A study of contaminated sharp injury and associated morbidity among health care workers

INTRODUCTION

Needles are one of the waste material generated during the treatment or procedure in the hospital. Improper handling, capping or disposal technique causes a major health hazard among the health care workers (HCWs). Needle stick injuries (NSIs) can occur accidentally at any time when people use, disassemble, or dispose needle. An estimated 600,000 to 800,000 needle stick and other percutaneous injuries are reported annually among U.S.¹ It is estimated that 100,000 NSIs occur annually in UK alone.² The causes consist of various factors like type and design of needle, recapping activities, handling, transferring specimen, collision between HCWs or sharps clean–up manipulating needle in patients line related work ,passing handling device or failure to disposed of the needle in puncture proof containers.³ HCWs who are exposed to needles in their clinical activities are at an increased risk of acquiring needle stick injury, which may lead to serious or fatal infections with blood-borne pathogenic infections such as hepatitis B virus (HBV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV).⁴

Other infections that are transmittable through needle sticks include syphilis, malaria, and herpes.⁵ According to WHO study, the annual estimated proportion of HCWs exposed to blood borne pathogens globally were HBV (5.9%), HCV (2.6 %), HIV (0.5%) corresponding to about 66000 HBV, 16000 HCV infections among them.⁶ The average risk of transmission of HIV to a HCWs occur as a result of per-cutaneous exposure to HIV infected blood has been estimated as three in one thousand.⁷ Seventy percent of the world’s HIV population lives in Sub-Saharan Africa, but only 4% of worldwide occupational cases of HIV infection are reported from this region.⁸ The risk of occupational transmission has been extrapolated by the WHO to convey the risk of an unsafe injection.⁹

The aim of the present study were to find out the burden of chronic morbidity due to NSIs to HCWs, to find out various factors responsible for causative chronic disease to HCWs and to suggest the prevention and control of needle stick injury among the HCWs.

METHODS

This was a cross-sectional study. Survey was conducted in the month of March 2013 to March 2014 covering of six different categories of HCWs of both sexes in a private tertiary care hospital Rohilkhand Medical College and Hospital Bareilly Uttar Pradesh who normally was dealing with needles. These were doctors, interns (M.B.B.S), nursing staff, nursing students, operation theatre (OT) technician and lab technician. Sample size (n) was calculated by using the formula (n)=4PQ/L2 (5% of p)². Sample size was calculated by assuming the prevalence of NSIs as 85.1% in a previous study with 10% absolute error.¹⁰ By using the formula 4PQ/L2 (5% of p)². Assuming 10% non-response rate, the sample size was 312. Equal number of participants was taken from each category of HCWs.

Data collection involved the simple interviewing technique using a semi-structured questionnaire that was filled by interviewer. The information was collected and data entry has been done in specific software SPSS version 20.0.

RESULTS

Table 1 presents among 312 HCW males were 59.3% and females were 40.7%. Majority (46.5%) of the HCWs were in the age group of 20-24 years and 48.7% had length of service less than one year. 52 participants were taken from each category out of total 312 only 71.5% (223) were found vaccinated for hepatitis B vaccine.

χ2=34.192, df =5, p=0.05 (significant).

χ2=35.911, df=5, p=0.05 (significant).

Table 2 presents among all the HCWs, needle stick injury was present in 164 (52.6%) of the workers. Nursing student and OT technician had got the maximum needle stick injury (69.2%) each followed by nursing staff (67.3%), intern (44.2%), lab technician (34.6%) and doctors (30.8%) respectively and association was found to the statically significant.

Table 3 represents it was observed that two third of the HCWs (67.7%) were using gloves during procedure and among them OT technician (100%) were using glove maximally followed by interns (78.3%), resident doctors (75%), and lab technician (72.2%). Association between utilization of gloves and needle sticks injuries was found to be statically significant.

χ2=39.334, df=5, p=0.05 (significant).

Table 4 shows that 46.2% HCWs were recapping the needle with two handed method while (29.5%) HCWs recapping the needle with one hundred method. Practice of recapping with one handed methods was found maximum among OT technician (42.3%) and rest of the HCWs (24.4%) were not using the one hundred recapping methods.

Table 5 represents that out of the 164 HCWs who sustained NSIs, only 63.4% of them had already undergone various investigations and rest of the HCWs (36.6%) did not agree for the investigations because of the ignorance or lack of awareness regarding NSIs. Investigation has been done after getting injured and association between two was found to be statically significant.

