Needle stick injuries among health care workers of Alexandria University hospitals

Needle stick injury has been recognized as one of the occupational hazards which results in transmission of blood borne pathogens. As there was limited data on the national level about these injuries determinants of such injuries are important to investigate and to design effective prevention programs. The purpose of this study was to investigate the prevalence and circumstances of needle stick injuries among heath care personnel working at Alexandria University hospitals. Effectiveness of the existing control measures and practice of standard precautions were also assessed. A cross-sectional survey was carried out among 913 health care workers [HCW] in different clinical departments of the three teaching hospitals from January to December 2007. Data were obtained by an anonymous, self-reporting questionnaire. Health Belief Model [HBM] was used to explain standard precautions practice. Multiple linear regression was performed to predict factors associated with the practice of standard precautions. Of the recruited participants, 70.6% [645/913] had completed the questionnaires. Nurses had the highest response rate [92.5%]. More than two thirds [68.0%, n=438] of participanting HCWs had sustained at least one needle stick injury in the last 12 months. Risk of [Needle Stick Injuries [NSls] was significantly associated with younger age of the participants and fewer years of work experience. More specifically, of all occupational groups, nurses have the highest risk to experience needle stick injuries [62.3%]. Disposable syringes accounted for 38.4% of injuries. Most needle stick injuries [36.5%] occurred at the patient's ward. Evaluating the kind of activity under which the needle stick injury occurred, on average 36.0% of injuries occurred during recapping of a needle especially if this practice was handily done. High risk patients [one with a history of infection with HIV, hepatitis B, hepatitis C, or injection drug use] were involved in 8.2% of injuries. The majority of NSIs [73.1%] occurred at end of the shift. Most health care workers [77.4%] were mentally distressed during their injury. Factors increase possibility of infection transmission were the procedure involving a needle placed directly in patient's vein or artery, exposure to a source patient who had evidence of blood borne infection, low immune status of the HCW [i.e., no vaccination with HBV], deep injury, and lack use of personal protective equipment. A total of 327 respondents [74.7%] did not report the injury to an employee health service. Lack knowledge of appropriate procedure after injury was the most common cited reason for not reporting the injury. The survey revealed that use of preventive measures was inadequate. Only 10.0% of all participant workers knew new needless safety devices. The significant protective factors that decreased the frequency of needle stick injuries were using devices with safety features [OR=0.41], satisfactory adherence of a health care worker to infection control guidelines [OR=0, 42], having training in injection safety and appropriate work practices [OR=0.14], comfortable room temperature during injection [OR=O.32], and availability of written protocol for prompt reporting of such injuries [OR=0.37]. The mean standard precautions practice percent score for the health care workers was 46.32%. In multiple linear regression model, knowledge score of infection transmission [adj beta: 0.18] and the work experience [adj beta: 0.06] were the only significant predictors of standard precautions score. There is a high rate of needlestick injuries in the daily routine of Alexandria teaching hospitals with subsequent risk of infection transimission. Greater collaborative efforts are needed to prevent needlestick injuries. Such efforts are best accomplished through a comprehensive program that addresses all circumstances that contribute to the occurrence of needlestick injuries in health care workers. Critical to this effort is the elimination of needle use where safe and effective alternatives are available and the continuing development, evaluation, and use of needle devices with safety features. All such approaches must include serious initial and ongoing training efforts