Occupational Exposure to Needle Stick Injuries among Health Care Workers in a Tertiary care hospital: A KAP study

Background: Needle stick injuries (NSIs) are serious occupational health problem related to accidental exposure of health care workers (HCWs) while involved in patient care services. The percutaneous exposure to potentially contaminated blood and body fluids with blood borne pathogens are responsible for significant prevalence of Hepatitis B, C & HIV infections amongst HCWs. Methods: This is a descriptive cross sectional study conducted in hospital settings over a period of one year. 178 HCWs were selected for study using systematic random sampling after proportional allocation for each professional category in the hospital. Collected data was processed on SPSS ver 24. The association between needle stick and associated factors were measured using the odds ratio at a 95% confidence interval. The statistical significance was made at a p-value of less than 0.05. Results Total of 62 incidences of sustaining a needle stick injury in a year was recorded amongst 178 HCWs. In this study, statistically significant results with p value less than 0.05 was obtained with association with variables like gender [AOR=1.36 (0.64 - 2.68)], experience in years as HCWs [AOR=1.23 (0.32 - 2.12)], profession [AOR=0.063 (0.001- 0.43)], observance of universal precautions as wearing gloves [AOR=0.33 (0.169 – 0.631)] or any training on PEP or universal precautions [AOR=2.29 (1.320 - 4.696)]. Conclusion: NSIs have the potential to affect the health system both directly and indirectly. To lessen the dangers and impacts of NSIs stringent training should coordinate the endeavors toward preparing of health care workers, utilization of wellbeing designed gadgets, and diminishing patient burden per health care workers.

Prevalence of needle stick injuries, its associated factors and awareness among nursing staff at tertiary care hospital of North India

Background: Needle Stick Injuries (NSIs) are defined as accidental skin penetrating injuries caused by needles. It is the single greatest occupational hazard to a medical personnel. In developing countries, needle stick injury is associated with the highest global prevalence of HIV, Hepatitis B, and Hepatitis C. Aim & Objectives: To estimate the prevalence of needle stick injuries, its associated risk factors and assess the awareness regarding needle stick injuries among nursing staff. Material & Methods: A cross-sectional study was conducted among nursing staff who were working at a tertiary care hospital in Northern India during June 2019 to November 2019. The study commenced after taking prior approval from institutional ethics committee. A census method was used to include the participants. Results: Around 66.7% of the nursing staff was exposed to NSIs during their working hours at the hospital. There was significant association of needle stick injuries with place of working and education of nursing staff in multivariate binary logistic regression. About 26% of the nurses were unaware that recapping should be done or not for used needle, and 35% of staff nurses recapped the needle after the use. Conclusion: Needle stick injuries can be prevented by continued education, effective training, providing better safety devices, a positive work environment.

Needle Stick and Sharp Injuries among Health Care Workers in Kelantan: A Retrospective Six-Year Cohort Study

@#Introduction: The prevalence of needle stick and sharp injuries (NSSIs) still high among healthcare workers and many of them, without reason had defaulted the post management follow up. Thus, the aim of the study was to determine factors associated with default follow up among healthcare workers sustained NSSIs in Kelantan. Method: A retrospective cohort study using secondary data from Sharp Injury Surveillance notification system within period of six years started from January 2010 was done. Data were collected using proforma and analysed using SPSS version 22.0. Two hundred and seventy cases were selected by using multistage random selection method. Binary logistic regression analysis was used to determine the factors. Result: Majority of reported NSSIs involved female, with the mean age of 33 years. Most of them were intern that had less than ten years’ experience. Most of the accident occurred during office hours at tertiary healthcare setting during venepuncture for blood or intravenous fluid management. The workers with age less than 40 years and those who work at hospital setting have higher possibility to default the follow up with (Adj. OR 2.80; 95% CI: 1.12,7.00; p = 0.027) and (Adj. OR 4.65; 95% CI: 1.77,12.33; p = 0.002) respectively. Conclusion: NSSIs can occur at all level of occupational setting particularly among those who has less experience and work at tertiary healthcare setting. Thus, an intensive precaution action should focus on them since they are also the group that has higher odd to default the post management follow up.

