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

Current status and high-risk factors of blood-borne occupational exposure among midwives in China: A cross-sectional survey

BACKGROUND

To identify the problems and high-risk factors of blood-borne occupational exposure among midwives in China.

METHODS

Midwives from the obstetrics department and delivery room of hospitals in institutions. The self-compiled questionnaire on the current status of blood-borne occupational exposure of Chinese midwives was used for data collection.

RESULTS

The incidence rate of blood-borne occupational exposure was 46.77%. The independent risk factors were working years ≤5 years (P = .001), unable to take standard prevention at work (P = .000), unaware of human immunodeficiency virus treatment procedures (P = .000), and average daily working hours of 8 hours (P = .002), the high risk of blood-borne occupational exposure at work (P = .000), and contact with patient fluids, blood without gloves (P = .000).

DISCUSSION

Midwives are at high risk of blood-borne occupational exposure, and midwives with ≤5 years of service are the focus group. Failure to achieve standard prevention, the length of working hours and the ignorance of the treatment process of acquired immunodeficiency syndrome have a certain impact on the occurrence of blood-borne occupational exposure.

CONCLUSION

It is necessary to focus on cultivating high-level midwifery talents to overcome the shortage of midwives and rationally use midwifery resources, as well as to strengthen standard prevention and improve the occupational protection and guarantee system for midwives.

Prevalence and associated factors of needle stick and sharps injuries among healthcare workers in northwestern Ethiopia

Background

Needle stick and sharp injuries (NSSIs) are a common problem among healthcare workers (HCWs). Although the factors related to NSSIs for HCWs are well documented by several studies in Ethiopia, no evidence has been reported about the magnitude of and factors related to NSSIs in hospitals in northwestern Ethiopia.

Methods

An institution-based cross-sectional study was carried out from January to March 2019 among 318 HCWs in three randomly-selected hospitals of the eight hospitals found in South Gondar Zone. Sample sizes were proportionally allocated to professional categories. Study participants were selected by systematic random sampling methods using the monthly salary payroll for each profession as the sampling frame. Data were collected using a self-administered questionnaire. The outcome of this study was the presence (injured) or absence of NSSIs during the 12 months prior to data collection. A binary logistic regression model with 95% confidence interval (CI) was used for data analysis. Variables from the bi-variable analysis with a p-value ≤ 0.25 were retained into the multivariable analysis. From the multivariable analysis, variables with a p-value less than 0.05 was declared as factors significantly associated with NSSIs.

Main findings

The prevalence of NSSIs was 29.5% (95% CI: 24.2–35.5%) during the 12 months prior to the survey. Of these, 46.0% reported that their injuries were moderate, superficial (33.3%) or severe (20.7%). About 41.4% of the injuries were caused by a suture needle. Factors significantly associated with NSSIs were occupation as a nurse (adjusted odds ratio [AOR] = 2.65, 95% CI: 1.18–4.26), disposal of sharp materials in places other than in safety boxes (AOR = 3.93, 95% CI: 2.10–5.35), recapping of needles (AOR = 2.27, 95% CI: 1.13–4.56), and feeling sleepy at work (AOR = 2.24, 95% CI: 1.14–4.41).

Conclusion

This study showed that almost one-third of HCWs had sustained NSSIs, a proportion that is high. Factors significantly associated with NSSIs were occupation as a nurse, habit of needle recapping, disposal of sharp materials in places other than in safety boxes and feeling sleepy at work. Observing proper and regular universal precautions for nurses during daily clinical activities and providing safety boxes for the disposal of sharp materials, practicing mechanical needle recapping and preventing sleepiness by reducing work overload among HCWs may reduce the incidence of NSSIs.

Investigation and Analysis of Sharp Injuries among Health Care Workers from 36 Hospitals in Shandong Province, China

Background

This study investigated and analyzed the current situation of sharp injuries among health care workers (HCWs) in China's Shandong Province.

Methods

By means of questionnaire survey, the incidence of sharp injuries among HCWs from 36 hospitals in China's Shandong Province in October 2019 was investigated, and the results of this survey were compared with those of October 2012.

