|Year : 2014 | Volume
| Issue : 1 | Page : 32-37
Behavior, perception and compliance related to adoption of safety measures in response to needle stick injuries among nursing personnel at a tertiary care institute of North India
Davinder Kaur1, Surinder Jaspal1, Sukhminder Jit Singh Bajwa2
1 Department of Nursing, Gian Sagar College of Nursing, Ram Nagar, Banur, Punjab, India
2 Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India
|Date of Web Publication||7-Feb-2014|
Sukhminder Jit Singh Bajwa
House No. 27-A, Ratan Nagar, Tripuri, Patiala - 147 001, Punjab
Source of Support: None, Conflict of Interest: None
Background: Needle stick injuries (NSIs) caused by sharp instruments such as hypodermic needles, blood collection needles; intravenous (IV) cannula or needles used to connect parts of IV delivery system are common in clinical practice. A potential risk of transmission of various fatal diseases such as acquired immunodeficiency syndrome, hepatitis and others have been a matter of serious concern in busy clinical settings. Aim and Objectives: The present survey study was carried out to evaluate the prevalence of NSIs among nursing personnel of our institute so as to identify the potential risk factors responsible for possibly acquiring NSIs. The study also aims to reinforce uniformly the recommended preventive measures by the nursing personnel in our institute with the formulation and implementation of newer preventive strategies by hospital authorities. Materials and Methods: A cross-sectional survey was carried out from July 2012 to November 2012 in the nursing department of our hospital. Informed verbal consent was taken from nursing personnel prior to distribution of the self-reporting questionnaire. Questions related to awareness such as cause of NSIs, number of NSIs, procedures that caused NSIs, clinical response of personnel after injury, preventive measures like hepatitis B immunization, use of personal protective equipment (PPE) and reasons for not using the PPE and training regarding prevention of NSIs were also included. A total of 179 staff nurses from all clinical areas of the hospital participated in this study excluding those who were on any kind of long leave. Statistical analysis was performed by using the Statistical Package for the Social Sciences version 15 for windows and value of P < 0.05 was considered as significant and P < 0.001 as highly significant. Results: Almost more than half of the nursing personnel (57.5%) had NSIs at one occasion or the other. Nearly 58% nursing personnel had NSIs for 3-times and few had even more than 10 times. NSIs during bedside care of the patient (57.2%) were reported as one of the significant potentially vulnerable location to get the NSIs as compared with the operation theater and emergency (5%) areas (P < 0.001). About 92% of the nursing personnel reported that needles used in routine injection practices were the main instrument that caused NSIs as compared with the hypodermic needle and surgical blades. Recapping of needles (66%) was the main procedure that caused NSIs as compared to IV line (20.4%) and others (P < 0.001). Around 81% nurses were already vaccinated against hepatitis B before the survey study. Conclusion: NSIs are highly prevalent among nurses. Injection practices have to be improved with reinforcing and modification of existing preventive measures. Procedures associated with higher risks of NSIs such as recapping of needles, non-wearing of gloves, improper disposal of sharps and others should be strongly discouraged so as to decrease the incidence of NSIs and morbidity and mortality associated with it.
Keywords: Blood borne infections, health-care workers, needle stick injury, occupational health hazard
|How to cite this article:|
Kaur D, Jaspal S, Bajwa SS. Behavior, perception and compliance related to adoption of safety measures in response to needle stick injuries among nursing personnel at a tertiary care institute of North India. J Sci Soc 2014;41:32-7
|How to cite this URL:|
Kaur D, Jaspal S, Bajwa SS. Behavior, perception and compliance related to adoption of safety measures in response to needle stick injuries among nursing personnel at a tertiary care institute of North India. J Sci Soc [serial online] 2014 [cited 2019 Dec 14];41:32-7. Available from: http://www.jscisociety.com/text.asp?2014/41/1/32/126743
| Introduction|| |
Needle stick injuries (NSIs) are wounds caused by sharps such as hypodermic needles, blood collection needles, intravenous (IV) cannulae or needles used to connect parts of IV delivery systems. , NSIs are one of the most frequent occupational hazards faced by nurses, phlebotomist, operation theater staff, intensivists, physicians and other health-care workers (HCWs) as well as those working in cleaning and waste disposal. ,, Muralidhar et al. reported that among the HCWs, nurses had the highest percentage (100%) of NSIs followed by junior doctors (87.5%), nursing students (85.3%) laboratory technicians (84.3%), interns (82.7%), senior residents (80%) and undergraduates (53.3%).  Nurses are the core care providers for patients in the hospital. It might be possible that the higher incidence of NSIs among nurses can possibly be due to performance of invasive and non-invasive procedures to patients besides injection administration more often than anyone. Previous research studies have observed that few of the important risk factors for NSIs are working for more than 40 h/week (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.20-3.31), recapping of needles (OR: 1.78, 95% CI: 1.11-2.86) and not using gloves when handling needles (OR: 1.91, 95% CI: 1.10-3.32). 
