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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 23  |  Issue : 1  |  Page : 24-28

Prevalence of needlestick injury and factors associated with needlestick injury among health-care workers in a tertiary care hospital


1 Department of Infectious Diseases, Apollo Hospitals, Chennai, Tamil Nadu, India
2 Department of Infection Control, Apollo Hospitals, Chennai, Tamil Nadu, India

Date of Submission01-May-2021
Date of Decision30-May-2021
Date of Acceptance01-Jun-2021
Date of Web Publication16-Sep-2021

Correspondence Address:
Dr. Sowmya Sridharan
Department of Infectious Diseases, Apollo Hospitals, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacm.jacm_47_21

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  Abstract 


INTRODUCTION: One of the most common causes of occupational injury in hospitals is needlestick injury (NSI). Most injuries are self-inflicted but a few are inflicted by coworkers. The WHO reports that out of the 35 million health-care workers (HCWs), 2 million experience percutaneous exposure to infectious diseases each year. Early and prompt reporting of NSI enables hospitals to provide post-exposure prophylaxis and counselling as needed. Here, we present our hospital data for the year 2019.
AIMS AND OBJECTIVES: The aim and objective of the study are to calculate the incidence of NSI among HCWs in our hospital for the year 2019 and to analyse the reasons for the NSI and to formulate corrective actions for the same.
MATERIALS AND METHODS: A retrospective observational study of NSI from 1 January 2019 to 31 December 2019 at our tertiary care hospital. We performed a root cause analysis for the same.
RESULTS: A total of 59 cases of NSI were documented. The highest incidence of NSI was in the operation theatre(47.45%). Among all health care workers, doctors had the highest NSI incidents(40.6%), Around 63%(37) of the cases happened due to technique errors such as improper handling (while passing sharp instruments) and poor sharp management (while loading the scalpel blade over the handle).
CONCLUSION: NSI is a fully preventable occupational hazard. Prompt reporting of NSI is needed for corrective measures.

Keywords: Health-care workers, needlestick injury, occupational injury, percutaneous exposure


How to cite this article:
Sridharan S, Ramanathan Y, Panchatcharam SN, Venkatasubramanian R. Prevalence of needlestick injury and factors associated with needlestick injury among health-care workers in a tertiary care hospital. J Acad Clin Microbiol 2021;23:24-8

How to cite this URL:
Sridharan S, Ramanathan Y, Panchatcharam SN, Venkatasubramanian R. Prevalence of needlestick injury and factors associated with needlestick injury among health-care workers in a tertiary care hospital. J Acad Clin Microbiol [serial online] 2021 [cited 2021 Nov 29];23:24-8. Available from: https://www.jacmjournal.org/text.asp?2021/23/1/24/326048




  Introduction Top


One of the most common causes of occupational injury in hospitals is needlestick injury (NSI). The main occupational risk for acquiring a blood-borne pathogen is percutaneous sharps injury with a contaminated object. According to the Centers for Disease Control and Prevention (CDC), 5.6 million health-care workers (HCWs) are at risk of occupational exposure to blood-borne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV).[1] The WHO reports that out of the 35 million HCWs, 2 million experience percutaneous exposure to infectious diseases each year. 37.6% of hepatitis B, 39% of hepatitis C and 4.4% of HIV/AIDS in HCWs around the world are due to NSI.[2] According to CDC, 18% of the health-care professional trainees (resident, interns and fellows) sustain NSI annually.[1] Long and tiring working hours, stress and lack of sleep are some of the common reasons attributed by them. Apart from the risk of blood-borne infections and anxiety experienced by the injured HCW, NSI also causes substantial loss to the organisation both in financial terms and in relation to impact on manpower.[3] Most injuries are self-inflicted but few episodes are inflicted by coworkers. Among trainee doctors, CDC data reveal that only 50% report the NSI incident to the concerned authorities.[1] The overall percentages of the NSI reported from various hospitals may vary as it depends primarily on the self-reporting of NSI by HCWs. Considering the magnitude of the problem, our aim of the study was to estimate the frequency of NSI, type of HCW involved, factors associated with NSI, frequency of NSI in various areas of the hospital and post-exposure follow-up. Since our organisation adheres to a 'no blame culture', the reporting of NSI is voluntary and encouraged.