Results

A total of 48165 HCWs were investigated. 549 cases of sharp injuries occurred. The incidence of sharp injuries was 1.14%, which was significantly lower than that in October 2012 (9.71%). In the occupational distribution of sharp injuries among HCWs, the proportion of nurses was 58.65%, doctors 23.32%, and interns 12.02%. Among the distribution of sharp injury departments, general wards, operating rooms, intensive care units, disinfection supply centers, and outpatient clinics were the high-incidence sites of occupational exposure among HCWs. The main instruments causing sharp injuries in HCWs were syringes, scalp steel needles, surgical suture needles, vacuum blood collection needles, and glass slides. Drug administration, double-handed loop needle cap, blood extraction, surgical suture needle, and arteriovenous needle extraction were high-risk operations causing sharp instrument injuries in HCWs.

Conclusion

The incidence of sharp injuries among HCWs from 36 hospitals in Shandong Province in October 2019 was significantly lower than that in October 2012. Sharp injuries were a common type of occupational exposure for HCWs. The occurrence of sharp injuries should be effectively reduced by changing wrong habitual behavior and implementing standard protective measures.

Comparison of knowledge, attitude, and practices regarding needle-stick injury among health care providers

Introduction:

Needle-stick injury (NSI) is one of the most potential hazards for health care workers. They pose a significant risk of occupational transmission of blood-borne pathogens. The present study was done to determine the incidence of NSI among interns and nurses; their knowledge, attitude, and preventive strategies undertaken by the respondents after NSI.

Materials and Methods:

The cross-sectional study was done among interns and nurses in various departments of a tertiary care center in Kerala, India using a self-administered questionnaire.

Results:

The incidences of NSI among interns and nurses were 75.6% and 24.4%, respectively. The most common clinical activity leading to NSI among interns was blood withdrawal (42%) followed by recapping (29%). It was found that nurses had enough knowledge and followed better NSI practices and attitude than the interns.

Conclusion:

All the parameters analyzed were inadequate among the interns, indicating the need for continual awareness programs particularly during the preclinical years.

Study of needle stick injuries among healthcare providers: Evidence from a teaching hospital in India

Background:

Needle stick injuries (NSIs) are the injuries that are caused by needles, such as hypodermic needles, blood collection needles, intravenous stylets, and needles used to connect parts of intravenous delivery systems. NSIs are very common and in many instances unavoidable among healthcare providers when they are delivering patient care. Around 75% of the NSIs in developing countries are not reported. This study aimed to estimate the prevalence and other correlates and attributes of NSIs among healthcare providers in a tertiary care teaching hospital in South India.

Methods:

This is a cross-sectional study conducted in Narayana Medical College and Hospital in Nellore, Andhra Pradesh, between June 2012 and February 2013. Data using a structured questionnaire were collected among all the 1525 healthcare providers working in the teaching hospital.

Results:

Around 10.81% of the total healthcare providers in the teaching hospital were exposed to NSIs. Syringe needles (75%) were the most common devices leading to NSIs. Majority of NSIs took place in the wards of the different departments (75%). Morning shift (70%) was the most common time of the day for the occurrence of NSIs. Only 65% of the healthcare providers were wearing gloves at the time of injury. Majority (82%) took immediate treatment after NSIs.

Conclusions:

Establishment of formal reporting mechanisms, immediate reporting of NSIs, and the establishment of a comprehensive NSI prevention program will help in the reduction in the occurrence of NSIs and help in taking immediate remedial action in the form of prophylaxis and treatment.

Sharp injuries: a cross-sectional study among health care workers in a provincial teaching hospital in China

Background

The objectives of this study are to investigate the incidence and reporting behavior of sharp injuries among healthcare workers (HCWs) and identify the risk factors associated with these injuries.

Methods

A cross-sectional survey was conducted in February 2017 in a provincial teaching hospital in China. Data were collected from 901 HCWs using a self-administered questionnaire which included demographic information, experience, and reporting behavior of sharp injuries. Stepwise logistical regression was used to analyze the risk factors.

Results

HCWs (248 [27.5%]) had sustained a sharp injury in the previous year. Factors including seniority, job category, title, education, department, and training programs were associated with the occurrence of sharp injuries. According to the stepwise logistical regression, seniority, and training programs were the risk factors associated with the occurrence of sharp injuries. Of 248 sharp injuries, 130 HCWs were exposed to blood. Only 44 (33.9%) HCWs reported their injuries to the concerned body. The main reasons for not reporting the sharp injuries were as follows: perception that the extent of the injury was light (30.2%), having antibodies (27.9%), and unaware of injury (16.3%).