A study of percutaneous injuries amongst health care workers in a tertiary care hospital

Background: Percutaneous injuries (PCI) pose a significant risk of occupational transmission of blood borne pathogens to health care workers (HCWs). Their incidence is considerably higher than current estimates, and hence a low injury rate should not be interpreted as a non-existent problem.Methods: This prospective observational study was conducted over a period of 1 year at a tertiary care teaching hospital in northern India. As soon as the HCW sustains a PCI, they were instructed to report to the emergency department where note was made of all the details in the post exposure reporting form.Results: The incidence of PCI in this study was found to be 4.3%. PCIs were reported maximum among nursing staff (63.41%) compared to doctors (36.58%). Majority of PCIs were reported within 1 hour of sustaining the injury (57.1%). Needle stick injury was the commonest injury sustained by HCWs (84.5%). 91.46% of HCWs were fully immunized against hepatitis B.Conclusions: Preventing PCI is an essential part of infection control program in a hospital. Stress must be laid for mandatory reporting of all PCI irrespective of the source.

A Study of the Knowledge, Attitudes and Practices Regarding Needle Stick Injuries among Health Care Workers in Government Health Facilities of District Bandipora, J&K

Introduction: Needle stick injuries are often neglecteddespite being an important occupational hazard, withpotential to transmit infectious diseases. There is a need forraising awareness about them among all cadres of health careworkers. The current study was done to assess the problem inGovernment Health facilities of a rural district of J&K.Material and methods: Descriptive cross sectional study wasdone using all the secondary and 40% of the primary healthfacilities of the district. Study was conducted among doctors,paramedics and waste handlers. Statistics involved wereproportions or percentages, assessed by chi square test.Results: about 85% health workers considered needle stickinjury as a matter of concern. 27% were recapping the needleafter use. 12% had suffered a needle stick injury in the last oneyear and only half of them were immunized for Hepatitis B.Conclusion: There is a need of sensitization of the variouscadres of healthcare staff which is necessary to decreasethe risk of occupational exposure of infectious diseaseswith significant focus on waste handlers. There is a needfor enhancing the coverage of Hepatitis B immunizationespecially among the waste handlers who form the mostvulnerable group.

A study on needle stick injuries among health care workers in a tertiary care hospital in India

Background: Needle stick injury among health workers is regarded as an occupational hazard. Health care workers are at risk of having blood-borne diseases in case they are exposed to blood and other biological samples of the patients. Moreover, staff including doctors working in tertiary care hospitals has high work load which results in increased chances of getting these injuries. The aim and objectives of this study were to find out the prevalence of needle stick injury among different categories of health care workers. Authors also aimed to assess the knowledge, attitude and practices associated with it.Methods: A hospital based cross sectional study design to know the prevalence of needle stick injury among various health care workers of Karpagam Faculty of Medical Sciences and Research, a tertiary level care hospital in Coimbatore, Tamilnadu, India. A total of 250 health care workers were selected for the study purpose. A self-designed, semi-structured, pre-tested questionnaire was used to assess the prevalence of needle stick injuries and the factors associated with it.Results: A majority of health care workers (94%) knew about needle stick injury and 92% were aware that HIV can be transmitted through needle stick injury, 78.4% and 69.65% were aware of Hepatitis-B and Hepatitis-C transmission respectively. About 28.4% of subjects had encountered needle stick injury in their past. Furthermore, it was found that type of exposure and place of exposure was significantly associated with different categories of health care workers (p <0.001).Conclusions: Prevention of health workers against needle stick injury is the best possible way to prevent several bloods borne diseases. There should be a prevention programme which special focus on training of health care workers. Further strategies aiming at preventive measures and reporting of the Needle stick injuries accidents should be made compulsory among health care workers.

