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 Table of Contents  
PAPERS PRESENTED AT THE XVII ANNUAL CONFERENCE OF HOSPITAL INFECTION
Year : 2021  |  Volume : 9  |  Issue : 3  |  Page : 87-90

A study on the prevalence of needle stick injuries among health-care workers of a tertiary care hospital in Aligarh


1 MBBS Final Professional student at Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
2 Department of Microbiology, Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Date of Submission16-Apr-2022
Date of Acceptance19-May-2022
Date of Web Publication22-Jul-2022

Correspondence Address:
Dr. Manal Khursheed
Faculty of Medicine, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh - 202 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_14_22

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  Abstract 


Context: Globally, the reporting on the incidents of needle stick injuries (NSI) is far below the actual, and in hospitals which depend on their normal reporting systems, this figure may be up to ten times lower. NSIs can serve as a source of life-threatening infections; therefore, an insight into various factors that lead to it, along with the knowledge regarding prophylactic measures is important.
Aim: The study aimed to develop an understanding of the causes and probability of NSI and knowledge of prophylactic measures among health-care workers (HCWs).
Settings and Design: An institutional-based cross-sectional study was conducted.
Subjects and Methods: A structured questionnaire was developed for the study.
Statistical Analysis Used: IBM Statistical Package for Social Science (SPSS), v22.0 was used.
Results: A total of 255 HCW were recruited, which consisted of 129 doctors, 110 nurses, and 16 laboratory assistants. The results of the study found that 36.1% of the HCW suffered from NSI. Of the total reported needlestick injuries, the maximum was among the doctors and in the age group of 22–30 years. Only 35.9% had reported the incident. Injuries were mostly sustained to the fingers occurred during use in the morning shift. Majority of the HCW were aware of HBV transmissibility and were vaccinated against it. Although a substantial number (162) of HCW were aware to take post-exposure prophylaxis against HBV and HIV within 72 h, only 12% took prophylactic treatment against HIV.
Conclusions: NSI prevention strategies should be strictly implemented at the workplace and followed during procedures.

Keywords: Health-care workers, infections, needlestick injury


How to cite this article:
Khursheed M, Khan F, Hashmi ZA, Khan HM, Sultan A. A study on the prevalence of needle stick injuries among health-care workers of a tertiary care hospital in Aligarh. J Patient Saf Infect Control 2021;9:87-90

How to cite this URL:
Khursheed M, Khan F, Hashmi ZA, Khan HM, Sultan A. A study on the prevalence of needle stick injuries among health-care workers of a tertiary care hospital in Aligarh. J Patient Saf Infect Control [serial online] 2021 [cited 2022 Aug 18];9:87-90. Available from: https://www.jpsiconline.com/text.asp?2021/9/3/87/351733




  Introduction Top


The National Surveillance System for Healthcare Workers defines needlestick injury (NSI) as a wound from a needle piercing or puncturing intact skin. These are percutaneous injuries caused by penetration into the skin by a needle or other sharp objects that were in contact with blood, tissue, or other body fluid prior to the exposure.[1] NSI is not only a serious and common occupational hazard of the health-care sector but is also one of the most preventable occupational hazards among health-care workers (HCWs).[2]

Studies have attributed the high incidence of NSI to certain risk factors namely not using appropriate protective equipment, lack of required training, failure to observe universal precautions, young age, inadequate knowledge of bloodborne diseases, and needle recapping.[3],[4],[5]

Exposure to needlestick injury is considered an important risk factor for the transmission of bloodborne pathogens.[6],[7] The risk of NSI-associated infection for different diseases varies highly, for example, the risk of infection is reportedly 0.5% and 40% for HIV and HBV infections, respectively.[8]

Globally, the reporting of NSI incidents is far below the actual[9] and in hospitals which depend on their normal reporting systems this figure may even be up to ten times lower[10] resulting in health-care workers not getting post-exposure prophylaxis (PEP) at the appropriate time to prevent the subsequent development of infection.

The present study was designed to assess the prevalence of needlestick injuries and the knowledge of pre/post-exposure prophylactic measures among health-care workers of a tertiary health-care center in Aligarh.


