Medires Publishers - Article

Abstract

Background: Needle-Stick and sharp Injuries are among the hazards and problems that can expose health workers to infections. Hepatitis B, C & HIV are some of biological hazards threatening the health of thousands of healthcare workers. The most common mode of transmission of these diseases is via needle stick and sharp injury.

Objective: To assess magnitude and associated factors of needle stick and sharp injuries among Nurses in Arsi zone health facilities from December 2020 to January 2021.

Methods: An institutional based cross sectional study design was conducted among nurses working in five government hospitals in Arsi Zone, Ethiopia. Participants were selected randomly from each hospital. Data were collected using structured, pretested and customized questionnaires.  Multivariate logistic regression models were applied to determine the association between independent and dependent variables.

Result: A total of 303 Nurses participated in this study making the response rate 97.4%. Prevalence of Needle stick/sharp material injury in the past one year among Nurses in government Hospitals in Arsi zone was 42.2%. The highest prevalence of needle stick/sharp material injury 61.8% was recorded in Gobesa district Hospital, while the least prevalence 29.5% was recorded in Abomsa Hospital. Recapping needle after use and number of working hours per week, were some of the risk factors of needle stick and sharp materials injury.

Introduction

Occupational injury and illness occur across an extensive variety of occupations. An estimated 320,471 employees die annually from work-related transmittable infectious diseases worldwide (1). Compared to many other types of occupations, health care workers (HCWs) are at a greater risk of harm from exposure to blood and other pathogens. A study reveals a high level of occupational exposure to blood among HCWs (2).

Needle-Stick Injuries (NSIs) are among the hazards and problems that can expose health workers to infections (3). Although, as many as 20 different pathogens could be transmitted by NSIs:  hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) constitute the majority of blood-borne infections transmitted post-injury (4).

Approximately 3 out of 35 million HCWs worldwide experience needle stick injuries (NSIs) annually, exposing them to blood-borne pathogens (5, 6). Percutaneous occupational exposure accounts to approximately 37% of HBV, 39% of HCV, and 4.4% of HIV cases among HCWs (7).

The results of several studies have shown that different healthcare workers have had various rates of NSIs among which the proportion of nurses has been higher than others (8).

Needle sticks injury are common in the developing world and it is believed that 40–75% of these injuries are not reported (9). Unreported needle stick and sharp injuries are a serious problem and stop injured HCWs from receiving post exposure prophylaxis (PEP) against HIV, which is shown to be 80% effective in preventing HIV infection in these subjects (9).

Sub-Saharan African countries have the highest share of HIV prevalence and more than 90% of occupational exposure (10).

A study in Bahir Dar, Amhara, Ethiopia, showed that 65.9% of health care providers were exposed to blood and body fluids in the past year, of which 29.0% were needle stick injuries (11). NSIs can be regarded as preventable, if health care workers adopt a comprehensive program that addresses institutional, behavioral, and device-related factors that contribute to the occurrence of needle stick injuries in health care workers (12). NSIs are frequent and important cause of morbidity and mortality in health care workers who come into contact with patient blood and body fluids (13). Therefore, assessing the magnitude and factors associated with needle stick and sharp injury among health care workers is very important.

Methods

Study area, design and period

Institutional based cross-sectional study design was conducted in five government hospitals found in Arsi zone, Ethiopia from December 2020 to January 2021

Study Population

The selected nurses working in five government hospitals in Arsi zone and interested to participate in the study were the study population of this study.

Sample size determination and sampling procedure

The actual sample size of this study was determined using the formula for single population proportion by assuming 5% margin of error and 95% confidence interval using proportion(P) of needled stick and sharp injury among health workers in Bale zone Ethiopia which is 19.1% (14). After considering 10% for non-response, a total of 311 generated. The total sample size is allocated equally for the selected hospitals. The participants were selected randomly from each hospital

Data collection

Socio-demographic data and factors associated to needle stick and sharp injury were collected using structured, pretested and customized questionnaires. The data were collected through self-administered questionnaire.

Data quality assurance

The questionnaires were prepared in English and translated into Amharic. The Amharic version was translated back into English by a researcher conversant in both languages. The two versions were compared to identify any inconsistency in the wording. From the total sample size, 5% samples were used for pre-testing the tools and to check for the validity and reliability as well as the ambiguity of questions among data collectors and supervisors. In order to assure the data quality, two days training were given to the data collectors and supervisors about the objectives as well as a detailed description of each question. Data were checked for completeness and consistency on daily basis.

Data management and Analysis

The data was checked for completeness and entered in to Epi Info version 7. It was then exported to SPSS version 25for further analysis. Descriptive analysis like frequency, percentage, and mean, were presented using different tables and graphs. Multivariate logistic regression models were applied to determine the association between independent and dependent variables.

Ethical Consideration

Ethical approval was obtained from the Arsi University Health Sciences College Ethics Review Board. Support letter was written by Arsi University College of health Sciences to all selected hospitals and to other concerned bodies. Informed consent was obtained from participants after comprehensive explanation of the purpose and procedure of the study in local languages. The data collected from the participants will remain anonymous for an indefinite period of time.