Occupational Exposure to Potentially Infectious Biological Material Among Physicians, Dentists, and Nurses at a University

OBJECTIVE: The objective of this study was to evaluate the prevalence and incidence of accidents with biological material, the level of knowledge, and compliance to standard precautions (SPs) among dentists, physicians, nurses, and dental and medical students.METHODS: A closed cohort study with a prospective and retrospective component was conducted between August 2014 and September 2015. The participants were contacted in two moments during the follow-up period, during which a structured questionnaire divided into six sections was used; the interviews were conducted during the follow-up period (Month 6) and at the end of the observation period (Month 12).RESULTS: The global prevalence of accidents in the previous 12 months was 10.2%, with a difference between professionals and students (13.0% vs. 5.1%, respectively; p < 0.003). The incidence rate was 6.49 per 100 person/year, with difference between the groups (6.09 per 100 person/year in professionals and 7.26 per 100 person/year in students), type of specialization (hazard ratio, 3.27), and hours worked per week (hazard ratio, 2.27). The mean of compliance to SP was 31.99 (±3.85) points, with a median of 33 (30, 35) points against the expected 27.75 points. Adherence to SP was associated with the accident report (p < 0.020).CONCLUSION: We conclude that the proportion/incidence rate of accidents with biological material was high in relation to that in the literature, being higher in professionals and especially among physicians. The levels of knowledge and adherence to SP were good, with the best found in dentists and dental students.

Cutaneous manifestations of anti retroviral therapy used for post-exposure prophylaxis

Health care workers are at increased risk of needle stick injuries. Blood borne diseases that could be transmitted by such an injury include HIV, Hepatitis B, HCV and many others. Post exposure prophylaxis should be immediately started within 72 hours and should be continued for 28 days. Currently two Nucleoside Reverse Transcriptase Inhibitors (NRTIs) are given along with one NNRTI (Non- Nucleoside reverse Transcriptase Inhibitor) including Efavirenz or Nevirapine. Multiple adverse effects have been reported with all the Anti- Retroviral Therapies including various cutaneous manifestations. A 22-year-old intern doctor studying in tertiary hospital of Ahmedabad had a needle stick injury with a needle contaminated with blood of HIV positive patient. Post Exposure prophylaxis was started within 72 hours consisting of fixed dose regimen of Tenofovir disprodoxil sulphate, Efavirenz and lamivudine. He was started with the drug within 2 hours and was prescribed one drug per day for next 27 days. On 22nd day he started having rash on his body which started on palms and soles. On 23rd day he saw severe facial edema along with edema on lips and rash spreading to other parts of the body. He was diagnosed with Hypersensitivity reaction and angioedema due to ART drug therapy. He was instructed to stop ART medications and was given antihistaminic for the symptoms. Patient's angioedema was relieved in 2-3 days and rash disappeared after 4-5 days. As he had already finished 23 days of therapy he was instructed to discontinue the drugs. No recurrence of rash or angioedema was noted. This case points out the severity of side effects in the normal healthy people taking ART as Post Exposure Prophylaxis. Apart from cutaneous manifestations, angioedema is a very grievous condition which doctors should always have lower threshold for diagnosis. Early diagnosis can prevent further complications. ART drugs have many complications and these patients should have intensive regular monitoring while on treatment. Also, proper education is required for needle cut injuries in health care workers.

New plastic ampoule opening design for use without needles: an evaluation study / 中国实用护理杂志

Objective To produce a plastic ampoule with an opening that fits syringe adapters to allow solutions to be drawn up without needles (to avoid needle stick and sharps injuries) and to test the effectiveness of the new design in terms of residual fluid volume and risk of microorganism contamination. Methods Evaluation study based on laboratory research was adopted. For the experimental group, 30 ampoules based on the new design were produced by 3D printing. The ampoules were sterilized and filled with 2 ml sterile water. The sterile water was drawn up without the use of needles, and the wastage fluid (i.e., 2 ml minus the quantity drawn up) was calculated. A 1 ml aliquot of sterile water from each ampoule was dropped onto a nutrient agar plate, and the number of colony-forming units was assessed after 48 h. For each ampoule, the experiment was performed twice. Sixty 2 ml glass-packaged sterile water injections constituted the control group. The fluid was drawn up with a needle, and the superfluous fluid and number of colony-forming units were assessed, as in the experimental group. Results The mean wastage fluid was 0.06 ml, 95% CI was 0.05-0.07 ml in the experimental group and the superfluous fluid was 0.06 ml, 95% CI was 0.06-0.07 ml in the control group, there was no significant difference between the two groups (Z=-1.194, P=0.233). The number of colony-forming units was 8 in the experimental group and 4 in the control group, there was no significant difference between the two groups (P=0.224). Conclusions The newly designed plastic ampoule opening could help health workers to avoid needle stick and sharps injuries when drawing up solution. The wastage fluid and microorganism contamination levels met the required standards, indicating that the new design is suitable for clinical application.

