The Stark Prevalence of NSIs Among Surgical Residents

Needlestick and sharps injuries (NSIs) are not rare occurrences in surgical training, they are almost inevitable. A national study of general surgery residents found that 27.7% experienced an NSI within a six-month period, and 28.7% of those injuries went unreported [1]. International research reflects a similarly troubling pattern. In a 2025 survey of Irish surgical trainees, nearly all respondents had sustained at least one NSI, with some experiencing more than twenty. Only 14% of incidents were consistently reported, largely due to administrative burdens and a culture of silence [2]. Earlier data from the U.S. revealed that by their final year, 99% of surgical residents had sustained at least one NSI, with more than half of recent incidents unreported [3]. These figures expose not just a clinical training issue, but a systemic safety failure.
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Why Surgical Trainees Are Especially Vulnerable

Multiple factors contribute to the heightened vulnerability of surgical trainees. They are asked to perform technically challenging procedures during a steep learning curve, often in high-acuity environments with limited rest and intense pressure. Fatigue, common in surgical residency, impairs coordination and judgment, increasing NSI risk. Cultural expectations also play a role, residents may fear that disclosing injuries will reflect poorly on their competence or affect evaluations. In many programs, the operating room culture prioritizes speed and tradition over safety innovation, reinforcing unsafe habits and underreporting.
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System-Level Failures in Surgical Education

High NSI rates are a consequence of institutional design, not resident deficiencies. In many training programs, residents receive limited practical instruction in the use of safety-engineered sharps devices. Reporting systems are time-consuming, underpublicized, or perceived as punitive, which deters transparency. Environmental conditions, such as overcrowded ORs, inadequate lighting, and outdated equipment, exacerbate risk. Perhaps most damaging is the persistent disconnect between safety policy and the daily realities of surgical practice.
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Solutions: Protecting the Next Generation from Day One

Surgical training must integrate safety as a core clinical competency. This means ensuring access to engineering controls that support safe behavior, including intuitive devices like HypoHolder, a Class I FDA-registered device designed by KODA Ideaworks. HypoHolder allows for safe one-handed uncapping, recapping, and disposal of hypodermic needles, and is especially suited to high-stress clinical and perioperative environments. Its ease of use and integration into existing workflows help reduce cognitive load while improving safety adherence.

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Beyond equipment, institutions must streamline NSI reporting and establish non-punitive mechanisms for sharing and reviewing incidents. Residents should be encouraged to participate in structured debriefings, and their feedback should inform ongoing safety protocol refinement. Simulation-based training should be expanded to allow for risk-free practice in both technical and team-based sharps safety. Trainees must also be engaged in selecting devices, shaping policy, and improving workflows, building a sense of ownership over the systems meant to protect them.
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Safe Training Environments Are a Professional Obligation

The near-total exposure of surgical trainees to needlestick injuries is not a rite of passage, it is a systemic failure that places young clinicians and their patients at risk. By embedding safety from the start, supporting mental well-being, and pairing policy with practical tools like HypoHolder, we can rebuild training environments that are not only educational, but also protective. Ensuring a safer future for the profession begins with protecting those still learning to serve.