Conclusions

Sharp injuries in the studied hospital were common and were likely to be underreported. Therefore, an effective reporting system and sufficient education on occupational safety should be implemented by the relevant institutions. Moreover, it is important to take effective measures to manage sharp injuries in HCWs and provide guidance for their prevention.

Awareness of blood-borne infections and burden of occupational exposures to blood and body fluids among health care personnel in a tertiary care teaching hospital

Background and Objectives:

Occupational exposures (OEs) to blood and body fluids (BBFs) pose significant risk of transmission of blood-borne infections (BBIs) to health care personnel (HCP) and are grossly underreported. We aimed to study the awareness of BBIs and their prevention, burden of OEs, assess factors contributing to them and their poor reporting and assess the practices for their prevention among HCP.

Materials and Methods:

This cross-sectional study conducted at a tertiary care teaching hospital located in south India used a self-administered questionnaire to assess the awareness of BBIs, attitude and practice of HCP for prevention of OEs, and to quantify the burden of exposures. All formally self-reported OEs during the study period of 2 years were documented prospectively.

Results:

Majority (369/401, 92%) of HCP surveyed had fair general awareness of BBIs. Though 90% were aware of the concept of universal precautions (UPs), self-reported adherence to barrier precautions was acceptable in only 80%. Overall, 56% and 46% of HCP were aware of human immunodeficiency virus (HIV) and hepatitis B post-exposure prophylaxis (PEP) respectively. Eighteen percent (74/401) were either not vaccinated or incompletely vaccinated against hepatitis B. Recapping of used needles was reported by 79% (317/401). Nearly half (208/401) reported OEs over preceding year and 70% (146/208) of exposed had not formally reported them. Over the 2-year study period, 53 formally self-reported exposures were documented prospectively. Needle stick injuries accounted for 83% of the exposures, and appropriate personal protective devices were not being used during 47% of exposures. Though doctors had the highest awareness, they reported lowest adherence to barrier precautions and highest burden of exposures (P < 0.05).

Conclusion:

Though majority of HCP had fair awareness of BBIs, it did not translate into adequate adherence to UPs and safe practices. High burden of OEs and their poor reporting emphasize the need to motivate our HCP to adhere to safe work practices and to promptly seek professional counselling after exposures. There is an urgent need to educate HCP about the availability and effectiveness of PEP for HIV and hepatitis B. A uniform national policy for prevention and reporting of OEs has to be framed.

The impact of sharps injuries on student nurses: a systematic review

AIMS AND OBJECTIVES

The purpose of this review was to discover the impact of sharps injuries in the student nurse population.

BACKGROUND

Much is known and reported about sharps injuries in registered nurses, but there has been a lack of published evidence regarding sharps injuries within the student nurse population.

METHOD

A systematic review of nursing, health and psychology databases was conducted. The limits set were publications between 1980 and 2014 in the English language. Studies were identified then, following a rigorous critical and quality appraisal with validated tools, were selected for the systematic review.

RESULTS

A total of 40 articles met the inclusion criteria, reporting studies conducted in 18 countries. Psychological and physical impacts of sharps injuries in student nurses were reported, such as fear, anxiety and depression, although these impacts were not quantified using a validated instrument.

CONCLUSION

The impact of sharps injuries can be severe, both psychological and physical. This systematic review shows that further research is needed into this, especially in under-researched areas such as the UK, to establish the impact of sharps injuries within this population. Further research would also aid the education and prevention of this harmful problem. The review also emphasises the psychological issues relating to sharps injuries, the impact these can have on individuals and the support and counselling that student nurses require after injury.

RELEVANCE TO PRACTICE

These findings highlight the potential psychological issues that can result from sharps injuries in this population.

Occurrence of Needlestick and Injuries among Health-care Workers of a Tertiary Care Teaching Hospital in North India

INTRODUCTION

Occupational hazards such as accidental exposure to sharp, cuts, and splashes are common among health-care workers (HCWs).

AIMS AND OBJECTIVES

To determine the occurrence of self-reported occupational exposures to these hazards and to know the prevalent practices following the exposure. The second aim was to know the baseline antibody levels against hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) immediately after these accidents.

METHODS

An observational prospective study was done in the HCWs of a tertiary care academic health organization of North India from January 2011 to December 2013. At the time of self-reporting of injury, a questionnaire was administered. Blood sample of HCWs and of the source, if identified, was collected for baseline HBV, HCV, and HIV serum markers. The exposed HCWs were followed up and repeat testing was done after 3-4 weeks for seroconversion up to 6 months.