Seroepidemiological survey of health care workers in Maharashtra.

Context: HCWs all over the world carry occupational risk of getting infected with major blood borne infections through needle stick injuries (NSIs). As health care industry has been expanding, risk of nosocomial infections is increasing proportionately. Measures to prevent it and put in place a mechanism to control these injuries are needed urgently, especially in India where there is not only increase in domestic demand but impetus in health tourism. Aim: To determine HBs Ag, HBc IgM level and to assess anti-HBs level prevalence in HCWs, in a tertiary care hospital and to study the influence of factors like age and sex in the vaccinated HCWs and formulate mechanism to increase awareness to create a safe working environment in the hospitals. Settings and Design: 437 HCWs, working in Laboratories, Surgical, Medical or Dental departments in 11 Civil Hospitals and Sub-district Hospitals covering 8 circles of the State. Methods and Material: Qualitative and Quantitative estimation of HBs Ag and Anti-HBs by sandwich ELISA technique and qualitative HBc IgM level by antibody-capture, non-competitive test. Liver profile (SGPT, SGOT and Alkaline Phosphatase) by IFCC method done. Statistical Analysis Used: Tabulation and Pie Circle Result: 193 of the total 229 vaccinated HCWs tested positive for core antibody, meaning that they were infected prior to HBs Ag vaccination, leaving a total of 36 ‘truly’ vaccinated HCWs. 11 HBs Ag positive HCWs were tested for Liver Profile and all had ALAT, ASAT and ALP within normal range. Out of total number of 141 HCWs having 10 and below IU/L anti HBs, 5 HCWs were positive for HBS Ag, showing a positivity of 3.5%. Conclusion: Need of vaccination and for post-vaccination serological testing of all HCWs considering the high rates of non-responders and low responders (anti-HBs-34.2%). Importance of educating the HCWs of safety precautions while handling body fluids, and the management of ‘ sharps ‘ injuries.

Needle stick injuries among nurses of secondary care hospital: A cross-sectional study from Gaza Strip.

Background: Nurses are among the most highly prone professionals for needle stick injuries. The aim of this study was to determine the rate of needle stick injuries as well as the prevalence of vaccinating nurses against HBV. Methods: A hospital based cross-sectional study was conducted at all Shifa medical complex wards. A total of 634 nurses were eligible for participation and data were collected during working hours for three consecutive weeks in March 2014 using self-developed questionnaire. Chi square and univariate analysis were applied. Results: Ninety nine percent (628 out of 634) of nurses positively responded. The mean age of nurses was (35,54±10,12) and 222 nurses (35,7%) were from surgical, 191 (30,7%) from Internal medicine and 209 (33,6%) from Obst/Gyn hospital. Only 7% (43) have not received any dose of hepatitis B vaccine, 8,3% (51) received one dose, and 17% (104) received two doses. Whereas, 67,6% (413) completed the vaccination schedule of three doses. Regarding needle stick injuries, 54,1% (333 out of 615) of nurses reported at least one exposure in the last 6 months distributed as follow: 47.5%, 48.6%, and 66.3% in surgical, internal medicine and Obst/Gyn hospital respectively. Conclusion: The rate of NSIs among Shifa hospital nurses are relatively high and nurses should be aware of infection prevention and control standards to prevent further preventable injuries. The culture of reporting should be promoted and much efforts must be done to widening the hepatitis B vaccination coverage. Employer mandated vaccination policy to improve vaccination coverage.