  Materials and Methods Top


This was a cross-sectional observational study of NSI from 1 January 2019 to 31 December 2019 among HCWs in our tertiary care hospital. The number of HCWs who voluntarily reported NSI during the above time period were assessed based on the incident reporting form maintained by our hospital. This form contains the details of type of exposure, area of incident, description of the NSI incident, nature of injury, risk assessment of exposed person which includes usage of personal protective equipment, hepatitis B vaccination and anti-hepatitis B surface (Hbs) antibody titre status etc., and the details of the source of exposure. It also includes the follow-up strategy for the exposed person including administration post-exposure prophylaxis based on protocols and periodic follow-up to look for seroconversion. A unique questionnaire filled by the exposed person was used for the root cause analysis of the factors associated with NSI, and risk reduction strategies were planned based on their responses[Figure 1], [Figure 2], [Figure 3]. Data collected was entered into Microsoft Excel spreadsheet and assessed by Microsoft assessment tool.
Figure 1: Incident reporting form

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Figure 2: Root cause analysis of needlestick injury

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Figure 3: Root cause analysis action plan risk

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  Results Top


A total of 59 cases of NSI were documented during the above-mentioned period. Our NSI data state that highest incidence of NSI was in the operation theatre (47.45%) [Figure 4]. Among all HCWs, doctors had the highest NSI incidents (40.6%) [Figure 5]. While analysing the reasons for NSI, it was found that only 5% (3) of the NSI occurred due to patient-related factors, 8% (5) were due to supervisory issues and 19% (11) related to improper waste disposal [Figure 6]. Around 63% (37) of the cases happened due to technique errors such as improper handling (while passing sharp instruments) and poor sharp management (while loading the scalpel blade over the handle). Suture needles and scalpel blades were the most common source of injury. Forty-seven per cent (27) of the NSI was caused by solid bore needles, 48% (28) were caused by hollow needles and only 7% (4) by blades [Figure 7]. Analysing the sero-status of the 57 patients from whom the NSI was sustained (2 did not consent to testing), it was noted that 4 were HIV positive, 5 were hepatitis B surface antigen (HbsAg) positive and 2 were anti-HCV positive. All HCWs who sustained NSI from the 5 HbsAg-positive patients had protective anti-HbS titres of > 10 IU/ml. The two HCWs who sustained pricks from anti-HCV-positive patients were followed up and did not seroconvert. The HCW who sustained pricks from HIV-positive patients did not seroconvert on follow-up.
Figure 4: Area-wise distribution of needlestick injury

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Figure 5: Occupational distribution of needlestick injury

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Figure 6: Factors contributing to needlestick injury

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Figure 7: Types of sharp causing needlestick injury

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A fishbone analysis was created based on the questionnaire [Figure 8].
Figure 8: Fishbone analysis of needlestick injury

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The following mitigation strategies were developed and introduced into the system based on the factors associated with NSI.

  1. Training on usage of sharp and biomedical waste management for all HCWs – at the time of joining the organisation, continuous nursing education (CNE) for all nurses, workshops, screensavers on ward desktop computers and focused training for each department post-NSI, one-to-one counselling and training for doctors on NSI such as demonstration of capping techniques and methods for safe disposal of sharps
  2. The availability of devices with safe engineering controls such as Venflon, glucometer lancet, pre-loaded syringes, sample collection vacutainers in blood collection area, trifurcate or bifurcate connectors, luer lock intravenous sets, puncture proof containers and needle cutters was made available in every ward, occupational therapy (OT) and critical care unit
  3. Safe techniques to avoid NSI in work practices were introduced. These include disposal of sharps immediately after use, disposal of sharp is everybody's responsibility, availability of spill kits in all patient care areas, passing sharps in kidney trays, double gloving during surgery in OT, dressing, providing suturing and suture removal trays in all patient care areas
  4. Use of safe scalpel blades which are disposable scalpels with a retractable plastic guard, which when actively deployed sheathes the scalpel.


