Knowledge, Attitude and Practice on Needle Stick Injury Management among Nurses and Nursing Students: A Cross-sectional Study

Prevalence and Perception of Needle Stick Injury Among Health Care Professionals at a Tertiary Care Hospital, Karachi, Pakistan

Epidemiology and risk factors of needle stick injuries

Context: Nurses and other health care workers, and at the same time nursing students in clinical training, are at high risk for needle stick injury. The main problem is that needle stick injury (NSIs) can lead to an increase in the risk of over 20 types of infection transmission among health care workers (HCWs), and the most dangerous infections are hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV).
 Aim: This study aimed to explore awareness and assess the prevalence of needle stick injury among nursing students at King Abdulaziz University, KSA.
 Methods: A cross-sectional study was conducted among a convenience sample of 217 nursing students at king Abdulaziz University. A pretested, structured self‐administered questionnaire was used for data collection.
 Results: Most of the students (92.6%) were aware that it is necessary to report the needlestick injury, 90.8% thought that there was a chance of getting an infectious disease from a needle stick, and 47.9% knew that all HIV, Hepatitis B, and Hepatitis C are of these infections. About one-third of students (32.3%) knew that the most common cause of needle stick injury was recapping the needle. For students' practice, 91.2% and 74.2% wore protective gear while handling sharp instruments and did not recap the needle after use. The mean knowledge and practice scores were 9.43± 2.96 and 1.65± 0.52, respectively. The prevalence of needle stick injuries among nursing students was 14.7%.
 Conclusion: The study concludes that a good awareness level of nursing students regarding needle stick injuries. This data emphasizes the importance of increased awareness, training, and education of nursing students for preventing needlestick injuries and reporting the incidence.

Background Healthcare workers are at high risk of occupational exposure to needle stick injury worldwide. Occupational exposure to needle stick injury represents the most common sources of infection such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. Thus, this review aimed to determine the career time and previous one-year global pooled prevalence of occupational exposure to needle stick injury among healthcare workers. Methods The review considered articles written in English language and published from 2012 to 2020. The articles were searched using nine electronic databases (PubMed, Google Scholar, CINAHL, MEDLINE, Cochrane library, Web of Science, SCOPUS, MedNar, and ScienceDirect) using a combination of Boolean logic operators (AND, OR, and NOT), Medical Subject Headings, and keywords. Quality assessment was performed to determine the relevance of the articles using Joanna Briggs Institute critical appraisal tools. Several steps of assessment and evaluation were taken to select and analyze the relevant articles. Results The worldwide pooled prevalence of needle stick injuries among healthcare workers during career time and previous one year was 56.2% (95% CI: 47.1, 64.9) and 32.4% (95% CI: 22.0, 44.8), respectively. The career time pooled prevalence of needle stick injuries based on the socioeconomic development and study area was 54.8% and 55.1%, respectively, and one-year pooled prevalence of needle stick injury was 26.0% and 20.9%. Conclusion The review found a high prevalence of occupational exposure to needle stick injury among healthcare workers and suggests the need to improve occupational health and safety services in the healthcare systems.

Background: Needle stick injuries are serious occupational hazards in the transmission of a variety of bloodborne diseases, more than twenty pathogens can be transmitted through NSI including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (AIDS) among healthcare workers. Objectives: Assess the knowledge, attitude and practice of health care workers towards needle stick injuries. Determine the prevalence of needle stick injuries among healthcare workers and its predisposing factors. Methods: Cross-sectional descriptive study, a convenient sample of 260 health care workers was selected from Baghdad Teaching hospital and Ghazy Al Hariri hospital in Baghdad, Iraq. Data were collected by an anonymous questionnaire from January to June 2020. The collected data were analyzed by using statistical package for the social sciences (SPSS version 23). Results Prevalence of NSIs among HCWs was found to be 53.8%, which was higher in nurses (29.3%) and laboratory technicians (28.5%) followed by surgeon doctors (15.7%), assistant surgeons (13.6%) and dentists (12.9%) .The highest number of needle stick injuries occurred by recapping of needles (41.4%) followed by during drug administration (27.9%), from hand to hand (10.7%) and during blood drawing (7.9%). A proportion of (64.5%) of health care workers whom sustained needle stick injury had reported their Injury. Doctors scored better than others regarding mean scores of knowledge, attitude and practice. There was a highly significant association among knowledge, attitude and practice scores of the HCWs (P<0.001). A considerable percentage of the participants (80.2%) were completely immunized against HBV. Conclusions: The study showed a high prevalence of NSIs among health care workers. The score of knowledge was high, moreover acceptable responses were obtained in most attitude and practice statements, except for recapping of needles statements.