RESULTS

A total of 476 injuries were reported. Needlestick injury of fingers was the most common. Doctors were found to have the highest exposure rate (73.7%) distantly followed by nurses (19.1%). A significant number of the HCWs (125, 26.3%) vaccinated in past had hepatitis B surface antibody (anti-HBs) titers <10 mIU/mL (protection defined as anti-HBs level ≥10 mIU/ml). Only 44 sources were found to be seropositive (11 for HIV, 9 for HCV, and 24 for HBV). No seroconversion was seen in any of the exposed HCWs after 6 months.

CONCLUSIONS

The incidence of needlestick and sharp injuries is most often encountered in emergency wards. Anti-HBs titers were suboptimal in many of the HCWs requiring a booster dose of HBV vaccination.

Knowledge, attitude, and practice of needle stick and sharps injuries among dental professionals of Bangalore, India

Background:

A needle stick injury (NSI) is an accidental skin-penetrating stab wound from a hollow-bore needle containing another person's blood or body fluid. Healthcare workers (HCWs) including dental professionals are at an occupational risk of exposure to blood-borne pathogens following NSIs and sharps injuries (SIs). A thorough understanding of the safe practices while handling needles and sharps is crucial for HCWs to create a risk-free work place environment.

Aims and Objectives:

To assess the knowledge, attitude, practice, and prevalence of NSIs and SIs among dental professionals in a dental college at Bangalore.

Materials and Methods:

A cross-sectional survey was conducted in September 2012 using a structured, pretested, guided interview-based questionnaire that was administered to 200 dental professionals in a dental college at Bangalore to assess the knowledge, attitude, practices, and self-report information of NSIs.

Results:

In the present study, 81.5% of dental professionals were vaccinated against hepatitis B. A total of 27.5% participants had an NSI during the previous 12 months. About 41.80% of NSIs occurred during device recapping. Most common reason for failure to report the incidents of NSIs, as declared by 29.09% of the participants, included the fear of being blamed or getting into trouble for having an NSI.

Conclusion:

The knowledge of dental professionals on NSIs and their preventive measures are inadequate; however, training on Universal Precaution Guidelines, protocols regarding post-exposure prophylaxis, and safety devices has to be provided to prevent such injuries in future among the dental professionals.

Post exposure prophylaxis following occupational exposure to HIV: a survey of health care workers in Mbeya, Tanzania, 2009-2010

INTRODUCTION

Approximately, 1,000 HIV infections are transmitted annually to health care workers (HCWs) worldwide from occupational exposures. Tanzania HCWs experience one to nine needle stick injuries (NSIs) per year, yet the use of post-exposure prophylaxis (PEP) is largely undocumented. We assessed factors influencing use of PEP among HCWs following occupational exposure to HIV.

METHODS

A cross-sectional study was conducted in Mbeya Referral Hospital, Mbozi and Mbarali District Hospitals from December 2009 to January 2010 with a sample size of 360 HCWs. Participants were randomly selected from a list of eligible HCWs in Mbeya hospital and all eligible HCWs were enrolled in the two District Hospitals. Information regarding risk of exposure to body fluids and NSIs were collected using a questionnaire. Logistic regression was done to identify predictors for PEP use using Epi Info 3.5.1 at 95% confidence interval.

RESULTS

Of 291 HCWs who participated in the study, 35.1% (102/291) were exposed to NSIs and body fluids, with NSIs accounting for 62.9% (64/102). Exposure was highest among medical attendants 38.8% (33/85). Out of exposed HCWs, (22.5% (23/102) used HIV PEP with females more likely to use PEP than males. Reporting of exposures (OR=21.1, CI: 3.85-115.62) and having PEP knowledge (OR =6.5, CI: 1.78-23.99) were significantly associated with using PEP.

CONCLUSION

Despite the observed rate of occupational exposure to HCWs in Tanzania, use of PEP is still low. Effective prevention from HIV infection at work places is required through proper training of HCWs on PEP with emphasis on timely reporting of exposures.

