Correspondence Address:
F S Vaz
Department of Preventive and Social Medicine, Goa Medical College, Goa
India

Full Text

Hepatitis C and HIV are two of the most serious of the 20 blood-borne pathogens that health care workers are exposed to in their daily work caring for the worlds health. Personnel who regularly practice invasive procedures such as blood sample collection and starting intravenous lines are particularly at risk to percutaneous injuries [1] . Needle stick injuries present the single greatest risk to medical personnel [2] . Most people at risk for occupational exposures are in developing countries where there is paucity of standard reporting protocol [3] . This study was undertaken to analyze the problem of needle stick injuries among health care workers at a tertiary care hospital.

A cross-sectional study was conducted during June-August 2007 among health care workers at a tertiary care hospital in Goa to study the problem of needle stick injuries. The health care workers studied comprised of consultant doctors, resident doctors, interns, nurses, laboratory technicians, patient attendants and nursing students. A total of 662 health care workers were selected by stratified random sampling technique for the study, of which 575 responded (non-response rate: 13.1%). Only those with minimum work experience of 12 months were selected and the stratification was done according to job designation. From each group, 50% of the eligible subjects were included. A self administered structured questionnaire was used to collect the relevant information from the participants. Participants were asked to recall needle stick injuries in the preceding 12 months. Accidental needle stick injury was defined as a prick with a needle or other sharp object during use of the object for patient care [4] . Factors such as work experience, cause of injury, type of procedure, action taken following injury etc. were also studied. Data analysis was done with SPSS 14.0 software. Proportion, chi-square and incidence rates were calculated.

Around 34.8% (200/575) of the Health care workers had experienced an accidental needle stick injury in the last one year. As far as different categories were concerned 55% of senior residents, 47.2% of junior residents, 38.1% consultants, 37.4% nurses and 35.3% patient attendants reported needle stick injuries [Table 1].{Table 1}

As far as gender distribution was concerned 36.7% male and 34.2% female health care workers reported needle stick injuries however this difference was not statistically significant (P=0.588). Needle stick injuries were equally distributed across different work experience periods and no significant association was found between years of work experience and incidence of needle stick injuries [Table 2].{Table 2}

Hollow bore needles were responsible for 77.5% of needle stick injuries followed by suturing needles (19.2%) and scalpel blades (3.3%). Around 31.7% of injuries occurred during sharps disposal while, 21.6% injuries occurred during operative procedures. Taking blood samples (13.8%), starting an intravenous line (13.4%), giving an injection (13.2%) and recapping the needle (6.3%) were the other circumstances wherein the needle stick injuries occurred.

As far as use of personal protection was concerned only 58% of the health care workers were wearing gloves at the time of the injury. Glove usage was lowest among nurses (46.3%) and highest among consultants (100%). Around 52% of the health care workers who suffered a needle stick injury washed the site with soap and water, 71.5% applied an antiseptic, 3.5% washed with water while, one health care worker totally ignored the injury.

Only 3% (6/200) health care workers with needle stick injuries had taken post exposure prophylaxis for HIV infection. Only 32% of the health care workers with a needle stick injury reported the injury to the concerned superior. The rate of reporting needle stick injury was highest among patient attendants (55%), followed by interns (50%), nursing students (33.3%), senior residents (27.3%), laboratory technicians (25%), nurses (22.4%), Junior residents (12%) and consultants (6.25%).

Overall 55.5% of the participants were aware of post exposure prophylaxis (PEP) for HIV. All doctors (consultants, residents and interns) were aware of post exposure prophylaxis. Among other staff 63.7% nurses, 74.5% nursing students, 45.8% laboratory technicians were aware of PEP for HIV. Only 2.4% of patient attendants were aware of PEP.

Occupational exposure to blood and blood fluids through needle stick injuries was quite high (34.8%) at the hospital. Resident doctors had the highest proportion of needle stick injuries closely followed by consultant doctors and nurses. Singru et al. [4] reported that the overall prevalence of occupational exposure to blood and body fluids was 32.75% at a tertiary care hospital in Mumbai. The highest incidence was among nurses (39.63%), followed by interns (37.34%), laboratory technicians (26.92%), and least among resident doctors (21.01%).

Evans et al. [5] in their study in UK reported that the most commonly exposed groups to percutaneous injuries were nurses (45%) and doctors (2%).

No gender difference in needle stick injuries was observed in our study. Pournaras et al. [6] reported a considerably higher rate of needle-stick injuries among female health care workers compared to male health care workers. There was no association between years of work experience and rate of needle stick injuries in our study. Contrary to our study findings Telali et al. [7] in their study in south India reported that as work experience increased the incidence of needle stick injuries decreased.

A majority (77.5%) of the needle stick injuries were due to hollow bore needles. Russi et al. [8] reported that 62% of exposure to blood and body fluids involved hollow bore needles.

Most of the needle stick injuries occurred during sharps disposal (31.7%), operative procedures (21.6%), while collecting blood samples (13.8%), while starting an intravenous line (13.4%) and while giving injections (13.2%).

Patric Cervini et al. [9] reported that majority of injuries among doctors occurred while suturing (46%), and while assisting in a procedure (25%). Lai Kah Lee et al. [10] found that needle stick injuries most commonly occurred during Venepuncture (41.1%), suturing (5.3%), and setting drips (3.9%).

In the present study only 58% of health care workers were using gloves at the time of injury. Lai Kah Lee et al. [10] reported that in 71 cases of needle stick injuries 62% had worn gloves during the procedure.

As far as post injury action was concerned around 52% of the health care workers immediately washed the injury site with soap and water and 71.5% applied an antiseptic. Newsom et al. [11] reported that the most common action was to squeeze the puncture site and then to wash it with bleach.

Only 3% of health care workers with needle stick injuries had taken post exposure prophylaxis for HIV. Singru SA et al. [4] reported that 21.6% of health care workers exposed to blood and body fluids took PEP for HIV.

Only 32% of the health care workers with needle stick injuries reported the injury to a higher official. Askarian et al. [12] found that 82% of all injuries went unreported. Lai Kah Lee et al. [10] found that only 40.8% of needle stick injuries were reported and that the reporting rates between different categories of health care workers were significantly different.

All doctors (100%) were aware of PEP for HIV compared to only 2.4% of patient attendants. Wig [13] in a study among doctors in Delhi reported that 62.8% of doctors were not aware of PEP for HIV.

Occupational exposure to blood and body fluids through needle stick injuries was quite high at the hospital. Given the dangers of disease transmission through needle stick injuries, the surprising lack of awareness of these dangers and the correct actions to be taken post injury makes it imperative to address this issue urgently. Training in universal precautions, proper sharps disposal and action to be taken in case of injury needs to be given to all categories of health care workers. The hospital needs to have a uniform needle stick injuries policy covering safe work practices, safe disposal of sharps, procedures in event of needle stick injury, training including pre-employment training, monitoring and evaluation of needle stick injuries and procedures for reporting needle stick injuries.

References