Health care workers (HCWs) are exposed to bloodborne pathogens, especially hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus (HIV) through job-related risk factors like needlestick, stab, scratch, cut, or other bloody injuries. Needlestick injuries can be prevented by safer devices. The purpose of this study was to investigate the frequency and causes of needlestick injuries in a German university hospital. Data were obtained by an anonymous, self-reporting questionnaire. We calculated the share of reported needlestick injuries, which could have been prevented by using safety devices. 31.4% (n = 226) of participant HCWs had sustained at least one needlestick injury in the last 12 months. A wide variation in the number of reported needlestick injuries was evident across disciplines, ranging from 46.9% (n = 91/194) among medical staff in surgery and 18.7% (n = 53/283) among HCWs in pediatrics. Of all occupational groups, physicians have the highest risk to experience needlestick injuries (55.1%-n = 129/234). Evaluating the kind of activity under which the needlestick injury occurred, on average 34% (n = 191/561) of all needlestick injuries could have been avoided by the use of safety devices. Taking all medical disciplines and procedures into consideration, safety devices are available for 35.1% (n = 197/561) of needlestick injuries sustained. However, there was a significant difference across various medical disciplines in the share of needlestick injuries which might have been avoidable: Pediatrics (83.7%), gynecology (83.7%), anesthesia (59.3%), dermatology (33.3%), and surgery (11.9%). In our study, only 13.2% (n = 74/561) of needlestick injuries could have been prevented by organizational measures. There is a high rate of needlestick injuries in the daily routine of a hospital. The rate of such injuries depends on the medical discipline. Implementation of safety devices will lead to an improvement in medical staff's health and safety.

Background: A needle-stick is a sharp-pointed instrument used for puncturing tissues or passing a ligature around or through a vessel, but possibly also it could be a sharp instruments or objects for other purposes. Healthcare workers (HCW) can easily contact infections with blood-borne pathogens such infections are hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV), when health workers are exposed to occupational blood diseases through the use of sharp instruments and needle sticks. Objective: This research investigated the prevalence, causes and prevention of needle stick injury among healthcare workers at the Federal Medical Centre (FMC), Owerri. Materials and Methods: The sample size was fifty respondents while the major instrument for data collection was a well constructed, validated and reliable tested questionnaire, including observations made. Data obtained was analysed using frequency distribution, and chi-square. Results: Results of the a study indicated majority of the injuries occur during injection procedure (34%), recapping (14%), and improper disposal of used syringes and needle (6%), stress had (6%), overfilled disposal boxes also recorded (2%) and lack of experience among workers had (0%). Sex of respondents recorded 86% for female and 14% for male. Conclusion: A standard and understandable programmes to avert NSI should be encouraged.. Examples of such measures are as follows: recapping should be avoided, the use of disposal containers should be encouraged, surgical gloves and other safety devices can also be used to reduce a high cause of developing chronic blood-diseases like hepatitis, cirrhosis and liver cancer. Keywords: Needle- stick injury, hepatitis, healthcare workers, occupational hazard, disposal containers