Table 6 shows that out of those HCWs who got investigated after getting NSI in previous one year (104), 24.0%were found to be positive of Hepatitis B, followed by HCV (8.7%) and HIV (1.9%).

DISCUSSION

The present study was planned to find out the burden of chronic morbidity due to NSIs, determinants responsible for causing chronic disease and to suggest there mediable measures for prevention and control of NSIs among HCWs. Increase prevalence of morbidity could be due to lack of awareness regarding injury and poor practices. In present study percentage of female HCWs were less (40.7%) as compare to Sharma et al at Delhi reported higher percentage of female HCWs (49.7%).¹¹ Out of total 312 HCWs in the study, 185 (59.3%) HCWs were male, 145 (46.5%) were in age group of 20-24 years and length of service were less than one year was reported 152 (48.7%) where as in Sharma et al study number of male and female HCWs were nearly equal (50.2 and 49.7% respectively), majority were in age group of 20-25 years (68.9%) and duration of service of HCWs was 1-2 year (35.7% ).¹¹ In this study 71.4% of the HCWs were immunized with hepatitis B. whereas immunization with Hepatitis B vaccination was higher (91.5%) in Sharma et al and lower (67%) in the shah et al study.^11,12 The prevalence of needle stick injury among HCWs was 164 (52.6%) however this prevalence is much higher than 23.5% reported by Rampal et al in Malaysian and Hofranipour et al (39.4%) in Iran study.^13,14 Higher prevalence of NSI as compare to our study was reported by various studies.^15,16 In this study 67% HCWs had worn gloves during the injury while Salelkar study reported only 58% of the HCWs were wearing gloves at the time of the injury.¹⁷ Lee et al reported 62% of needle stick injury victims had worn gloves during the procedure.¹⁸

Only 29.5% of the HCWs were doing recapping with correct method while 24.4% were not doing recapping whereas Kakizaki et al have reported that three quarters of HCWs (73.6%) were not recapping the needle after procedure.¹⁹ Among the 164 HCWs who get NSIs, more than fifty percent 104 (63.4%) were investigated. Among them majority were tested for HBV (87.5%) followed by HIV (50.9 %) and HCV (18.3%). It was found that one quarter (24%) of the source patient was infected with hepatitis B followed by HCV (8.7%) and HIV (1.9%). In Singru et al study the source patient were HIV negative in 52.87% of the occupational exposures; while in only 6.97% of the exposures, the source patient were HIV positive; in the rest (40.16%), the HIV status was unknown.²⁰ In Rampal et al study the knowledge on body fluid transmitted by HIV/AIDS and blood products was high (99.1%) whereas Kermode et al reported knowledge of transimission by HIV/AIDS (56.0%), and hepatitis B (10.6 %) was low.^21,22 According to shah et al among 100% HCWs hepatitis B was transmitted by infected needle-stick injury, which was higher as compare to present study.²³ Almost half (48.2%) of the HCWs also mentioned other disease like tuberculosis, malaria, cancer, leprosy, diabetes, asthma, tetanus, pneumonia and fever.

CONCLUSION

Occupational exposures to percutaneous injuries are substantial source of infections with blood borne pathogens among health-care workers because of the poor practice regarding protective measures. These infections are highly preventable and should be eliminated. There is a need of health education campaigns to enhance understanding of the importance of practicing protective measures.

Recommendation

In view of the above findings it is recommended that HCWs should be given education regarding universal precaution for NSIs. They should be immunized with hepatitis B and tetanus toxoid on joining the hospital. While handling with injection and sharps, they should follow universal precautions to prevent NSIs. Availability of adequate safety wear should be ensured to HCWs.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

