The pattern of needle stick injury among health care workers at West Bengal

Abantika Bhattacharya; Mausumi Basu; Palash Das

doi:10.4103/0975-9727.128940

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ORIGINAL ARTICLE

Year : 2014 | Volume : 5 | Issue : 1 | Page : 29-33

The pattern of needle stick injury among health care workers at West Bengal

Abantika Bhattacharya¹, Mausumi Basu², Palash Das³
¹ Assistant Professor, Department of Community Medicine, Midnapore Medical College, Paschim Medinipur, West Bengal, India
² Associate Professor, Department of Community Medicine, IPGME and R, Kolkata, India
³ Associate Professor, Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, India

Date of Web Publication

15-Mar-2014

Correspondence Address:
Mausumi Basu
Department of Community Medicine, IPGME and R, Kolkata, West Bengal
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0975-9727.128940

Abstract

Introduction: Health care workers (HCWs) are at increased risk of infection with blood-borne pathogens; because of occupational exposure. Objectives: The objective of the following study is to assess the occurrence of needle stick injury (NSI) among HCWs, various factors responsible for NSI, the circumstances under which they occur and explored the responses of the HCWs after an injury. Materials and Methods: A descriptive hospital based observational epidemiological study, cross-sectional in design was conducted in indoor and Out-patient Departments of Surgery, Medicine and Gynaecology and Obstetrics of Burdwan Medical College and Hospital from June 2012 to August 2012 using a pre-designed pre-tested semi-structured self-administered anonymous questionnaire among senior residents, junior residents, house-staffs, internees, nursing staff and nursing students and laboratory technicians. Results: 132 (53.0%) reported NSI in the preceding 1 year in the health care facility. Nurses and nursing students had the highest percentage (42.4%). Only 40.2% HCWs were wearing gloves at the time of NSI. Recapping of needles was the most common cause implicated in causing NSI. 49.2% HCWs took action instantly after an NSI. Conclusion: Occurrence of NSI among the HCWs in West Bengal was high. Information, education and communication materials should be displayed prominently at the places of work.

Keywords: Blood borne pathogens, health care workers, needle stick injury

How to cite this article:
Bhattacharya A, Basu M, Das P. The pattern of needle stick injury among health care workers at West Bengal. Muller J Med Sci Res 2014;5:29-33

How to cite this URL:
Bhattacharya A, Basu M, Das P. The pattern of needle stick injury among health care workers at West Bengal. Muller J Med Sci Res [serial online] 2014 [cited 2023 Jun 1];5:29-33. Available from: https://www.mjmsr.net/text.asp?2014/5/1/29/128940

Introduction

Health care workers (HCW) are at increased risk of infection with blood-borne pathogens; namely hepatitis B and C viruses (HBV, HCV) and the human immunodeficiency virus (HIV); because of occupational exposure. Most exposures among HCWs are caused by percutaneous injuries with sharp objects contaminated with blood or body fluids which include needles, scalpels, lancets and broken glass. The World Health Organization estimated the global disease burden from contaminated sharps injuries to HCWs at the workplace by analyzing 25 risk factors. ^[1]

Overall, number of HCWs at risk world-wide was calculated to be 35, 702, 000. Globally, it was estimated that more than 3 million HCWs will be exposed to a sharp object contaminated with HCV, HBV or HIV every year. This corresponds to almost one HCW out of 10.

In developing regions, 40-65% of HBV and HCV infections in HCWs were attributable to percutaneous occupational exposure. In developed regions, by contrast, the attributable fraction for HCV was only 8-27% and that for HBV was less than 10%, largely because of immunization and post-exposure prophylaxis. The attributable fraction for HIV in the various regions ranged between 0.5% and 11%. ^[1]

However, the actual number of needle stick injuries (NSI) remains unknown due to under-reporting. According to Pirwitz et al. ^[2] and Holodnik and Barkauskos ^[3] the underreporting rate was estimated between 64% and 96%.