NSI's are highly dangerous as it can have varied results ranging from transmitting life- threatening blood borne pathogens, including hepatitis B (HBV), hepatitis C (HCV), human immunodeficiency virus (HIV) and many more known and unknown infections. Risk of HBV transmission is very high as it only requires 1/10,000 ml of infected plasma. The risk of transmission of HBV infection by a NSI is between 6% and 30% for susceptible HCWs without post-exposure prophylaxis or sufficient HBV vaccination. 
Risk for transmission of HIV following a hollow needle injury is approximately 0.3% as compared with 3% for HCV and 30% for HBV. According to one World Health Organization (WHO) report, 16,000 hepatitis C, 66,000 hepatitis B and 1000 cases of HIV may have occurred world-wide in a single year (2000) among nurses through NSI's.  According to the other WHO report, NSIs accounted for about 40% of hepatitis B and C infections and 2.5% of HIV infections in HCWs world-wide (WHO, 2002). In addition to the potential risks for infectious diseases, NSIs incur direct costs required for laboratory tests, including tests for HIV antibodies, hepatitis B serology and a baseline test for anti-hepatitis C, as well as treatment for any other clinical disease resulting from these infections. , High costs are also accrued during post-exposure prophylaxis for the nursing staff and other medical professionals that can cause economic strains on the financial budget of the hospitals as these employees remain abstain from the clinical work especially in resource challenged settings of developing nations. ,
Mostly NSI's occur during and after use of needles especially during disposal of needles and sharps. HBV is stable in dried blood for at least 7 days and HCV at least for 16 h.  HIV may survive for up to 4 weeks in syringes after HIV infected blood has been drawn up into the syringe and survive in dried blood at room temperature for up to 6 days. , Use of safety devices can prevent injuries from sharp objects and reduce the patient's risk of exposure to blood of injured personnel. 
Considering the high risks associated with NSIs, the present survey study was carried out to evaluate the prevalence of NSIs among nursing personnel of our institute so as to identify the potential risk factors responsible for possibly acquiring NSIs. The study also aims to reinforce uniformly the recommended preventive measures by the nursing personnel in our institute with formulation and implementation of newer preventive strategies by hospital authorities.
| Materials and Methods|| |
After clearance from institutional review board, a cross sectional survey was carried out from July 2012 to November 2012 in the nursing department of our hospital. Informed verbal consent was taken from nursing personnel prior to distribution of the self-reporting questionnaire. Questions relating to awareness such as cause of NSIs, number of NSIs, procedures that caused NSIs, clinical response of personnel after injury, preventive measures like hepatitis B immunization, use of personal protective equipment (PPE) and also reason for not using the PPE as well as training regarding prevention of NSIs were also included. A total of 179 staff nurses from all clinical specialties of the hospital participated in study excluding those who were on any kind of long leave. Statistical analysis was performed by using the Statistical Package for the Social Sciences version 15 for windows. Intra-group comparison of NSIs with different equipment was done with analysis of variance and post-hoc significance. Value of P < 0.05 was considered as significant and P < 0.001 as highly significant.
| Results|| |
Majority of nursing personnel (84%) belong to age group of 20-30 years and mean age was 27.7 years. Nearly 90% of the nursing personnel had basic qualification and 60% of nurses had a clinical patient care experience between 1 and 3 years, whereas only 5% of nursing personnel had more than 12 years.
Almost more than half of the nursing personnel (57.5%) had NSIs at one occasion or the other. 58% nursing personnel had NSIs for 3-times and some had even more than 10 times. NSI's during bedside care of the patient (57.2%) was reported as one of the main potential location to get the NSIs as compared to the operation theater and emergency (5%). Around 92% nursing personnel reported that needles were the main instruments that caused NSIs as compared to the hypodermic needle and blades [Table 1] and [Table 2], [Figure 1] and [Figure 2].
Almost half of the nursing personnel (53%) were wearing gloves during NSIs [Figure 3]. Majority of nursing personnel (73.8%) got NSI during the morning shift (P < 0.001).
|Figure 3: No of nursing personnel wearing gloves during needle stick injuries|
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Maximum number of nursing personnel washed the injured part with antiseptic solution (72.8%) which was clinically and statistically significant whereas only 12.6% washed only with soap [Table 2]. Only 66% nursing personnel reported their injuries and others gave the reasons that they were too busy for not reporting the NSI as they took it casually or had a lack of awareness. About 73% considered that NSIs are often neglected (P < 0.001). 15% reported that there is no active reporting system.
About 81% nurses were vaccinated against hepatitis B (P < 0.001). All the nursing personnel were aware and agreed that NSIs results in possible transmission of blood borne diseases. All the nursing personnel were aware about post-exposure prophylaxis also. They all are using PPEs like gloves and mask during every task while handling blood and body secretions. Only half of the nursing personnel (54.7%) had got training regarding health safety on NSI (P < 0.05).
| Discussion|| |
NSIs are a serious problem among HCWs.  In the present study, almost more than half of the nursing personnel (57.3%) had NSIs. Majority of the nurses had experienced NSIs in their career either once and few of them had experienced it many times. Similar observations related to NSIs were also reported in India and globally. , Smith et al. also found that 46% nurses had NSIs among heath care workers.  It was also reported that 79.7% nurses experience sharp and NSI during their professional life.  The majority of registered nurses (70.4%) experienced at least one NSI in the year. 