REFERENCES

1. 1. NIOSH. Preventing needle stick injuries in health care settings. Washington, DC: National Institute for Occupational Safety and Health; 1999: 2000-2108.
2. 2. Hofmann F, Beie M. Needle stick injuries in health care– frequency, causes and preventive strategies. Gesundheitswesen, 2002;64:259-66.
3. 3. Wilbum SQ. Needle sticks and sharps injury prevention. Online J Issues Nurs. 2004;9(3):5.
4. 4. NIOSH. Preventing needle stick injuries in health care settings. U.S. Department of Health and Human Services. Cincinnati: DHHS (NIOSH) Publication; 1999.
5. 5. Centers for Disease Control and Prevention. Guidelines for infection control in health care personnel. Infect Control Hosp Epidemiol. 1998;19:445.
6. 6. Pruss-Ustun A, Rapiti E, Hutin Y. Sharps injuries: global burden of disease from sharps injuries to health-care workers. WHO Environmental mental Burden of Disease Series, No. 3. Available at: www.who.int/quantifyingehimpacts/global/7sharps. Accessed on 12 October 2012.
7. 7. Tokars JI, Marcus R, Culver DH, Schable CA, McKibben PS, Bandea C, et al. Surveillance of HIV infection and zidovudine use among health care workers after occupational exposure to HIV-infected blood. Ann Intern Med. 1993;118(12):913-19.
8. 8. Wilburn SQ, Eijkemans G. Preventing Needle stick Injuries among Health care workers. Int J Occup Environ Health. 2004;10:451-6.
9. 9. Kane A, Lloyd J, Zaffran M, Simonsen L, Kane M. Transmission of hepatitis B, hepatitis C and human immunodeficiency virus in the developing world: model based on regional estimates. Bull WHO. 1999;77(10):801-7.
10. 10. Khurram M, Ijaz K, Bushra HT, Khan NY, Bushra H, Hussain H. Needle stick injuries: a survey of doctors working at tertiary care hospitals of Rawalpindi. JPMA. 2011;61:63.
11. 11. Sharma S, Gupta A, Arora A. Knowledge, attitude and practices on needle stick and sharps injuries in tertiary care cardiac hospital: A survey. Indian J Med Sci. 2010;64:396-401.
12. 12. Shah R, Mehta HK, Fancy M, Nayak S, Donga BN. Knowledge and awareness regarding needle stick injuries among health care workers in tertiary care hospital in Ahmadabad Gujarat. Nat J Community Med. 2010;1(2):93-5.
13. 13. Montella F, Di Sora F, Recchia O. Can HIV-1 infection be transmitted by a “discarded” syringe?. J Acquir Immune Defic Syndr. 1992;5:1274-5.
14. 14. Hofranipour FG, Asadpour M, Ardebili HW, Niknam S, Hajizades E. Needle stick/sharp injuries and determinants in nursing care. Europ J Soc Sci. 2009;2(2):191-2.
15. 15. Khan AA, Kumar A, Sayani R. Needle stick injuries- risk and preventive factor: a study among HCWs in tertiary care hospital in Pakistan. Global J Health Sci. 2013;5(4):85-92.
16. 16. Alam M. Knowledge, attitude and practice and healthcare workers on needle stick injuries. Ann Saudi Med. 2002;22(5-6):1-4.
17. 17. Mihir G, Parul P, Sunil N, Mehta HK, Rakesh S, Dharmesh D, et al. Needle stick and sharp instruments injuries among Health care providers at cardiology institute, Ahmedabad. Natl J Community Med. 2010;1(2):114-7.
18. 18. Ashat M, Batia V, Pyri S, Thakare M, Koushal V. Needle stick injury and HIV risk among health care in north India. Indian J Med Sci. 2011;65(9):371-8.
19. 19. Kakizaki M, Ikeda N, Ali M, Enkhtuya B, Tsolmon M, Shibuya K, et al. Needle stick and sharps injuries among health care workers at public tertiary hospitals in an urban community in Mongolia. BMC Res Note. 2011;4:184.
20. 20. Singru AS, Banerjee A. Occupational exposure to blood and body fluids among health care workers in a teaching hospital in Mumbai, India. Indian J Community Med. 2008;33(1):26-30.
21. 21. Rampal L, Zakaria R, Sook LW. Needle stick and sharps injuries and factors associated among health care workers in a Malaysian hospital. Europ J Soc Sci. 2010;13:354-62.
22. 22. Hofranipour FG, Asadpour M, Asrdebili HE, Niknami S, Hajizades E. Needle stick/sharp injuries and determinants in nursing care workers. Eur J Soc Sci. 2009;2(11):191-7.
23. 23. Shah R, Mehta HK, Fancy M, Nayak S, Donga BN. Knowledge andawareness regarding needle stick injuries among health care workers in tertiary care hospital in Ahmadabad Gujarat. National J Com Med. 2010;1(2):93-6.