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Occupational exposures in US obstetrics and gynecology resident physicians

Published online by Cambridge University Press:  11 February 2021

Alison A. Garrett Open the ORCID record for Alison A. Garrett [Opens in a new window]  and
Harold C. Wiesenfeld
Alison A. Garrett*
Affiliation:
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
Harold C. Wiesenfeld
Affiliation:
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania
*
Author for correspondence: Alison A. Garrett, E-mail: garrettaa@upmc.edu
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Abstract

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Type
Research Brief
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 4 , April 2021 , pp. 485 - 486
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Occupational exposures are defined as any exposure to body fluids that are potentially infectious during performance of healthcare duties; these include sharps injuries and mucous membrane exposures (MMEs). These events pose a risk of infection to providers and patients should transmission of an infectious agent occur. Providers of obstetrics and gynecology frequently perform procedures and are therefore at risk of experiencing occupational exposures. Procedures with high blood loss, common in obstetrics and gynecology, are associated with higher rates of occupational exposures.Reference Myers, Epling, Dement and Hunt1 Several studies document high rates of occupational exposures and infrequent reporting of injuries among surgical trainees; however, few obstetrics and gynecology resident physicians are represented in these reports.Reference Kessler, McGuinn, Spec, Christensen, Baragi and Hershow2,Reference Marnejon, Gemmel and Mulhern3 We determined the self-reported frequency of occupational exposures and exposure reporting trends by US obstetrics and gynecology residents.

Methods

An online survey was circulated to leadership of all Accreditation Council for Graduate Medical Education (ACGME)-accredited obstetrics and gynecology residency programs requesting distribution to all resident physicians. Also, 3 reminders were sent over the following 6 weeks. The voluntary 22-item university institutional review board-approved survey remained open from May 1 through June 25, 2019. Consenting residents answered the survey and entered a raffle for a $50 e-gift card.

The survey was created using REDCap (Research Electronic Data Capture) tool, managed by the coordinating team at the University of Pittsburgh, and it was verified for comprehension. Physicians reported the total number of sharps injuries and MMEs experienced during residency and whether they reported the exposures to occupational health. Descriptive analyses used percentages, means, and medians. Variables were evaluated for significance by χReference Kessler, McGuinn, Spec, Christensen, Baragi and Hershow2 test and analysis of variance (ANOVA). All P values were 2-sided. Demographics were compared to national ACGME information.4

Results

In total, 441 residents participated, representing 9% of the 4,716 residents in ACGME-accredited obstetrics and gynecology programs in 2019.4 The mean age of respondents was 29.9 years, and 85.7% were women. In comparison, among US obstetrics and gynecology resident trainees in 2019, the mean age was 28.5 years and 82.8% were women. Of 441 respondents, 356 (80.7%) experienced at least 1 occupational exposure (Table 1). Sharps injuries were sustained by 322 residents (73.0%) and increased with years of training (P < .01). MMEs were sustained by 255 residents (57.8%) and also increased with years of training (P < .01). By the final year of training, 91% of residents experienced at least 1 sharps injury (mean, 3.29). The mean number of exposures did not differ by gender (4.3 for women vs 3.4 for men; P = .25), marital status (4.3 for singles, 4.1 for those in long-term relationships, and 5.8 for those divorced or separated; P = .62), or academic versus community program (4 vs 4.5; P = .75).

Table 1. Number of Exposures in Relationship to Postgraduate Year of Training

Note. PGY, postgraduate year; MME, mucous membrane exposure. Added percentages may not equal 100 due to rounding.

a Sharps injuries and/or MMEs.

b One respondent had missing PGY data.

Injuries from sharp suture needles were most common (n = 259, 58.5%), followed by blunt suture needles (n = 66, 14.9%) and injection needles (n = 61, 13.8%). The most common MMEs were amniotic fluid splashes (n = 208, 45.1%) and blood splashes (n = 145, 31.5%).

Overall, 262 of 356 residents (73%) failed to report at least 1 exposure. Among those who did not report an exposure, 129 of 262 residents (49.2%) did not report any exposure experienced. Only 94 of 356 residents (26.4%) reported every exposure. Also, 36 of 72 interns (50%) had never reported their exposures.

Common reasons for reporting injuries included following institutional protocol (86 of 356, 24%) or personal safety concerns (65 of 356, 18%). Reasons for not reporting included perception that the patient was at low infection risk (116 of 356, 33%), a cumbersome reporting process (88 of 356, 25%), or lack of time (44 of 356, 12%).