Resultand Discussion

Socio-demographic characteristics of the study participants

A total of 303 Nurses participated in this study making the response rate 97.4%. The majority 182 (60.1%) of the respondents were male and of the respondents 239(78.9%) were age interval of 22 to 30 years old. Among the 303 respondents, 188 (62%) of study respondents had less than 5 years’ work experiences and of the respondents 192(63.4%) were degree holders. (Table 1)

The prevalence of needle stick/sharp material injury

The highest and the least prevalence of needle stick/sharp material injury in the past one year were 61.8% and 29.5% in Gobesa district Hospital and in Abomsa Hospital respectively. The overall prevalence of needle stick/sharp material injury in the past one year is 42.2 % (Table 2).

Table 2: Prevalence of Needle stick/sharp material injury in the past one year among nurses in government hospitals in Arsi zone in 2021

Table 1: Socio-demographic distribution of study participants of needle/sharp material injury among Nurses in Government Hospitals in Arsi zone/2021

Table 3: Prevalence of needle stick/sharp materials injury in their entire job among Nurses in Government Hospitals in Arsi zone/2021

Table 4: Prevalence of needle stick/sharp material injury with in different working units among nurses in government hospitals in Arsi zone/2021

The overall prevalence of needle stick/sharp material injury in the entire job is 65.3%. The highest and the least prevalence of needle stick/sharp material injury in the entire jobs is found in Gobesa and Robe Hospital respectively (Table 3).

When we see the prevalence of needle stick/sharp material injury in the past one year in terms of working unit are found to be 24.2%,18.8% and 16.4% in Emergency unit, in OPD, and in maternity ward respectively and on the other hand the least prevalence is found in Neonatal Intensive Care unit (Table 4).

Fig 1: Frequency of Injury in the past one year among Nurses in Arsi zone Government Hospitals/2021.

Fig 2: Frequency of Injury in the past one year among Nurses in Arsi zone Government Hospitals/2021.

Fig3: the report and Medical checkup among injured Nurses in Arsi zone Government Hospitals/2021

The study showed that the highest source of injury was syringe needle (17.2%) followed by broken ampoule (16.2%) while the least sources of injury was insulin syringe (1.3%). Table5

Table5: Proportion of Source of Sharp materials that cause injury among Nurses in Arsi zone public hospitals in 2021

The result showed that the procedure that cause the highest needle stick/sharp injury was broken ampoule followed by Injections 16.2% and 15.8%, respectively. The highest source of injury was syringe needle (17.2%) followed by broken ampoule broken (16.2%) while the least sources of injury was insulin syringe (1.3%). (Table 6).

6: Proportion of Procedures that Cause injury among Nurses in Arsi zone public hospitals in 2021

Fig 4: The reason for not reporting needle stick/sharp material injury among nurses in Arsi zone government Hospitals in /2021

Regarding post injury prophylaxis,11.6% had taken post injury prophylaxis whereas the rest 30.7% did not take post injury prophylaxis who sustained injury. In similar manner the serological status were unknown. (Figure5).

Fig 5: The serological status of source of needle stick/sharp material by which Nurses in Arsi zone being injured/2021

Fig 6 time of occurrence of injury among Nurses in Arsi zone in government hospital/2021

Regarding frequency of injury,28.1% of the respondents sustained the injury once where as the rest 38% sustained the injury more than once (Figure7).

Fig7: Frequency of needle stick/sharp material injury among Nurses in their entire jobs life.

Concerning the risk factor of needle stick/sharp material injury among Nurses in Arsi Zone government Hospitals recapping needle after use, Availability of working guidelines at workplace/unit, Number of working hours per week, Taking Full dose of HBV vaccination, Sleeping disorder have statistically significant association with needle stick/sharp material injury. (Table8)

Table8: Adjusted Odds Ratios Needle stick/sharp material injury in the past one year/2021

Discussion

The study was aimed at determining the prevalence of Needle stick/sharp material injury and associated factors among Nurses in Government Hospitals of Arsi Zone.

A total of 303 Nurses were participated in this study with response rate of 97.4% and out of
the 311 Nurses contacted for the study, 8 did not return the questionnaires. Regarding the prevalence of Needle stick and sharp material injury, the Prevalence of  NSIs in Egypt, Germany, Pakistan, Turkey, and Australia were 66.2%, 31.4%, 45%, 45%, and 51%, respectively (15-19).When we compare the finding of one year prevalence (42.02%) of this study ,there is consistency with the finding of Pakistan and Turkey(45%,45%) respectively and relatively smaller than the finding reported in Egypt and Australia(66.2%,and51% respectively) but greater than the result found in  Germany(31.4%).

The frequency rates of NSIs in Emergency unit, Pediatrics ward, Maternity ward, OR, Medical ward, surgical ward, OPD, NICU, ICU (24.2%, 10.2%, 16.4%,10.2%,9.4%,5%,18.8%,7%, and 0% respectively).When we compare this finding with the study conducted in Iran it has consistency in maternity(11%) and operating room(8%).But the overall reported injury in the past one year is slightly smaller than study conducted in Iran(50.2%e) (20).