Background: The objective of study was to determine prevalence of needle stick injuries among health care workers in a tertiary care hospital of Assam and to assess the knowledge, attitude and practices on needle stick injuries among them.Methods: It was a cross-sectional study conducted from June 2016 to August 2016 amongst health care workers of a tertiary care centre of Assam. Sample size was calculated to be 90. A total of 10 departments were selected purposively based on their magnitude of risk exposure and the required sample size was allocated proportionally among these 10 departments. The required numbers of health workers from each of the ten departments were selected by using simple random sampling. A predesigned and pretested proforma was used to collect the data. Data were presented in terms of percentages and significance was tested using chi-square and Fisher’s exact test.Results: Prevalence of needle stick injury among the health workers was found to be 21.1%. Regarding spread of diseases after an accidental needle stick injury, 100% were aware of HIV, 98.9% were aware of Hepatitis B and 67.8% were aware of Hepatitis C. Regarding their attitude to report to in-charge medical officer, only 21.1% had reported about their injury. Around 58.9% of health care workers used gloves regularly for prevention of such injuries. Practice of recapping among the health care workers was 66.7% and out of total needle stick injuries, recapping contributed to 26.3%. While considering sharp waste disposal, 37.8% health care workers did not follow proper waste disposal guidelines. Only 26.3% of health care workers had done screening for HIV/AIDS and Hepatitis B after their injury.Conclusions: There is a need to have a pre-employment training to improve the knowledge, attitude and practice regarding accidental needle stick injuries among the health care workers.

Introduction: Needle stick and sharp injuries (NSSIs) are hazardous and are frequently reported injuries among health care workers (HCW). These injuries expose them to infectious disease pathogens such as Hepatitis B, Hepatitis C and HIV that can be lethal. The physicians, nurses, medical students and other healthcare workers are highly susceptible to needle stick injuries. Standard precautions are available for all the workers and students’ safety purposes. Every incident is compulsory to be reported but some are under-reported. This represents a missed opportunity for initiating post exposrure prophylaxis, early detection of seroconversion and implementation of prevention strategies.Objectives: Obstetrics and Gynaecology Department is one of the department estimated as high risk of sharp injuries. The objective of the study is to identify the prevalence of needle stick and sharps injuries (NSSIs) and the rate of under-reporting to occupational health services. It also aims to explore the reasons for under-reporting and the knowledge, awareness and perception of risk of needle stick injuries in Obstetrics and Gynaecology Department of two teaching hospitals in Malaysia.Methods: A cross-sectional study of 194 respondents involving all the healthcare workers and students (Specialists, Medical Offiers, House offiers, Nurses, Medical assistants, Medical students and nursing students) from Obstertrics and Gynaecology wards in two teaching hospitals who are willing to participate were included. A structured questionnaire was used as the survey instrument. By using statistical analysis, we compared the data of sociodemographics of health workers, injury information, knowledge on risk of needle stick injury and risk perception on needle stick injury.Results: Out of 194 respondents, a total of 19(9.8%) respondents sustained needle stick injury. The prevalence was highest among medical student, 42.1%(n=8). Among the 19 cases, 36.8% did not report the incident due to perceived low risk of Hepatitis B/Human Immuno defiiency virus infection (42.9%), and that it was not important to report the incident (28.6%).Conclusion: There is a fair understanding of Universal Work Precaution among the HWCs in the Department of Obstetrics and Gynaecology in both the hospitals. However, there still exist a large gap between their knowledge, attitude and practice of the universal work precaution. As noted in the study, the highest prevalence of needle stick injury and its’ under-reporting is among medical students. Therefore, exposure prevention among the students must be an institutionalconcern, although every student must be aware of their responsibility for this prevention. Completion of three doses of Hepatitis B must be reiterated and HWCs must also be aware of their antibody status.

Context: Needle stick injuries (NSIs) are wounds caused by needles in health care setup that accidentally puncture the skin and may result in exposure to blood or other body fluids. NSI is a major occupational health and safety issue faced by health care professionals globally. Nurses have the highest rate of needle stick injury among health care workers. Aims: To determine the prevalence of needle stick injuries (NSIs) among the nurses, to determine the association between NSI and selected variables like age, marital status, years in service, educational qualification and to assess the measures undertaken by the respondents after the NSI. Materials and Methods: A cross sectional study was conducted in a tertiary care hospital in Imphal among nurses from October to November 2011. Self-administered questionnaire was used for data collection. Descriptive statistics were used. Chi square test was used to see the association and a P-value of Results: The prevalence of NSI within the last one year was found to be 28.1% (N=86). Of them 49(46.5%) had two or more NSIs in the last one year. More than half of the NSIs occurred during intravenous (IV) injection, 16.3% during intramuscular (IM) injection and only 1.6% during recapping of the needle. Eighty three (96%) of them did not were gloves during NSI. Forty (46.5%) of them washed the injured part with water and soap as immediate measure. Thirty seven (43%) did not report it. Though 251(82%) knew about the free availability of Post Exposure Prophylaxis (PEP) in the hospital, only 5(5.7%) took PEP. Conclusion: Needle stick injury is an important occupational health hazard among the nurses. Reporting to the concerned authorities, screening after NSI and promotion of safety measures should be greatly encouraged.

