UNDER-REPORTING OF CONTAMINATED NEEDLESTICK INJURIES IN EMERGENCY HEALTH-CARE WORKERS

Study hypothesis: There is considerable under-reporting of contaminated occupational needlestick and other sharp object injuries among emergency health care workers. Population: A convenience sample of emergency physicians, emergency nurses, and emergency medical technicians (EMTs). Method: A survey instrument eliciting demographic and work-related factors was developed and administered; survey items included age, sex, occupation, years in occupation, number of procedures performed per week, number of contaminated needlestick (and other "sharps") injuries recalled, and number of these injuries formally reported during the previous five years. Nonsegmented visual analog scales were used to assess eight attitudes possibly associated with nonreporting. Analysis was by analysis of variance and multiple linear regression with stepwise variable selection. Results: Two hundred fifty-nine subjects recalled 643 contaminated exposures during the five-year study period, but only 228 (35%) were formally reported. One or more injuries occurred in 55% of EMTs compared with 72% of nurses and 80% of physicians (P < .05). Physicians recalled a mean of 3.8 contaminated exposures, whereas nurses recalled 2.8 and EMTs recalled only 1.8 (P < .05). Physicians formally reported a mean of 0.26 exposures, whereas EMTs reported 0.85 and nurses reported 1.25 (P < .05). Physicians formally reported only one eighth of their injuries compared with EMTs and nurses, who each reported two thirds of these events (P < .05). Perception of risk, occupation, years in occupation, and concern about excessive paperwork were the most powerful predictors of low reporting rate (P < .05). Conclusion: Work-related contaminated sharp object injuries are under-reported by emergency health care workers, especially emergency physicians.