  Subjects and Methods Top


Study setting, design, and period

An institutional-based cross-sectional study with a quantitative approach was conducted from March to May 2021.

Study population

All HCWs who had worked for at least 1-year and above were included in the study. These included doctors (interns, resident doctors, and consultants), nurses, and laboratory personnel of a tertiary health-care center.

The HCWs whose day-to-day activities do not make them prone to exposure to sharp injuries (pharmacists, physiotherapists, and radiographers) were excluded from the study.

Description of the tool used

A structured questionnaire was developed for the study.

The questionnaire was subjected to a pilot study and suggested changes were incorporated to ensure its validity.

Data processing and analysis

The collected data were analyzed using the IBM SPSS (Statistical Package for Social Science), v22.0 software, Armonk, New York, USA. Pearson's Chi-square test was applied to find out the association between groups. Results were considered to be statistically significant at P < 0.05.


  Results Top


The study was conducted at a large tertiary care hospital in Aligarh city of North India. A total of 255 HCWs were enrolled, which consisted of 129 doctors, 110 nurses, and 16 laboratory assistants.

We found that a total of 36.1% HCWs had suffered from. Of the total reported needlestick injury (n = 92), the maximum was among the doctors (68.47%), followed by nurses (28.3%) and least (3.3%) among laboratory assistants [Table 1]. The data revealed a significant difference (P 0.0001) in the needlestick injury among doctors, nurses, and laboratory technicians when subjected to Pearson's Chi-square test. Needlestick injury was found to be more common in respondents belonging to the age group of 22–30 years. Moreover, there was a significant difference among respondents of various age groups (P = 0.0001). Only 35.9% of respondents had reported the incident to their respective supervisors. Approximately 52.2% of the injuries occurred during use, whereas 43.5% happened after use and before disposal of the needle; only 4.3% reported injury during disposal of the needle [Table 2]. About 87% of the respondents sustained NSI to their fingers, while only 12% had injuries on their hands (excluding fingers) [Table 3]. Most of the incidents happened during the morning shift (50%), followed by evening shift (16.3%). The night shift HCWs reported the lowest number of NSI incidents (14.11%) [Table 4]. Nineteen point six percent of the respondents who had suffered from needle stick injuries were unable to recall the shift during which the injury occurred. Among NSI sufferers, eight HCWs took no action, while 44% and 29.7% of the HCWs who sustained NSI had washed their hands with soap and cleaned with spirit respectively immediately following the incident [Table 5]. Fifty percent of respondents had worn latex gloves at the time of needlestick injury. Among the respondents who reported having sustained NSI, 44.6% had used needles on high-risk patients, “high-risk” being defined as known history of HIV, hepatitis B or C.
Table 1: Needlestick injury reported by health-care workers

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Table 2: Time of occurrence of needlestick injury

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Table 3: Part of the body injured by needlestick

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Table 4: Duty slot when the injury occurred

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Table 5: Response of health care workers to needlestick injuries

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The transmission of bloodborne pathogens can occur through contaminated needles and syringes. Among the respondents, 72.9% were aware that HBV is the most transmissible among the three most serious bloodborne infections (HIV, HBV, and HCV) and 70.7% were vaccinated against it. However, only 23.5% had had their antibody titer done, out of which 63.3% had an antibody titer of 10 IU/L. The study also found that a substantial number (162) of HCWs were aware of that PEP for HBV and HIV should be taken within 72 h, but only 12% of them took post-exposure prophylactic treatment against HIV [Table 6].
Table 6: Action taken after needlestick injuries

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  Discussion Top


Each year hundreds of thousands of HCWs are exposed to dangerous and deadly bloodborne pathogens through contaminated needle stick and sharps injuries (NSIs) while performing daily procedures in small-to-large hospitals. These exposures carry the risk of life-threatening infections with HBV, HCV, and HIV, the virus that causes acquired immunodeficiency syndrome.[11]

Sharma et al.[12] reported that an alarming number (79.5%) of HCWs sustained NSI at some point during their career. Another study conducted in rural north India had also reported 73% prevalence of NSI.[13] Several other authors from India as well as other countries have consistently found that a very high proportion of HCWs have suffered needlestick injuries while performing their duties.[14],[15],[16],[17],[18],[19]

