating room among residents in surgical specialties in the Aseer region, Saudi Arabia|
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[Table 2] illustrates sharp injuries reporting status. Only 9% of the residents reported all their injuries to the concerned authorities, but 41.6% of them recorded some injuries. As for reasons of not reporting, 56% claimed the reason that they were not bothered and 47.3% claimed that patients were of low risk. Being afraid of having infection which may affect career was the most third recorded cause (45.1%), whereas 12.1% did not know about reporting procedure.
|Table 2: Sharp injuries reported in the operating room among residents in surgical specialties in the Aseer region, Saudi Arabia|
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As for actions taken by injured residents [Figure 3], 36.7% replace gloves and needle after the injury happened, 26.5% follow each step of local policy, 25.9% ignore and continue, and 10.8% inform the scrub nurse.
|Figure 3: Actions taken for sharp injuries in the operating room among residents in surgical specialties in the Aseer region, Saudi Arabia|
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On relating sharp injury status with residents' sociodemographic characteristics [Table 3], it was clear that the highest rate was recorded among orthopedic residents (45.5%) followed by neurosurgery program (40%) and general surgery program (31.8%), while none of the plastic surgery residents were injured. These differences were found to be statistically insignificant (P< 0.05). Furthermore, female residents were insignificantly of higher injury record than that of males (42.1% vs. 33.6%, respectively). R2 residents recorded the highest injury rate (52%) followed by R1 (38.6%) and R3 (24%), whereas only 10% of R4 students were injured with recorded statistical significance (P = 0.006). Residents in Bisha city had the highest injury rate (83.3%) followed by Albaha city (60%) and Jazan city (41.2%) with significant differences (P = 0.035).
|Table 3: Distribution of sharp injury rates by residents demographic characteristics, Aseer region, Saudi Arabia|
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[Table 4] shows the relation between precaution awareness and practices among the study residents, and it was clear that 75.3% of them are aware of their local policies toward the sharp injuries and 54.2% consider their user policy is friendly. Regarding the precautions, about 80.7% use double gloving, only 44.6% use eye protectors, and about 70.1% practicing no-touch technique for the needles, whereas 65.7% have participated in sharp-related safety training. No relation between awareness level and having injury was recorded among the sampled residents.
|Table 4: Precaution awareness and practices among residents in surgical specialties in the Aseer region, Saudi Arabia|
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| Discussion|| |
Needlestick and sharp injuries among surgical residents and their behaviors to them have different important aspects of their health safety as well as patient's health safety, and hence, we have to improve our understanding of the causes, risk factors and how to improve our resident's behavior toward them, as they have more chances to get injured while they are in the theater room which is responsible for 16% of all high-risk exposures reported regarding the Public Health of England.
In the current study, it was demonstrated that more than half of the residents have had at least one sharp injury in the past 12 months which is in line with the study carried out in King Abdul-Aziz University Hospital study in Saudi Arabia which has showed that about 58.9% of the residents have had at least one sharp injury in the past 12 months, but actually current findings were higher by 4.6% in the southern region hospitals. Probably, the reason is due to the case pressure to these hospitals, especially in the Aseer region, Najran city, and Jazan city, which have the higher percentages of injuries, respectively, as a result of the pressure of the cases coming from the war in the southern borders of Saudi Arabia with Yemen and as the presence of Aseer Central Hospital in Aseer region who receiving the different referring cases from the other hospitals in southern region. Another study done in 2007 showed that about 83% of their residents had needlestick in the past year.
Exactly 15% of the residents have had a needlestick of a high-risk patient which we define it as a patient with a history of HBV, HCV, or HIV, while in literature it is farther than that as it mentioned in a study published in The New England Journal of Medicine 53% of injuries involved a high-risk patient. A systemic literature review done in Brazil confirmed the presence of occupational HIV infection among health workers. Another systemic review done by Monique Elsevier professor and her team demonstrates that sharp injuries resulted in 0.42 HBV infections, 0.05–1.3 HCV infections, and 0.04–0.32 HIV infections per 100 sharp injuries among healthcare workers.
Most of their needlestick injuries were self-induced with a solid needle while they were suturing; this is in line with the literature results mentioned in 2006 study which was published in The American Journal of Surgery, which showed that most of the injuries were among the residents (43%–44%), 60% of it was self-inflicted and only 9% of it with hollow-bore needles. Another study ensures that the vast majority of the injuries were during suturing, with 60% of the participants injured during the suturing procedure.
In this study, most of the needlestick and sharp injuries were due to fatigue and rushed, respectively, while in King Abdul-Aziz University Hospital study, the main cause was rushed (61.1%). Another study addressed that the most common cause of the sharp injuries among their residents in training was rushed.
The most common action post the injury was replacing the gloves and the needle followed by following each step of the policy while in a study conducted on surgical team member state that 100% of their surgeons replace the gloves followed with 60% of them apply a pressure into the injury site and disinfect it with alcohol and betiding.
Only 9% have reported all of their injuries, and 49.4% have not reported any. This is a low percentage compared with a study done in UK hospitals which revealed that 19% of them have reported about all of their needlestick injuries. The most common cause of not reporting in the present study was they were not bothered while the most common cause of not reporting in another study was lack of time. Another study states that the most common cause was that the process was time-consuming. Regarding the awareness of the local sharp policy and procedures, most of them were aware of it which is very good compared with the UK study as about 54% of them did not aware of their policies.
We have found a significant relation between the residency level and sharp injuries which was directly proportional to the residency level as they get more involved in different surgical procedures and different studies agreed with our result as a study published in The New England Journal of Medicine which states that needlestick injuries during residency increased according to the postgraduate year.,
In the current study, more than half have stated that the polices were friendly compared with the King Abdul-Aziz University Hospital study which demonstrates that 31.4% agree with how policies are friendly.
Most of the residents apply the double gloving and no-touch technique for needle, while most of them do not use visor↱/other eye protection instruments. A positive point is that more than half of them have participated in sharp-related safety training programmers. The double gloving has great advantages in preventing injuries during procedures , and other precautions have a great effect in preventing needlestick and sharp injuries during the procedures.,,]
Finally, this study has some limitations as it involved just the surgical residents in training without other health-care workers as it approved of their high risk than other attending operation room staff. The other limitation is the lacking of the injuries outcomes data as it might provide us with the result of serological HIV, HBV, and HCV.
| Conclusion|| |
Sharp injuries and needlestick are common among surgical residents. Their reporting awareness of the concerned authorities is so weak, and this is our duty to improve their understanding of its importance. We need further efforts to expand the knowledge and use the precaution techniques which are impotent in lowering the impact of the sharp injuries.
The authors would acknowledge and appreciate Abdullateef Hasan Al-Zahrani, Mohammed Ibrahim Mohammed Albakri, Abdulrahman Jalwi M. Korkoman and Angham Ali Sahli for their recognized efforts in the data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]