Underreporting of blood and body fluid exposures among health care students and trainees in the acute care setting: A 2007 survey Chad S. Kessler, MD, a,b Marcella McGuinn, MD, a,b Andrej Spec, MD, c Jessica Christensen, MD, a Rashmi Baragi, MD, a and Ronald C. Hershow, MD a Chicago, Illinois Background: It has been estimated that more than 8 million health care workers (HCWs) in the United States may be exposed to blood and body fluids via sharp and mucocutaneous exposures. Methods: An anonymous questionnaire was distributed among 505 HCWs. The target sample population included all the medical students; nursing professionals; dental professionals; and residents in internal medicine, emergency medicine, surgery, and obstet- rics and gynecology at the University of Illinois Medical Center, Chicago, Illinois, a metropolitan tertiary care and referral center for Northern Illinois and Northwest Indiana. The sample was limited by the number of HCWs who were available to take the survey. The number and the characteristics of occupational exposures and reporting practices were recorded and compiled. Subsequently, a review of the English literature was performed using PubMed to analyze reasons for underreporting. Secondary and tertiary ar- ticles were located based on findings from the initial searches. Results: One hundred three of 455 (22.6%) HCWs reported a sharps exposure during their career, including their student years; thirty-four (33.0%) of these were not reported. One hundred five of 455 (23.1%) HCWs reported a mucocutaneous exposure during their career; 87 (82.9%) of these were not reported. The most common year of exposure was the intern year. The most common reason for not reporting was the belief that the exposure was not significant, followed by the combination of believing the expo- sure was not significant and being too busy. Conclusion: Underreporting of blood and body fluid exposures is common because of a belief that most exposures are not signif- icant. More education of HCWs is needed to change this perspective. Key Words: Underreporting; needlestick; mucocutaneous; percutaneous; blood; education. Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc. (Am J Infect Control 2011;39:129-34.) The Centers for Disease Control and Prevention (CDC) has estimated that as many as 384,325 health care workers (HCW) are exposed to blood and body fluids via sharp and mucocutaneous injuries per year in the United States. 1 Approximately 800,000 percuta- neous injuries are reported by HCWs per year in the United States. 2 As a result, HCWs are at risk for acquir- ing bloodborne pathogens such as the HIV and hepati- tis B and C viruses. The risk of HIV seroconversion after a needlestick has been estimated at 0.3% and 0.1% or less for a mucocutaneous exposure. 3 The risk of hepa- titis B seroconversion after a needlestick is reported to be 2% for hepatitis B e antigen-negative and 30% for hepatitis B e antigen-positive blood. 3 Hepatitis C sero- conversion is estimated at 1.8% for a percutaneous injury. 3 Reporting and risk stratification of such exposures with administration of postexposure prophylaxis (PEP) may prevent acquisition of bloodborne patho- gens including HIV and hepatitis B. 4 We sought to de- scribe sharps and mucocutaneous exposures and to investigate reasons for underreporting across multiple disciplines including resident physicians of various fields, medical students, nursing staff, and dental stu- dents and residents. METHODS This is a cross-sectional survey study obtained by utilization of an anonymous questionnaire distributed among HCWs and a literature review. The study sub- jects were internal medicine (n 5 61), general surgery From the University of Illinois at Chicago Medical Center, Chicago, IL a ; Jesse Brown Veterans Administration Medical Center, Chicago, IL b ; and Rush University Medical Center, Chicago, IL. c Address correspondence to Chad S. Kessler, MD, 820 S Damen Ave, M/C 111, Emergency Medicine, Chicago, IL 60612. E-mail: Chad. Kessler@va.gov. These data were presented at the IDSA 2008 conference in Washington, DC. Conflicts of interest: None to report. 0196-6553/$36.00 Published by Elsevier Inc. on behalf of the Association for Professionals in Infection Control and Epidemiology, Inc. doi:10.1016/j.ajic.2010.06.023 129