pronged approach with one of our medical schools. First, we revised the bloodborne exposure lecture that is presented to rising third-year medical students during their tran- sition to clinical rotations. Presentation slides in past years have described what constitutes a bloodborne pathogen exposure and the steps needed to report it. We augmented the presentation with a frank discussion about barriers to reporting, addressed the impor- tance of an injured student using objective criteria to evaluate whether an injury is an exposure, and encouraged students to report when an exposure occurs. Most Common Injuries In our study, most injuries were caused by hol- low needles and occurred during injection pro- cedures. Solid needles and scalpels/blades were the next most common instruments associated with injuries. This finding is consistent with data obtained from the 2021 Exposure Preven- tion Information Network (EPINet) Report for Needlestick and Sharp Object Injuries, which reported that sharps injuries were associated with hollow needles (58%) during injection procedures (29%), followed closely by suture needles (21%) during suturing (28%) (Interna- tional Safety Center, 2021). For dental students, training procedures— especially administering an injection in a confined space—can help to decrease the rate of injury from sharps. Overall, though, engineering controls and work practices have been shown to be the most eective way of preventing injuries from sharp instruments, regardless of clinic setting. Therefore, training should include the use of safety-engineered devices and accepted safe work practices. Examples include not recapping needles using both hands but instead, using a one-handed scoop technique for recapping needles if nec- essary. For dental professionals, it is advisable to remove dental burs prior to disassembling
handpieces from dental units; for surgical professionals, it is advisable to use instru- ments instead of fingers for tissue retraction and palpation during suturing and anesthesia administration (Centers for Disease Control and Prevention, 2016). Additionally, training medical residents on proper line placement and encouraging use of available safety-engi- neered devices can help mitigate injuries. Timing The majority of sharps injuries occurred dur- ing the afternoon shift between 12 and 5 p.m. This timing is consistent with the literature (Matsumoto et al., 2019). Most employees and students are working a day shift, which typically ends between 4 and 5 p.m. As such, they might be rushing to complete a proce- dure or be fatigued, therefore increasing their risk of injury. Improving Reporting Practices To improve reporting practices, a clearly defined protocol needs to be in place. The pro- tocol should be distributed to each department and should include periodic updates. Several initiatives could improve reporting practices. These initiatives could include training new employees, house sta, and o-cycle hires. Each year, a reminder of reporting procedures for bloodborne pathogen exposure could be incorporated into the clinical health and safety training, with emphasis on the dier- ence between high- and low-risk injuries. The training materials should also make the report- ing process easier for students and employees, with an online link or QR code available within the materials. QR codes can be used in mul- tiple healthcare education applications and are relatively easy to use (Karia et al., 2019). Study Limitations Our study reviewed self-reported injuries in a database. Underreporting is a primary con-
cern and might have occurred disproportion- ately across dierent professions and roles. This limitation negatively aects our ability to compare rates of reporting across professions. Our data were obtained from the Rutgers University Accident Reporting Database, which has several fields that are free-text entries and are optional, further limiting the utility of the data. As a result, we are working with the IT department to restructure several fields so that the information obtained from the database can better inform preventive measures. Conclusion Injuries from sharps continue to occur in aca- demic medical centers, even with the wide availability of safety-engineered devices. Den- tal students had the highest rate of reported injuries and reported these injuries more promptly than the other health professionals in our study. The higher rate of reporting in the dental school might reflect that the proce- dures confer a higher risk of injury, a stronger culture of reporting among dental students, or both. Further studies to characterize the culture of reporting work-related sharps inju- ries among workers (e.g., students, trainees, and employees) in various healthcare fields are needed to better guide targeted measures to improve reporting practices. Acknowledgments: The authors thank Rut- gers University Environmental Health & Safety and Nick Taylor, senior application developer, Rutgers Institution Planning and Operations Division–IT, for assisting with the acquisition of data. Corresponding Author: Julie Caruth, MPH, MD, Rutgers, The State University of New Jer- sey, Environmental and Occupational Health Sciences Institute–Clinical Center, 170 Frel- inghuysen Road, Piscataway, NJ 08854. Email: jec253@eohsi.rutgers.edu
References
Bernard, J.A., Dattilo, J.R., & LaPorte, D.M. (2013). The incidence and reporting of sharps exposure among medical students, orthopedic residents, and faculty at one institution. Journal of Surgical Educa- tion , 70 (5), 660–668. https://doi.org/10.1016/j.jsurg.2013.04.010
Centers for Disease Control and Prevention. (2016). Summary of infection prevention practices in dental settings: Basic expectations for safe care . U.S. Department of Health and Human Services. https:// www.cdc.gov/dental-infection-control/media/pdfs/2024/07/safe- care2.pdf
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January/February 2025 • Journal of Environmental Health
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