In India, authentic data on NSI are scarce. However, several studies consistently found that a very high proportion of HCWs receive NSI while performing their work, both in India and internationally. ^[4],[5],[6]

Factors associated with an increased risk of occupational exposure of NSI differ from place to place. While developed countries are busy with designing new protective devices and improving their policies, the developing world still struggles with the lack of basic equipment, inadequate policies and poor adherence to them. ^[4] Many of these injuries could have been easily avoided if suitable preventive measures has been introduced earlier.

Thus, the present study addressed the occurrence of NSI [Table 1] among the HCWs in a tertiary care hospital in West Bengal, the various factors responsible for NSI, the circumstances under which they occur and explored the responses of the HCWs after an injury.

Table 1: Responses of various categories of health care workers to different questions regarding their NSI (NSI)

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Materials and Methods

A descriptive hospital based observational epidemiological study, cross-sectional in design was conducted in indoor and Out-patient Departments (OPD) of Surgery, Medicine and Gynecology and Obstetrics of Burdwan Medical College and Hospital from June 2012 to August 2012 using a pre-designed pre-tested semi-structured self-administered anonymous questionnaire. Study population were senior residents, junior residents, house-staffs, internees, nursing staff and nursing students and laboratory technicians in the Departments of Surgery, Gynecology and Obstetrics and General Medicine of Burdwan Medical College and Hospital.

The questionnaire was prepared in English by the researchers with the help of experts of community medicine. As a new tool, the tool was validated by three public health specialists. Initially, a pilot study for pre-testing of the questionnaire was carried out. Then rectification of the questionnaire was carried out by necessary correction and modification and structuring was done before final data collection. Study technique was the administration of the questionnaire. Sample size was 249 interns, house staffs, junior residents, senior residents, nurses and nursing students, resident medical officers (RMOs) and laboratory technicians. Sampling design was purposive sampling technique for operational and technical feasibility. The inclusion criteria were HCWs in the hospital, both male and female and including those professionals who normally deal with needles-interns, post-graduate trainees, house-staffs, RMOs, nursing staff and students and laboratory technicians and who were willing and available at the time of study.

Exclusion criteria were all professors, specialists and consultants, the HCWs of the departments who do not normally involve in use of needles and who unwilling or on leave during that period.

Study variables were occurrence of NSI, distribution/risk of injury among different groups, number of injuries per HCWs during last 1 year, universal precautions taken [Table 1] or not, size of needle, instruments involved in injuries, procedures/activities carrying a high risk of injury, causes of NSIs [Table 2], place where injury occurred and reaction following NSIs [Table 3].

Table 2: Cause of most recent NSI as per the health care workers (n=132)

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Table 3: Distribution of the study population based on their response following NSI (n=132)

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Data Collection Techniques

Before actual study, permission was obtained from the authority. A questionnaire was designed in consultation with three experts; one each from medicine, surgery and gynaecology and obstetrics and pre-testing of the same was done for validity. Date and time was fixed up. Each month was utilized to complete data collection in each department (Departments of General Surgery, General Medicine and Gynecology and Obstetrics). Thus a total of 3 months time was required to collect information. In the morning, on two fixed dates (Monday and Wednesday), OPD visits were made. The participants were informed about the purpose of the study and their informed verbal consent was taken. They were assured about their confidentiality and anonymity. They were given the option that they may or may not join in the study. The questionnaire was given to willing participants who filled it up subsequently. After OPD visit, indoor visits were made and similar procedure was followed. History of NSI in the preceding 1 year in the health-care facility was asked.

Data Analysis

Finally, the collected data were tabulated and interpretations were done by proper statistical method (percentage and Chi-square test).

Results

A total of 249 HCWs participated in the study including post-graduate trainees 37 (14.85%), house-staffs 18 (7.22%), interns 78 (31.32%), RMOs 11 (4.41%), nursing staff and student nurses 85 (34.13%) and student laboratory technicians 20 (8.03%). The respondent rate was 100.0%.