Needle Stick Injuries and their Related Safety Measures among Nurses in a University Hospital, Shiraz, Iran

BACKGROUND: This study aimed to determine the prevalence and factors related to needle stick injuries (NSIs) and to assess related safety measures among a sample of Iranian nurses. METHODS: In this cross-sectional study, a random sample of 168 registered active nurses was selected from different wards of one of the hospitals of Shiraz University of Medical Sciences (SUMS). Data were collected by an anonymous questionnaire and a checklist based observational method among the 168 registered active nurses. RESULTS: The prevalence of NSIs in the total of work experience and the last year was 76% and 54%, respectively. Hollow-bore needles were the most common devices involved in the injuries (85.5%). The majority of NSIs occurred in the morning shift (57.8%) and the most common activity leading to NSIs was recapping needles (41.4%). The rate of underreporting NSIs was 60.2% and the major reasons for not reporting the NSIs were heavy clinical schedule (46.7%) and perception of low risk of infection (37.7%). A statistically significant relationship was found between the occurrence of NSIs and sex, hours worked/week, and frequency of shifts/month. CONCLUSION: The study showed a high prevalence of NSIs among nurses. Supportive measures such as improving injection practices, modification of working schedule, planning training programs targeted at using personal protective equipment, and providing an adequate number of safety facilities such as puncture resistant disposal containers and engineered safe devices are essential for the effective prevention of NSI incidents among the studied nurses.

Prospective and Retrospective Incidence and Post-exposure Reporting of Needlestick Injuries / 병원감염관리

BACKGROUND: Most studies on the incidence rate (IR) and post-exposure reporting rate (RR) of needle-stick injuries (NSIs) were performed using retrospective surveillance, which is vulnerable to recall bias. This study aimed to identify the agreement between IRs and RRs obtained from prospective and retrospective surveillance. METHODS: The prospective surveillance was performed with 716 nurses working at 3 hospitals from August to September in 2012. They prospectively reported when they experienced the NSIs, and the investigator retrospectively calculated the RR from records in the infection control unit or health care unit during the same periods when they reported the number of NSIs. The retrospective surveillance was carried out with 312 nurses who participated in the prospective surveillance. They retrospectively answered the question on the number of NSIs and post-exposure reporting after recalling the experienced NSI from August to September in 2012. RESULTS: The IR of NSIs was 9.8 per 100 nurses by the prospective surveillance and 36.4 per 100 nurses by the retrospective surveillance, which was statistically significantly different (P<0.001). The RR of NSIs was 14.3% by the prospective surveillance and 8.5% by the retrospective surveillance, which was not statistically significantly different. CONCLUSION: We recommend using a prospective approach for calculating the IR of NSIs to reduce the risk of recall bias. However, the RR of NSIs can be calculated using both prospective and retrospective approaches.

A qualitative research on the feelings of clinic nurses after needle-stick injuries / 中国实用护理杂志

Objective To explore the feeling of nurses after needle stick injuries and analyze the cause and impact of needle stick injuries,so as to explore protection measures.Methods The phenomenological methodology was used in the study to analyze the main causes of needle stick injuries,handling method and report reasons.Results The main causes of needle stick injuries were violation of the operation sequence and the weakness of protection awareness.The main reactions of nurses to needle stick injuries were fear and worry.The report circuit was complex.Conclusions It is suggested to pay attention to the analysis and discussion of needle stick injuries and make standardized the operation sequence,improve self-protection awareness,and perfect the support system after needle stick injuries,then bring it into the routine management work.

Needle stick injury and HIV risk among health care workers in North India.

Objectives: To determine the occurrence of needle stick injuries among various categories of health care workers (HCWs), the causal factors, and the circumstances under which these occur. 2. To explore the possibilities of measures to prevent these through improvement in knowledge, attitude, and practice. Materials and Methods: The study was conducted in two government tertiary level hospitals. Study sample comprised 107 HCWs, providing medical care in two government tertiary level hospitals of Chandigarh. Subjects were enquired about their exposure to needle prick injuries during patient management in the last 6 months and also the action taken following exposure. The statistical tools employed were: ratio, proportions, and other basic methods of data interpretation. Results: The study among 107 HCWs included 27 doctors (25.2%), 68 nurses (63.5%), and 12 paramedics (11.2%), with 87 (81.3%) being females. The prevalence of needle stick injury and exposure to blood was reported by 73 (68.2%) participants. The main factor ascribed for this exposure was heavy patient load (42.5%). The maximum accidents occurred during emergency care (30.1%). Most common action following exposure was cleaning with spirit (46.3%). Only 51 (47.7%) of HCWs admitted following universal precautions. Among those exposed, only 10 (13.7%) persons had undergone HIV testing. Conclusion: Two-thirds of HCWs were exposed to needle stick injuries. Lack of awareness about post-exposure prophylaxis (PEP) was found.