Impact of interventions

The sheer fact that none of the HCWs who sustained NSI from HBV/HCV or HIV-positive patient seroconverted due to periodic sero-surveillance and the diligent use of post-exposure prophylaxis stands testimony to the positive impact of the interventions. Although data regarding the incidence of NSI during the subsequent years have not been analysed, heightened awareness among HCWs regarding NSI and a substantial reduction in the incidence of NSI was observed after the implementation of the above mitigation strategies. Moreover, the CNE programmes and workshops regarding NSI conducted for the nurses and the doctors, respectively, were a huge success and hence have been incorporated into the induction programme for all employees joining our institution.


  Discussion Top


NSI is a common occurrence in the health-care profession. The operation theatre is an area in the health-care facility where the team members work under intense time pressure and resort to extensive use of sharps. These circumstances put them at an increased risk of NSI. In a retrospective study done at a tertiary hospital in North India, it was noted that the incidence of NSI was highest among doctors (73.7%).[4] Our study also showed a similar finding with NSI being most common among doctors followed by nurses (40.6%). NSI often occurs in the context of administering injections, collecting blood samples, recapping needles and handling them, transfer of syringes from one person to other while doing procedures, handling disposed trash containing uncapped needles after procedures on the tray [Table 1]. While a study from Delhi noted that 34% of NSI occurred during recapping,[5] in our study around 67% (37) occurred due to improper handling with recapping errors happening only in 8% (5) of the total.
Table 1: Technique errors contributing to needlestick injury

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Our study has a few limitations. First, ours was an observational study that analysed collected data. Second, the trends and patterns in NSI have to be analysed over a period of many years to formulate corrective actions. Data regarding the impact of the post-intervention phase need to be compared and analysed, but these could not be done as our period of analysis was short. Despite the above limitations, our data would be useful to understand the common reasons for occurrence of NSI among HCW and to device preventive actions for the same. In addition, this study has been done in a developing country such as ours where they may be resource constraints, challenges in education, especially with house-keeping, language barriers with various segments of workers and increased attrition, and hence, this study may offer avenues to target the deficiencies better.


  Conclusion Top


NSI is a fully preventable occupational hazard. Prompt reporting of NSI is needed for corrective measures. Repeated training of health-care providers on usage of sharps and education regarding proper disposal methods are vital in preventing NSI.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Schillie S, Murphy TV, Sawyer M, Ly K, Hughes E, Jiles R, et al. CDC guidance for evaluating health-care personnel for hepatitis B virus protection and for administering postexposure management. MMWR Recomm Rep 2013;62:1-19.  Back to cited text no. 1
    
2.
Available from: https://www.who.int/occupational_health/activities/2needguid.pdf. [Last accessed on 2021 Jul 16].  Back to cited text no. 2
    
3.
Adams S, Stojkovic SG, Leveson SH. Needlestick injuries during surgical procedures: A multidisciplinary online study, Occup Med 2010;60:139-44.  Back to cited text no. 3
    
4.
Goel V, Kumar D, Lingaiah R, Singh S. Occurrence of needlestick and injuries among health-care workers of a tertiary care teaching hospital in North India. J Lab Physicians 2017;9:20-5.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Sharma R, Rasania S, Verma A, Singh S. Study of Prevalence and Response to Needle Stick Injuries among Health Care Workers in a Tertiary Care Hospital in Delhi, India. Indian J Community Med 2010;35:74-7.  Back to cited text no. 5
[PUBMED]  [Full text]  


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