Occurrence of NSI

Among 249 respondents, 132 (53.01%) reported NSI in the preceding 1 year in the health care facility.

Distribution/Risk of Injury Among Different Professional Groups

Among the HCWs with NSIs, nurses and nursing students had the highest percentage 56/132 (42.42%) and RMOs the lowest 6/132 (4.54%). The result was statistically significant (P < 0.005).

Number of Injuries Per HCWs During Last 1 Year

The following numbers of injuries were reported: 1 injury 62.10% (n = 82), 2-3 injuries 28.80% (n = 38) and >3 injuries 9.10% (n = 12).

Universal Precautions Taken

It was disheartening to note that only 40.15% (53/132) of HCWs were wearing gloves at the time of NSI.

Size and Type of Needle

The length of the needle in most cases of NSI was medium sized (58.33%) of cases (77/132) while large (25.75%) (34/132) and small sized needles (15.90%) (21/132) were also implicated.

62.12% of the needles involved were hollow bored (82/132), while 37.87% (50/132) were of solid or curved variety.

Instruments Involved in Injuries

Types of needles implicated in causing NSI included injecting needle (56.0%), suturing needle (18.0%), cannula (21.0%) and other types of needles (5.0%).

Procedures/Activities Carrying a High Risk of Injury

Procedures performed at the time of NSI included intramuscular injections 50.00% (66/132), intravenous procedures 35.60% (47/132), suturing 9.84% (13/132) and subcutaneous injections 4.54% (6/132).

Causes of NSIs

Recapping of needles was the most common cause implicated in causing NSI in 32.57% (43/132), whereas collision with sharps in 3.78% (5/132) was the least common cause.

Place where Injury Occurred

Highest number of NSIs occurred in the wards 53.03% (70/132), followed by in operating rooms 16.66% (22/132), in emergency/casualty 12.87% (17/132), in intensive care units 6.06% (8/132) and in other places 11.36% (15/132).

Reaction Following NSIs

After an NSI, 49.24% (65/132) of HCWs took action instantly; while 12.26% took action later on the same day and 38.50% did not take any action.

Source

Known sources accounted for 109 (82.57%) NSIs and unknown sources accounted for 23 (17.42%) of the injuries. Of the known sources, 11/109 (10.09%) were positive for hepatitis B surface antigen (HBsAg), 9/109 (8.25%) for HIV and 2/109 (1.83%) for HCV.

Discussion

The proportion of HCWs in the general population varies substantially by region (0.2-2.5%) (mean 0.6%), as do the average number of injuries per HCW (0.2-4.7) per year. The annual proportions of HCWs expose to blood-borne pathogens is 2.6% for HCV, 5.9% for HBV and 0.5% for HIV, corresponding to about 16,400 (5900-86,000) HCV infections, 65,600 (2400-240,000) HBV infections and 1000 (200-5000) HIV infection world-wide; which will result in 142 (51-749) early deaths in HCV, 142 (51-749) in HBV and about 736 (129-3578) in HIV. ^[1]

Globally, occupational infections with HBV, HCV and HIV accounted for about 37.0%, 39.0% and 4.4% respectively, of all HBV, HCV and HIV infections in HCWs.

The present study highlighted certain aspects of NSI in a tertiary care government hospital.

Occurrence of NSI

It was found that 53.0% of HCWs had experienced NSI at some point in the preceding 1 year of their career, which was a concerning number. The corresponding figures were 46.7% in Witbank Hospital by Lachowicz and Mathews, ^[4] 79.5% in Delhi by Sharma et al., ^[5] 80.1% in Delhi by Muralidhar et al., ^[6] 49.6% in Iran by Askarian et al., ^[7] 11.0% in Singapore by Ng et al., ^[8] 57.0% in Karnataka by Radha and Khan, ^[9] 61.4% in Kolkata by Joardar et al., ^[10] 34.8% in Goa by Salelkar et al., ^[11] 94.0% in Pakistan by Siddique et al. ^[12] and 66.0% in Karachi by Aslam et al. ^[13]