The Effect of the Prevention Program of Needle-Stick Injury on Needle-Stick Knowledge, Compliance and Incidence / 병원감염관리

BACKGROUND: The purpose of this study was to develop and apply a prevention program for needle-stick injuries among health care workers who have a high occupational risk of such injuries, and to analyze the effect of the program on the subjects' knowledge regarding such injuries and compliance with protocols, as well as the incidence of needle-stick injuries among subjects. METHODS: The subjects of this study were nurses (RNs) and nurse's aides (NAs) working at a university hospital in Daegu. The data were collected by conducting surveys and determining the incidence of needle-stick injuries during a 1-year period before the application of the program. The program consisted of preventive education on needle-stick injury, the use of standardized boxes to measure blood sugar test, and the use of intravenous catheters with safety needles. Six months after the intervention, surveys were conducted to analyze the incidence of needle-stick injuries. The data on knowledge and compliance related to needle-stick injuries before and after program application were analyzed using the paired t-test, and data on the incidence of injuries were analyzed using the chi-square test. RESULTS: The scores on knowledge (RN, P<0.001; NA, P=0.007) and compliance (RN, P<0.001; NA, P=0.038) were significantly higher after the intervention than before. However, the number of reports on the incidence of needle-stick injuries before and after the intervention were not significantly different (RN, P=0.691; NA, P=0.079). CONCLUSION: The prevention program for needle-stick injuries was effective in improving the knowledge and compliance related to needle-stick injuries among RNs and NAs, but the number of reports on the incidence of injuries showed no difference. Therefore, the prevention program must be reevaluated and further developed after continuously monitoring and analyzing it in a hospital setting in order to decrease the incidence of needle-stick injuries.

Study of needle stick injuries among health care workers at a tertiary care hospital.

A cross-sectional study was conducted among health care workers at a tertiary care hospital in Goa to study the problem of needle stick injuries. A structured questionnaire was used to interview the study participants at their work place. Participants were asked to recall needle stick injuries in the preceding 12 months. Factors such as work experience, type of procedure, action taken following injury etc were also studied. Statistical analysis was done with SPSS software. Around 34.8% (200/575) of the Health care workers had experienced a needle stick injury in the last one year. Needle stick injuries were equally distributed across different work experience periods. Hollow bore needles were responsible for 77.5% of needle stick injuries followed by suturing needles (19.2%). As far as use of personal protection was concerned only 58% of the health care workers were wearing gloves at the time of the injury. There is therefore an urgent need at the hospital level to have a uniform needle stick injuries policy covering safe work practices, safe disposal of sharps, procedures in event of needle stick injury, training including pre-employment training, monitoring and evaluation of needle stick injuries and procedures for reporting needle stick injuries.

Needle-Stick Injuries among 379 Nurses:Analysis and Surveillance / 中华医院感染学杂志

OBJECTIVE To investigate rate,cause,psychology and prevention of needle-stick injuries among nursing staff.METHODS A retrospective questionnaire was distributed to a convenience sample of 426 clinical nurses in a hospital.RESULTS Totally 379 nurses(88.97%) suffered from needle-stick injuries with an average of 4.75 times per person annually.The nurses with needle-stick more than 10 times accounted for 6.10%.The main reasons of needle-stick included pulling needles,adding medication,separating needle and so on.CONCLUSIONS Nurse should consolidate them self-protective consciousness.Therefore,it is a very important task of occupational prevention to improve the education of concept of universal precautions,prevent needle stab and reduce the occurrence of blood born diseases.