Among 128 Nurses who sustained needle stick/sharp material injury,82 (27.1%) of them injured once in the past year while the rest 46 (15.2%) experienced injury more than once. Study conducted in Saudi Arabia, South Africa, Ghana, Nigeria and Kenya revealed the prevalence of needle stick injury 29.8%,26.3%,28.9%,51% and 46.2% respectively (21,22,23,24and25). In similar manner study conducted in Tigray, Amhara Region Awi Zone, Dessie town, Hawassa Eastern Hararge and Bale zone indicated the prevalence of Needle stick injury 38.5%,18.7%,53.7%,28%26.5% and 19% respectively (26—30,14).When we compare the finding of this study with above results, it is consistence with study done in Nigeria and Kenya (23—24) but higher than the study done in Saudi Arabia, South Africa and Ghana( 21,22 and 25).On the other hand, it is slightly similar with the study done in Tigray and Dessie town(26,28) but higher than the study done in Awi zone, Hawassa ,Eastern Hararge and Bale zone(27,29,30 and 14).

Regarding reporting system among Nurses who sustained injury in the past one year,47(15.5%) reported the occurrence of needle stick/sharp material injury for the concerned body whereas the rest 81 (26.7%) did not report the incidence of Needle stick/sharp material injury for different reasons like negligence, fear of discrimination and fear of the outcome of the injury. Out of 128 Nurses who sustained injury 74 (24.4%) of them undertaken the medical checkup of the outcome of the injury while the rest 54 (17.8%) did not perform medical checkup. From the total injured Nurses 35 (11.6%) took Post Injury prophylaxis while the rest 93 (30.7%) did not take Post Injury prophylaxis. Pertaining the serological status of needle stick/sharp materials by which Nurses got injured in the past one year, out of 128 injuries 69 (22.8%) of them their serological status was known while the rest 59 (19.5%) their serological status was Unknown. Regarding the time of occurrence of accident, majority of the nurses 114 (37.4%) got needle stick/sharp material injury at night,88 of them at day time and 74 of them both at night and day time.

Pertaining the associated factors of Needle stick/sharp material injury Recapping needles after use (P-value=016*,AOR=.517 95%CI .303, 1.883), Availability of working guidelines at workplace/unit (P-value=.012*AOR=.517 95%CI .303, 3.486), Number of working hours per week, (P-value=.028* AOR=1.795, 95%CI  1.064, 3.030),  Taking Full dose of HBV vaccination,(P-value=.047*,AOR=.600 95%CI .354, 1.016),Sleeping disorder(P-value=.034*,AOR=.542 95%CI  .277 , 1.060) have statistically significant association with Needle stick/sharp material injury among Nurses in Government hospital in Arsi zone.

Nurses who did not recap needle after use were 0.517 less likely to be injured by needle stick than who used to recap. On the other hand Nurses who used to work where no working guideline available are 2.016 times less likely to be injured with needle stick/sharp material.

Conclusion

A total of 303 Nurses were participated in this study with response rate of 97.4%. The overall prevalence of needle stick/sharp material injury in the past one year is 42.2%. In similar manner the overall prevalence of needle stick/sharp material injury in the entire job is 65.3%. When we see the prevalence of needle stick/sharp material injury in the past one year in terms of working unit, the highest proportion are found to be and 16.4% in Emergency unit, in OPD,the highest proportion of Needle stick/sharp material injury is found in Emergency and OPD(24.2% and 18.8%) respectively. Regarding the associated factors of needle stick/sharp material injury, recapping needle after use, Availability of working guideline, Number of working hours per week, taking full dose of HBV vaccine and sleeping disorder have statistically significant association with Needle stick/sharp material injury among Nurses in Government hospital in Arsi Zone.

Recommendation

Regional and Zonal health bureau including health facility should fulfill all necessary logistics and working guideline. Both Regional and Zonal health bureau should provide Sustainable Infection prevention training in collaboration with respective Universities.

All concerned and administrative bodies of respective health facilities should take all administrative controlling action regarding work load per week, sleeping disorder and work shift/rotation per working unit and should provide health care waste collection/disposal devices.

Data Availability Statement

The raw data being used during this research is not available or not attached to this document because the Ethics of institutions does not allow to share the raw data.

Funding Statement

There is no fund for this research publication process because we are from the poorest country which is Ethiopia. We are living subsistence live which is from from hand to mouth. Our institution which is Arsi University college of health science has no extra budget to support this research publication process except our salary.

Acknowledgement

First of all, we would like to thank Arsi University College of health Sciences for giving us this nice opportunity.

We also thank the college librarians for their provision of free internet service and other materials for this research.

We would also like to pass our deep hearted thanks to our colleagues’ staff of college of health sciences for their valuable and constructive comments during the development of proposal and result writing.

Last but not least, we would like our family members for their support and encouragement during this activity.

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