Needle stick injury (NSI) is a common occupational injury among healthcare workers (HCWs) and it is important that individuals in the health care field become well informed about the exposure risks and are educated regarding the appropriate response. But the disadvantage with the current reporting system is that it most often records only cases with an important exposure, thus leading to under-reporting of sharp injury cases with wide variation in the prevalence of NSI among HCWs both worldwide as well as in India (30–80%). HCWs need to be familiar with immediate management both for themselves if they become injured and for assisting injured colleagues. Hence, this review presents a summary of the prevalence, risk factors, prevention and management of NSIs among HCWs inside hospitals. A step-wise approach to post-exposure prophylaxis (PEP) for HCWs according to different guidelines has also been summarized.

The study aims to assess healthcare workers' needle-stick injury (NSI) knowledge, attitudes and practices (KAP). A cross-sectional study was conducted in a 600-bedded hospital throughout six months. The data were collected using an anonymous, self-reporting questionnaire. Participants were various healthcare workers (HCW) drawn through stratified random sampling and their knowledge, attitude and practice regarding NSI were assessed. There is significant difference in the mean knowledge, attitude and practice scores among healthcare workers. Even though scores are better for doctors and nurses, practice scores were better for technical staff. Healthcare workers, who had better practice scores, had suffered fewer NSIs. Since this study is a cross-sectional, the population's NSI incidence could not be calculated. This study emphasizes that applying knowledge to practice is required to prevent NSIs. Various recommendations to help prevent and deal with NSIs are made. This study analyses healthcare workers' NSI knowledge, attitude and practices, and also assesses their correlation with NSI incidence, which has not been done previously.

Background and objectives: Needle stick injuries pose a high risk to health care workers including dental students. They represent a major risk factor for transmitting blood borne pathogens including hepatitis B virus, hepatitis C virus and human immunodeficiency virus. Needles of syringes are the most commonly identified sharp object causing the injuries. Therefore, this study conducted to determine the prevalence of needle stick injuries among dental students in Ishik university facualty of dentistry and Hawler medical college. Aim and objectives of the study: The study aimed were to: 1. Find out the prevalence of NSI among dental student in Erbil city-Iraq. 2. The percentage of dental students that had taken Hep B vaccine. 3. Study the knowledge of dental students regarding NSI.Subjects and method: The study was a cross sectional in nature, 114 students from Ishik University and Hawler Medical University Collage of Dentistry and data collections were done from the 1st of Dec till 2 of Feb 2018. Later on, data analysis and writing the thesis completed in May up to June, 2018. A questionnaire was completed through direct interview of the study students to measure their knowledge and practice about needle sticks injuries. All the obtained information including prevalence of needle sticks injuries, within previous 12 months, time of injury, and training on needle stick injury, knowledge, practice and attitude about needle sticks was then analyzed using statistical package for the social science software version 21.Results: The mean age of the participants was 22. The results of the study demonstrated that the prevalence of needle stick injury during past 12 months among dental students was 47,4%. Needle stick injury happened after using the needle in 35.2%, while in re-capping the needle occur in 27,8% and around 41.2% of the samples have precautions regarding NSI.Conclusion: The dental student had taken hepatitis B vaccine in a high percentage, while the prevalence of NSI was high and male showed higher prevalence than female. Training course regarding the precaution and management of NSI may need to be added to the curriculum of dental students.