In this study, 92% nursing personnel reported that needles are the main instrument that caused NSIs as compared to the hypodermic needle and blades. Injuries occur most commonly with needles (52.8%), followed by ampoules (26.2%).  The most common devices that caused NSIs was suturing needle (41%) and hypodermic needles (44%). Majority of the NSIs (46%) occurred during manipulation of needles while managing patients with procedures like injections and accessing IV lines. 
Recapping of needles (66%) was one of the main procedures that caused NSIs as compared to securing IV line (21%). In one of the studies from UK, it has been observed that syringe needle cause more than 25% of NSIs.  Studies from Middle East have also reported identical findings of high incidence of NSIs due to recapping. , From the literary evidence available, it can be successfully derived that recapping of needles and non-wearing of gloves while handling needles were the major important risk factors.  On the contrary injections were the most common action that resulted in NSIs (24.44%) while recapping of needles was at the second order (21.11%).  It should be emphasized by authorities and necessary mandatory regulations should be implemented in the respective institutes regarding avoidance of recapping of needles after use and disposal of needles by the needle cutters.
Among the main potential areas, bedside of the patient (57.2%) was reported as the main location where highest incidence of NSIs was observed as compared to the operation theater and emergency (5%) wards. Similar findings have also been reported earlier in the literature.  Comparative data reported 71.1% of the students had NSIs, which most commonly (43.6%) occurred in patient rooms. 
NSIs occurred even when more than half (59%) of the nursing personnel had worn the gloves. Similar findings were also reported in earlier studies from Europe and India where almost 70.4% respondents were wearing the gloves. , Radha and Khan reported that 90% of respondents were wearing hand gloves at the time of injury and 89% of them washed the injured site with soap and water immediately after the injury. 
In the present study, 72.8% nursing personnel washed the injured area with antiseptic solution. A study carried out by Sharma et al. reported that 60.9% respondents washed the injured area with soap and water.  Sharma reported that HCWs (37.5%) washed the wound as it was bleeding and later on also applied an antiseptic.  In yet another study, similar findings were observed, which showed that 5.6% of nurses washed the wound with water and soap only, 5.7% squeezed the wound place while 70% of the nurses disinfected the wound with antiseptics. 
In the present study, 66% of the nursing personnel reported NSIs. Among the nurses those who did not report the injury cited a common reason that they were too busy. Nearly 15% reported that there either there is no reporting system or they are not aware of it. Comparative studies have also reported that 85% of the HCW didn't report the injury, reporting was done by 7% among doctors and 30% among nurses. This was because majority of them were not aware about the formal reporting system existent in the hospital. 
In the present study, 82% nurses were vaccinated against hepatitis B. The number of vaccinated HCWs ranged from 83% in doctors to 8% in nurses. Similar data were found in a Swedish university hospital where hepatitis B vaccination rate was strikingly low among HCW. 
Prevention of NSIs should be the main concern for nurses. , Researchers suggested that training program can lead to improvement in knowledge and reduction in NSIs.  To reduce the risk and prevention of NSIs among HCWs, adequate education about the risk and prevention of NSIs and post-exposure management is required for HCWs. , Use of AD syringes should be encouraged as per safer practices.  Health-care organizations should be responsible for provision of safe workplaces and work practices, policies, workplace culture and prevention strategies and appropriate responses when nurses are injured.  [Figure 4]
It is recommended that every hospital should prevent NSIs by adopting multipoint strategies such as educational training programs for risk reduction, posters, brochure, demonstrations, teachings, better safety devices, 100% vaccination against hepatitis B and well-established reporting system for post-exposure prophylaxis.  Hospital authorities should ensure that unsafe work practices such as recapping of needles should be avoided and used syringes and needles should be disposed in a sharp disposal container as per standard guidelines of bio medical waste management prior to its terminal disposal. Every HCW should follow universal precautions. Personal protective devices should be available for all the employees in the hospital. In hospital well-established reporting system should be there to improve the surveillance of all the reported NSIs. Reporting and auditing of all NSIs should be mandatory for all hospitals. Laboratory facility and post-exposure prophylaxis should be available in the hospital and all the employees should be aware about that.
| Conclusion|| |
Though known for decades, the measures to prevent NSIs need to be reviewed on time to time basis in each health set-up so as to improve and modify the existing protocols. As prevention is better than cure, this public health hazard needs a greater introspection with regards to human behavior, perception of health hazards and newer strategies to ensure a better compliance among health workers in each institution. The results of present study vastly helped in improving our preventive strategies and awareness of the grievous nature of NSIs. Similar questionnaires can be developed depending upon the type of health set-up and the level of nursing care so as to bring a significant change in the health practices with regards to needle usage and disposal. The survey studies are an essential component of a dynamic system to bring an effective change, which cannot be brought about exclusively by theoretical lectures.
| Acknowledgments|| |
We thank the institutional review board for granting the permission for the conduction of the study. We are grateful to Dr. Haris Habib for providing us the tool for necessary modifications. We also thank nursing superintendent and all the nursing personnel for providing us the information.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2]