Education of medical students and house staff to prevent hazardous occupational exposure.

1 is a poignant reminder to medical students and physicians of the risks of exposure to occupational hazards that are inherent to our profession. The risks of occupational exposure to potential hazards are high in the health care industry; it is an industry with a poor health and safety record, in which little attention has been paid to training its members in minimizing risks. The risk of exposure to occupational hazards is potentially the greatest for an inexperienced, tired individual in a new work environment — medical students and house officers during clinical training rotations, for example. A recent survey completed by 385 medical students and junior house staff at a New York City medical centre on occupational exposure to patients’ blood and body fluids found that 32% (122/385) of the respondents experienced hazardous exposures during the 6 months preceding the survey. Only 29% (35/122) of those respondents reported the exposure to the medical centre’s occupational health office, in accordance with the institution’s policy. Similar surveys conducted in American teaching hospitals of medical house staff, residents and medical students report exposure rates to patients’ blood and body fluids anywhere between 19% and 71%. Although the reports on occupational exposure to blood and body fluids often focus on HIV, the risk of infection from exposure to other organisms is higher. The risk of infection for health care workers in a dialysis setting was reported to be 4000 times higher for hepatitis B and 8000 times higher for hepatitis C than it was for HIV. Exposure to pathogens from routes other than blood and body fluids is also a concern; 46% (12/26) of internal medicine residents at a public hospital in the United States who had self-reported a negative tuberculin skin test received positive results on a repeat tuberculin test before they graduated. Many of the risk factors associated with tuberculosis exposure could have been avoided if the appropriate educational intervention programs had been offered. Unfortunately, there is little comparative data available from Canadian training centres on rates of exposure to occupational hazards. The rates of reporting occupational exposures to institutional or personal health providers have been reported to be between 9% and 30%. Reasons for not reporting an exposure included lack of formal reporting mechanisms, perceptions that the injuries did not pose a major risk (i.e., that the patient was not infectious), the outcome of the exposure would not be changed by making a report, and fears about confidentiality and professional discrimination. By not reporting their exposure these individuals potentially relinquished the chance to receive risk assessment, counselling, valuable information and worker’s compensation. Education in occupational exposure has been identified by students at the University of Calgary as an important topic that, although addressed in the curriculum, is perhaps lacking in necessary scope, breadth and practical grounding. At present, occupational exposure to infectious pathogens is covered in three 1-hour sessions (lectures or small groups) as part of the curriculum in clinical systems courses. For example, occupational exposure to bloodborne pathogens is included in lectures on the hepatitides and HIV, and the management of patients with suspected tuberculosis is discussed in small-group sessions. However, these sessions do not specifically cover techniques to prevent personal nosocomial exposure or the proper procedures to follow if exposure occurs. There is a session during clerkship orientation on the reporting of needle-stick injuries, but students have said that because they are so overwhelmed with the other information provided on their first day of clerkship, they may marginalize this information, not understanding its practical importance. Descriptions of coordinated programs at other universities are scarce in the literature. Educational programs on minimizing risk exposure in health care facilities are disEducation of medical students and house staff to prevent hazardous occupational exposure