ADVANCEMENT OF THE SCIENCE
TABLE 1
FIGURE 1 continued
Characteristics of Injuries by A) Injuries Reported by Group, B) Instruments Associated With Sharps Injury, and C) Time of Day When the Injury Occurred
Primary Activity Performed During Injury ( n = 122)
Activity
#
%
C
51
Injection
34
28
Dental procedure
20
16
Line placement
19
16
Biopsy or cutting
17
14
32
Suturing
15
12
Aspirating
5
4
Drawing blood
4
3
Other surgical procedure
4
3
13
Other nonsurgical procedure
4
3
4
scaler, elevator, or curette was implicated. Other sharps implicated in injuries included staples, scissors, rib spreaders, and unspeci- fied needle types or unknown objects. The median number of days to report an injury was 0 days for nurses and dental students, 2 days for medical residents ( p < .001), and 3 days for medical students ( p = .004).
12–5 a.m.
6–11 a.m.
12–5 p.m.
6–11 p.m.
Time of Day When Injuries Occurred
Discussion
culture within the dental school contributed to higher reporting rates. This culture is facil- itated by a streamlined reporting process and an environment with only a handful of clini- cal practices, resulting in guidance provided to students, faculty, and sta that is clear and has few variations. Although it is not possible to determine from our study if the number of reported inju- ries was a result of more consistent reporting, more needlesticks, or both—there is one major clue that suggests that a streamlined reporting structure plays a large role in enhancing the culture of reporting. This clue is the prompt- ness in reporting. Dental students consistently reported injuries sooner than did resident physicians or medical students. These findings present opportunities for improvement. While faculty, sta, and medical residents report injuries directly into the data- base, students rely on supervisors to sign o on injuries and order laboratory tests on the source patient. Even the process of reporting injuries directly into the database might be viewed by some as too cumbersome, resulting
in reporting delays or omissions. For students, supervisor sign-o might pose an additional barrier to reporting. Students might hesitate to report injuries due to worry that their clini- cal practices are too busy to process an injury report, that their supervisor might be unfamil- iar with the reporting process, that their injury will be perceived as incompetence and aect their evaluation, or that their injury might be minimized by the supervisor. Some structural factors also impact report- ing. Smaller departments with only a few assigned supervisors to sign o on an injury report could either help streamline the process or create bottlenecks due to stang shortages or overwork. In contrast, large healthcare systems, aliate hospitals, and community rotations commonly partner with medical schools and residency programs, which adds variables to the reporting process. A student might not know who to report an exposure to and supervisors are not always aware of the university’s reporting procedures. The suboptimal reporting time (i.e., time lag) presented an opportunity to try a multi-
Who Gets Injured Our study describes needlestick injuries at a large healthcare institution as outpatient practices began to reopen in 2021 after the height of the COVID-19 pandemic and elec- tive procedures resumed. The highest rate of injury was reported by dental students, fol- lowed by medical residents. This finding is consistent with the medical literature, where trainees reported more needlestick and sharps injuries than more experienced healthcare workers did (Kessler et al., 2011; Lee et al., 2014; Matsumoto et al., 2019). Dental stu- dents were less likely to experience an injury as they gained clinical experience (Wood et al., 2006). Similar to our findings, one study showed higher rates of injury in dental stu- dents compared with medical or nursing stu- dents (McCarthy & Britton, 2000). The Culture of Reporting While the lack of trainee experience might increase the risk of injury, we believe that the
16
Volume 87 • Number 6
Powered by FlippingBook