Discussion

This is the first study reporting on occupational exposures incurred by trainees in obstetrics and gynecology. Occupational exposures were commonly experienced by the residents who participated in this survey. Most respondents did not report all exposures, and 40% never reported an exposure. These results are similar to those among other surgical trainees.Reference Choi, Torres and Syed5 Although low reporting rates might reflect the perception that patients are at low risk of HIV infection, assessment of risk may be inaccurate.Reference Drumhiller, Geter, Elmore, Gaul and Sutton6 Further, the rising prevalence of hepatitis C infection heightens the concern for transmission of infection during occupational exposures.7 Lack of time and cumbersome processes were noted, similar to those reported from other surgical trainees.Reference Kessler, McGuinn, Spec, Christensen, Baragi and Hershow2,Reference Makary, Al-Attar and Holzmueller8 Most sharps injuries occurred using sharp suture needles. Safety device engineering, use of blunt sutures and double gloving can reduce percutaneous injuries.Reference Parantainen, Verbeek, Lavoie and Pahwa9,Reference Lancaster and Duff10

The low response rate was the main limitation of this study. The true response rate might actually be higher; we could not confirm that the resident program leadership forwarded our survey request to all residents. Sampling bias might have occurred because those sustaining exposures might have been more likely to participate. Recall bias is another limitation, particularly for upper level residents remembering exposures that occurred earlier in training. Additionally, we did not capture data on the individual exposures; therefore, we were unable to determine whether the nature of the exposure influenced reporting.

Occupational exposures are experienced by obstetrics and gynecology residents and are frequently not reported. Our study highlights the need for efforts to minimize occupational exposures among trainees. Further attention should be made to increasing educational efforts on the risks and long-term implications of these injuries as well as to streamline processes to enable opportunities for post-exposure prophylaxis.

Acknowledgments

We are thankful to the leadership of the training programs who distributed the survey to their residents.

Financial support

No financial support was provided relevant to this article.

Conflicts of interest

All authors report no conflicts of interest relevant to this article.

Footnotes

PREVIOUS PRESENTATION. This research was presented at the 2020 Council on Resident Education in Obstetrics and Gynecology & Association of Professors of Gynecology and Obstetrics Annual Meeting in Orlando, Florida, on February 26–29, 2020.

References

Myers, DJ, Epling, C, Dement, J, Hunt, D. Risk of sharp device-related blood and body fluid exposure in operating rooms. Infect Control Hosp Epidemiol 2008;29:1139–1148.CrossRefGoogle ScholarPubMed
Kessler, CS, McGuinn, M, Spec, A, Christensen, J, Baragi, R, Hershow, RC. Underreporting of blood and body fluid exposures among healthcare students and trainees in the acute care setting: a 2007 survey. Am J Infect Control 2011;39:129–134.CrossRefGoogle Scholar
Marnejon, T, Gemmel, D, Mulhern, K. Patterns of needlestick and sharps injuries among training residents. JAMA Intern Med 2016;176:251–252.CrossRefGoogle ScholarPubMed
ACGME Data Resource Book. Accreditation Council for Graduate Medical Education website. https://www.acgme.org/About-Us/Publications-and-Resources/Graduate-Medical-Education-Data-Resource-Book. Accessed January 14, 2020.Google Scholar
Choi, LY, Torres, R, Syed, S, et al. Sharps and needlestick injuries among medical students, surgical residents, faculty, and operating room staff at a single academic institution. J Surg Educ 2017;74:131–136.CrossRefGoogle Scholar
Drumhiller, K, Geter, A, Elmore, K, Gaul, Z, Sutton, MY. Perceptions of patient HIV risk by primary care providers in high-HIV prevalence areas in the southern United States. AIDS Patient Care STDS 2020;34:102–110.CrossRefGoogle ScholarPubMed
US Public Health Service. Updated US Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001;50(RR-11):1–52.Google Scholar
Makary, MA, Al-Attar, A, Holzmueller, CG, et al. Needlestick injuries among surgeons in training. N Engl J Med 2007;356:2693–2699.CrossRefGoogle ScholarPubMed
Parantainen, A, Verbeek, JH, Lavoie, M-C, Pahwa, M. Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff. Cochrane Database Syst Rev 2011;(11):CD009170.Google ScholarPubMed
Lancaster, C, Duff, P. Single versus double-gloving for obstetric and gynecologic procedures. Am J Obstet Gynecol 2007;196(5):e36–7.CrossRefGoogle ScholarPubMed
Figure 0

Table 1. Number of Exposures in Relationship to Postgraduate Year of Training