This study reports the occurrence of needle stick injury among HCWs at a tertiary care hospital in Aligarh. The frequency of needlestick injury reported by the HCWs during their career was approximately 36.1%. Studies conducted in India showed that the prevalence of NSIs among HCWs is between 57% and 79.5%.[13],[20] However, international studies have reported varying prevalence of NSIs; a study in Pakistan reported a 54.2% prevalence,[21] 63.3% in Iran,[16] and a 74% prevalence in Saudi Arabia.[22] This clearly shows that the prevalence of NSIs in our study was much less when compared to similar studies conducted in India or internationally, however, this can be attributed to under-reporting.

Our results are in strong agreement with the findings of Hassanipour et al.[23] who also reported that HCWs under the age of 30 years had experienced a higher incidence of needle stick injury. In contrast to the findings of Salelkar et al.,[24] who have reported that most incidents of NSI took place during needle disposal, the study found that 43.5% had happened after use and before disposal of the needle.

It is well known that gloves are important for HCWs to protect themselves from acquiring infections as well as transmitting infectious diseases to their patients. In this study, 50% of HCWs reported that they were not wearing gloves when the injury occurred. Earlier studies have reported a higher percentage of HCWs wearing gloves.[13],[25]

In contrast to the conclusion drawn by Khabour et al.,[26] who reported more than 80% of respondents had knowledge about disinfection procedures and had used it, we saw mixed responses toward the adaptation of disinfection procedures after NSI, and in the present study, only a small number of respondents reported that they did not use any form of disinfectants. Surprisingly, only 12.0% of the injured took post-exposure prophylactic treatment against HIV, though 44.6% had an injury from needles used on high-risk patients. Our observation is in contrast to an earlier report by Sriram,[25] who found that 82% of the HCWs took prophylaxis and treatment after NSI.

A much lower proportion of HCWs (35.9%) reported the incident to the authorities, in contrast to 58% in an earlier study.[25]

Needlestick injury is an occupational hazard that people working in any hospital face daily. Avoidance of NSI through proper education and awareness of prophylactic measures taken in response to NSI may help prevent numerous bloodborne diseases among HCWs.

Acknowledgment

The authors are grateful to Mrs. Salma, Senior Nursing Officer, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, for her assistance in data acquisition.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
The National Surveillance System for Healthcare Workers (NaSH). Summary Report for Blood and Body Fluid Exposure. Data Collected from Participating Healthcare Facilities (June 1995 through December 2007). U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC).  Back to cited text no. 1
    
2.
Spruce L. Back to basics: Sharps safety. AORN J 2016;104:30-6.  Back to cited text no. 2
    
3.
Gholami A, Borji A, Lotfabadi P, Asghari A. Risk factors of needle stick and sharps injuries among healthcare workers. Int J Hospital Res 2013;2:31-8.  Back to cited text no. 3
    
4.
Motaarefi H, Mahmoudi H, Mohammadi E, Hasanpour-Dehkordi A. Factors associated with needlestick injuries in healthcare occupations. A systematic review. J Clin Diagn Res 2016;10:IE1-4.  Back to cited text no. 4
    
5.
Yoshikawa T, Wada K, Lee JJ, Mitsuda T, Kidouchi K, Kurosu H, et al. Incidence rate of needlestick and sharps injuries in 67 Japanese hospitals: A national surveillance study. PLoS One 2013;8:e77524.  Back to cited text no. 5
    
6.
Gerberding JL. Management of occupational exposures to blood-borne viruses. N Engl J Med 1995;332:444-51.  Back to cited text no. 6
    
7.
American Academy of Pediatrics. Committee on infectious diseases. Injuries from discarded needles in the community. In: Pickering LK, editor. Red Book 2006. 27th ed. Elk Grove: American Academy of Pediatrics; 2006. p. 188-91.  Back to cited text no. 7
    
