ANNUAL FEATURE: IN PROGRESS: REPORTS OF NEW APPROACHES IN MEDICAL EDUCATION: CURRICULUM: Hot Topics
CHIN, RACHEL L. MD; TABAS, JEFFREY A. MD; NEIGHBOR, MARTHA L. MD; FRANCISCO, SAN
Section Editor(s): ANDERSON, M. BROWNELL
Association of American Medical Colleges
Inquiries: Rachel L. Chin, MD, Department of Emergency Services, San Francisco General Hospital, 1001 Potrero Avenue, RM 1E-21, San Francisco, CA 94110.
Objective: The hospital environment poses significant risks to medical staff for accidental needle sticks and exposure to body fluids. It is estimated that needle sticks threatens the health and safety of eight million nurses, doctors, and other medical and public safety workers around the nation. In 1999, the Centers for Disease Control and Prevention in Atlanta issued a safety alert to the nation's hospitals warning of the serious dangers of accidental needle sticks. The alert noted that for every 100 beds, an average of 30 potentially fatal needle injuries occur each year in hospitals. In 1999 we developed a teaching module intended to decrease the risk of needle stick and body-fluid exposure for medical students and housestaff.
Description: The Emergency Department at San Francisco General Hospital has developed a 10.5-minute video to teach several strategies to decrease the risk of needle sticks and body-fluid exposures. The goal is to improve the ability of our medical students and housestaff to practice health care safety. This video is shown to housestaff, to all medical students entering their preclinical years, and to all students and staff during their emergency medicine rotations. As of the end of 2000, the video had been viewed by approximately 300 medical students and housestaff.
The strategies outlined in this video were developed by comprehensive review of all needle sticks and exposures to body fluids over a ten-year period at the University of California, San Francisco, medical center and affiliated hospitals. The video gives an extensive review of universal precautions. It demonstrates phlebotomy with the Vacutainer system, IV placement with the Protect IV safety catheters, and suturing. The importance of adequate anesthesia during suturing is emphasized to encourage needle-stick safety and patient comfort. Safe cleanup and disposal techniques are outlined.
The video also has scenarios that teach the students to anticipate unexpected patient reactions. The video identifies the types of patients who may jerk or jump, such as the intoxicated, agitated, or uncooperative, and those with altered mental states. Students are also encouraged not to hesitate to ask for help. There is also advice about what to do if stuck with a needle or instrument.
Discussion: Medical students and residents experience numerous potential body-fluid and needle-stick exposures during their rotations. A recent review documented a 12% rate of exposures of medical students during their training, with some of the highest rates occurring in the emergency department elective. Because many medical schools and residency programs have informal or non-uniform training on this topic, it is incumbent upon faculty to take a greater role in educating the residents and medical students in their programs. This video provides uniform and standardized training about activities and procedures that present high-risk exposures and gives advice about strategies to decrease exposures.
Annual, Peer-reviewed Collection of Reports of Innovative Approaches to Medical Education