Distribution/Risk of Injury Among Different Professional Groups

Among the HCWs, nurses and nursing students were most prone to NSI in our study. This may be attributed to patient overload and lack of knowledge about universal precautions. Several other studies had also shown high occurrence of NSI among nurses. ^{[14],[15],[16],[17]} However, a study in Delhi by Sharma et al. ^[18] revealed that interns had the highest percentage (47%) of NSI. Another study in Mumbai by Rele et al. ^[19] showed NSI was highest among residents (76%), followed by nurses (11%) and interns (5%). The prevalence of NSI was highest among senior residents (55.0%) followed by junior residents (47.2%) in another study at Goa by Salelkar et al. ^[11]

Universal Precautions Taken

Wearing gloves is known to be an important line of defence but only 40.2% of respondents of the present study were using gloves at the time of their last NSI, similar to some other studies ^{[8],[12],[19]} (49.0%); but which felt much short of the figures shown by Sharma et al. in Delhi (72.7%), ^[5] Muralidhar et al. in Delhi (74.0%) ^[6] and Askarian et al. (96.2%) ^[7] in Iran. However, in this study and other studies too, several HCWs (60.0%) had not been wearing gloves at the time of their injury specially the lab technicians, nurses and interns. ^{[8],[12],[19]}

Size and Type of Needle

Our study showed that 62% of NSI was associated with hollow bore needles, which was almost similar as shown by Muralidhar et al. (71.0%), ^[6] Askarian et al. (72.2%) ^[7] Nee et al. (62.2%), ^[8] Radha and Khan (44.0%), ^[9] Salelkar et al. (77.5%), ^[11] Jayanth et al. (77.7%) ^[14] and Sureshkumar et al. (80.1%). ^[16] This association can have an impact on transmission of pathogens, as hollow bore needles are associated with higher fluid content and pathogen load.

Causes of NSIs

In our study, most of the injuries (32.7%) occurred during recapping of needles. Several other studies also showed recapping to be an important cause of NSI. ^{[5],[6],[8],[10],[16],[17],[19]} However, some other studies didn't revealed this finding. ^{[11],[14],[15]} All training programs emphasized that recapping of needles after use not to be done.

Reaction Following NSIs

Our findings showed that after an NSI, 49.2% of HCWs took action instantly and a matter of concern is that as high as 38.6% did not take any action. These findings were contradictory to findings of Sharma et al., ^[5] Radha and Khan ^[9] and Rele et al. ^[19]

Source

Known sources accounted for 109 (82.7%) NSIs and unknown sources accounted for 23 (17.3%) of the injuries. Of the known sources, 11/109 (10.1%) were positive for HBsAg, 9/109 (8.3%) for HIV and 2/109 (1.8%) for HCV.

These findings are nearly similar to findings of another study ^[11] where, known sources accounted for 75.3% NSIs and unknown sources accounted for 24.6% of the injuries. Of the known sources, 9.0% were positive for HBsAg, 6.3% for HIV and three 1.3% for HCV.

Conclusion

It was concluded from the present study that the occurrence of NSI among the HCWs in West Bengal was high. The factors responsible were not wearing gloves; recapping of needles and bending of needles. It was also of concern that less number of HCWs reported instantly to their seniors after an injury.

Limitations

Study population were only from the Departments of Surgery, Gynaecology and Obstetrics and General Medicine. Faculties not included in the study.

Recommendations

Information, education and communication materials may be displayed prominently at the places of work, highlighting the point about no recapping.
Training of HCWs and regular monitoring of safety practices among them needs to be an on-going activity at the hospital.
Self-reporting of NSI needs to be emphasized in all the health care setup.
All newly employed inexperienced HCWs should be taught the correct techniques of handling/disposing sharps and using protective clothing/devices.
There is a need for further study to evaluate existing techniques/practices involving the use of sharp instruments.

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