Background Needle stick injuries (NSIs) are a prevalent occupational hazard among healthcare workers (HCWs) globally. Strict adherence to standard work precautions by all HCWs at all times and the implementation of post-exposure prophylaxis (PEP) are measures for reducing the occurrence of NSIs. However, NSIs are poorly documented in the literature and may be a cause of morbidity in the long run. Objectives Our study aims to determine the prevalence of NSIs among HCWs and its associated factors in a tertiary healthcare centre in Kerala, India. Methods A cross-sectional study was conducted among 210 consenting HCWs who worked in different blocks of a tertiary care hospital in the Ernakulam district, Kerala, India. Data was collected using a semi-structured questionnaire through personal interviews.The questionnaire gathered sociodemographic information, details regarding NSI occurrences over the past one year, the devices involved and PEP. Data analysis was performed using StatisticalPackage for the Social Sciences (IBM SPSS Statistics for Windows, IBMCorp., Version 20.0, Armonk,NY), and categorical variables were expressed as frequencies and percentages. The chi-square test and binomial logistic regression were employed to identify factors associated with NSIs. Results The prevalence of NSIs among HCWs in the past 12 months was 31% (65 out of 210), with an average of 1.34 NSIs per HCW per year. The most commonly involved device was the intravenous (IV) cannula, and 22 out of 65 (33.8%)injuries occurred during injection procedures. A majority (45 out of 65; 69.23%) of HCWs reported NSI and 51 of them (78.4%) received PEP. Logistic regression analysis showed that HCWs aged over 31 years (adjusted odds ratio (AOR): 3.39; 95% confidence interval (CI): 1.29-8.42) were independently associated with a higher occurrence of NSIs. Conclusion Our findings underscore the importance of implementing comprehensive safety measures, including strict adherence to standard work precautions and timely administration of PEP.

DEAR EDITOR, Needle stick injuries (NSIs) has always been one of the most important risk factor for health care workers (HCWs) for transmission of various infections such as hepatitis B, hepatitis C, and human immunodeficiency virus.[1] Variety of procedures like needle recapping, injuries sustained in the operating room, blood collection or intravenous line administration, suturing, checking blood sugar etc., can lead to accidental NSIs [Table 1].[2,3] Although modern dentistry has been cited as the least hazardous of the all the occupations, risks like NSI still challenge the status of this occupation.[4] Compared with many other health care settings, dental professionals are at higher risk of acquiring infections due to the fact that dentists work in a limited-access and restricted-visibility field and frequently use sharp devices.[5] Table 1 Various determinants of NSIs Every year about 16 billion injections are administered in developing and transitional nations and approximately three million individuals are injured annually due to needle stick and sharp injuries.[6] These types of blood-borne exposures can be career and life-ending. There is gross under reporting of NSI and therefore the incidence of NSI is higher than the current estimates.[7] In developing countries such as Ghana, Indonesia and Uganda, 80–90% of patients who visited a health center received one or more injections per visit.[8] Another study reported a high incidence of needle stick and sharp injuries among HCWs in Jordan.[9] In a country like India, in spite of large number of awareness programs, it is not possible to estimate the annual incidence of NSI in different occupations because of scarcity of data.[1] Very few studies that have been conducted among dental HCWs reporting their knowledge, awareness and practice regarding NSI. Findings of a study conducted on dental students reported that on an average 89.23% of the students had correct knowledge about NSI and 89% of them were aware of taking postexposure prophylaxis (PEP) after an accidental NSI.[10] According to some other study reports, 11% of the students were not aware that the virus could be transmitted through infected needles and found that 44% of the students would destroy the needle using needle destroyer and 15% would destroy in puncture-resistant container with disinfectant.[11] Only 39.8% of the health care students could correctly define sharp instrument injury in some other study reports and 75.4% of the students experienced sharp instrument injuries during the last 1-year and 52.3% of the sharp instrument injuries occurred during administration of local anesthetic injection.[12] Reports of another study revealed that 88% of the dental students were aware of the occupational blood-borne diseases, and 75% of them reported exposures majority of who were postgraduate students.[13] It can be concluded that knowledge, awareness and practices of the dental students in among different studies is adequate though there is considerable variation in practice and management of NSI. Not every NSI can be preventable, but according to research 83% of injuries from hollow-bore needles can be prevented.[14] The present article also concludes that for prevention of NSI, knowledge and awareness amongst dental HCWs should be increased. More studies should be conducted involving dentists and other dental professionals as there is scarcity of literature on knowledge and awareness levels of dentists in India. Various health and safety measures can be adopted to decrease the incidence of NSI. Workers should be properly trained Personal protective equipment and clothing should be provided An effective occupational health and safety program should be established that includes immunization, PEP, medical and dental surveillance.