8.
Cheng HC, Su CY, Yen AM, Huang CF. Factors affecting occupational exposure to needlestick and sharps injuries among dentists in Taiwan: A nationwide survey. PLoS One 2012;7:e34911.  Back to cited text no. 8
    
9.
Au E, Gossage JA, Bailey SR. The reporting of needlestick injuries sustained in theatre by surgeons: Are we under-reporting? J Hosp Infect 2008;70:66-70.  Back to cited text no. 9
    
10.
Elder A, Paterson C. Sharps injuries in UK health care: A review of injury rates, viral transmission and potential efficacy of safety devices. Occup Med (Lond) 2006;56:566-74.  Back to cited text no. 10
    
11.
AN. Association, “American Nurses Association's Needlestick Prevention Guide, 2002.View at: Google Scholar.  Back to cited text no. 11
    
12.
Sharma R, Rasania SK, Verma A, Sigh S. Study of prevalence and response to needle stick injuries among health care workers in a tertiary care hospital in Delhi, India. Indian J Community Med 2010;35:74-7.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Kermode M, Jolley D, Langkham B, Thomas MS, Crofts N. Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. Am J Infect Control 2005;33:34-41.  Back to cited text no. 13
    
14.
Askarian M, Malekmakan L. The prevalence of needle stick injuries in medical, dental, nursing and midwifery students at the university teaching hospitals of Shiraz. Iran Indian J Med Sci 2006;60:227-32.  Back to cited text no. 14
    
15.
Whitby RM, McLaws ML. Hollow-bore needlestick injuries in a tertiary teaching hospital: Epidemiology, education and engineering. Med J Aust 2002;177:418-22.  Back to cited text no. 15
    
16.
Ebrahimi H, Khosravi A. Needlestick injuries among nurses. J Res Health Sci 2007;7:56-62.  Back to cited text no. 16
    
17.
Makary MA, Al-Attar A, Holzmueller CG, Sexton JB, Syin D, Gilson MM, et al. Needlestick injuries among surgeons in training. N Engl J Med 2007;356:2693-9.  Back to cited text no. 17
    
18.
Singru SA, Banerjee A. Occupational exposure to blood and body fluids among healthcare workers in a teaching hospital in Mumbai, India. Indian J Community Med 2008;33:26-30.  Back to cited text no. 18
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19.
Pournaras S, Tsakris A, Mandraveli K, Faitatzidou A, Douboyas J, Tourkantonis A. Reported needlestick and sharp injuries among health care workers in a Greek general hospital. Occup Med (Lond) 1999;49:423-6.  Back to cited text no. 19
    
20.
Radha R, Khan A. Epidemiology of needle stick injuries among the healthcare workers of a rural tertiary care hospital – A cross-sectional Study. Natl J Community Med 2012;3:589-94.  Back to cited text no. 20
    
21.
Sultana A, Kulsoom A, Iqbal R. Needle stick/sharps injuries in health care workers. J Rawalpindi Med Coll 2014;18:133-5.  Back to cited text no. 21
    
22.
Alam M. Knowledge, attitude and practices among health care workers on needle – Stick injuries. Ann Saudi Med 2001;22:396-9.  Back to cited text no. 22
    
23.
Hassanipour S, Sepandi M, Tavakkol R, Jabbari M, Rabiei H, Malakoutikhah M, et al. Epidemiology and risk factors of needlestick injuries among healthcare workers in Iran: A systematic reviews and meta-analysis. Environ Health Prev Med 2021;26:43.  Back to cited text no. 23
    
24.
Salelkar S, Motghare DD, Kulkarni MS, Vaz FS. Study of needle stick injuries among health care workers at a tertiary care hospital. Indian J Public Health 2010;54:18-20.  Back to cited text no. 24
[PUBMED]  [Full text]  
25.
Sriram S. Study of needle stick injuries among healthcare providers: Evidence from a teaching hospital in India. J Family Med Prim Care 2019;8:599-603.  Back to cited text no. 25
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26.
Khabour OF, Al-Ali KH, Mahallawi WH. Occupational infection and needle stick injury among clinical laboratory workers in Al-Madinah city, Saudi Arabia. J Occup Med Toxicol 2018;13:15.  Back to cited text no. 26
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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