Post-exposure prophylaxis in resource-poor settings: review and recommendations for pre-departure risk assessment and planning for expatriate healthcare workers

It is estimated that more than 3 million healthcare workers worldwide suffer needlestick and splash injuries whilst at work resulting in the potential transmission of blood-borne pathogens via exposure to bodily fluids. Under-reporting and the subsequent management of occupational injuries is a problem both in the United Kingdom and abroad. Many expatriate health care workers will work in low resource settings where the risk of transmission is greatest but in contrast to wealthier countries such as the United Kingdom, there is often a lack of effective systems for its safe management. This article provides important information about this risk and how to minimise it. The reasons for an increased risk in transmission, its subsequent management and pre-departure planning are discussed, together with the evidence for initiation of post-exposure prophylaxis; current National and International guidelines as well as the urgent need for International standardisation of these is also discussed.

Occupational exposure to blood and other body fluids among health care workers at a university hospital in Iran

Occupational exposure to sharp items or body fluid splash is a hazard for health care personnel via transmission of blood-borne viruses through such exposures. To determine the occurrence of needlestick injuries and other high-risk exposures among health care workers at a hospital in Iran, data collected for 2 years were reviewed. During this period, 171 occupational exposures were self-reported. Approximately 20% of all exposed personnel were men and 80% were women. One hundred twenty-six (74%) of the exposed personnel had needlestick injuries, 13 (8%) had sharp instrument injuries, and 32 (19%) had mucosal contact with potentially infectious fluids. Thirty-two percent of injuries occurred during or after sharp instrument disposal and 67% during operative procedures. Appropriate blood tests were performed for 55 (32%) and postexposure prophylaxis was administered to 31 (18%) of the exposed personnel.

Occupational exposure to body fluids among health care workers in Georgia

BACKGROUND

Health care workers (HCWs) are at increased risk of being infected with blood-borne pathogens.

AIMS

To evaluate risk of occupational exposure to blood-borne viruses and determine the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among HCWs in Georgia.

METHODS

The sample included HCWs from seven medical institutions in five cities in Georgia. A self-administered questionnaire was used to collect information on demographic, occupational and personal risk factors for blood-borne viruses. After obtaining informed consent, blood was drawn from the study participants for a seroprevalence study of HBV, HCV and HIV infections.

RESULTS

There were 1386 participating HCWs from a number of departments, including surgery (29%), internal medicine (19%) and intensive care (19%). Nosocomial risk events were reported by the majority of HCWs, including accidental needlestick injury (45%), cuts with contaminated instruments (38%) and blood splashes (46%). The most frequent risk for receiving a cut was related to a false move during a procedure, reassembling devices and handing devices to a colleague. The highest proportion of needlestick injuries among physicians (22%) and nurses (39%) was related to recapping of used needles. No HIV-infected HCW was identified. Prevalence of HCV infection was 5%, anti-HBc was present among 29% with 2% being HBsAg carriers.

CONCLUSIONS

Data from this study can be utilized in educational programs and implementation of universal safety precautions for HCWs in Georgia to help achieve similar reductions in blood-borne infection transmission to those achieved in developed countries.

Sharps injuries and job burnout: a cross-sectional study among nurses in China

The present study investigated the relationship between sharps injuries and job burnout in nurses. Sharps injury questionnaires and the Maslach Burnout Inventory (MBI) questionnaires were used to investigate and analyze job burnout among 468 nurses, of which 458 effective questionnaires were collected, for a response rate of 97.86%. A total of 292 nurses had at least one sharps injury (63.76% of the 458 nurses). The dimension scores were higher for injured nurses compared with non-injured nurses. The difference between the dimensions of emotional exhaustion and depersonalization for nurses with sharps injuries was statistically significant (P < 0.05). A rank correlation analysis showed that these two dimensions had a positive correlation with sharps injuries (r = 0.69-0.78). The prevalence of sharps injuries in nursing is associated with depersonalization, as measured by the MBI. Nursing administrators should pay more attention to clinically burned-out nurses, and provide more opportunity to nurses for training and education to reduce the prevalence of sharps injuries.

[HIV-1 infection after occupational accidents in the State of Amazonas: first reported case]

The medical care of occupational accidents in Tropical Medicine Foundation Dr. Heitor Dourado (FMT-HVD), involving blood and body fluids, started routinely in 1999. The objective of this report is to emphasize the importance of the measures used for the control of accidents with biological material. This study is carried out after a detailed epidemiological investigation confirmed one case of human immunodeficiency virus (HIV) seroconversion after an occupational accident involving bodily fluids and sharp instruments.