Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: An observational study

Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
BMC Infectious Diseases (Impact Factor: 2.61). 02/2009; 9(1):78. DOI: 10.1186/1471-2334-9-78
Source: PubMed


Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan.
At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors.
During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5%) followed by registered nurses (n = 283; 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002-04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and patients visits in clinics (p = 0.01).
We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project.

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    • "Hospitals are dynamic places where a lot of processes are continuously going on non-stop at all levels of structure, processes, and outcomes (Elverson & Samra., 2012). According to Cho et al., (2012) there are some factors that increase the risk of needlestick injuries inside hospitals, factors like re-capping needles after use, ignoring the use of needle-disposing containers, job stress, lack of experience, and emotional distress, but according to Zafar et al., (2009) the most common reasons for needlestick injuries are recapping and the unsafe collection and disposal of sharp wastes. Thus, it is of high importance to explore what has been done to understand and prevent this problem. "
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    ABSTRACT: Background: Needlestick and sharp injuries (NSSIs) are defined as percutaneous injuries with needles or sharp objects contaminated with blood or other body fluids. NSSIs are considered as a major occupational hazard among healthcare workers (HCWs) since needles and sharp objects are commonly used in hospitals. Objectives: The objective of this study is to conduct a systematic review on the published scientific literature to provide accurate assessment of needlestick and sharp injuries among healthcare workers including prevalence, risk factors, predictors, reporting, and interventions. Methods: The following selection criteria were used to perform a systematic search of the literature: research studies published in English language between 2011 and 2014, targeted population is the healthcare workers providing direct care to the patients in the hospitals. The outcome of the study is the needlestick and sharp injuries. The following databases were searched: ScienceDirect, Scopus, and EBSCO. The included search terms were: needlestick injury, sharp injury, NSI or NSSI and healthworkers. The search was limited to cross-sectional studies, retrospective studies, and randomized controlled trials conducted in the hospital. The criteria to select articles were limited to peer-reviewed scientific publications and review articles were excluded. Result: Based on the inclusion and exclusion criteria, screening was done to the 35 articles. 18 articles were found eligible to be included while 17 studies were excluded. The included studies consisted of 10 cross-sectional, 7 retrospective, and 1 intervention study. In general, higher NSSI rates were found in nurses (average reported between 64.1% - 44.3%) compared to other occupational groups (average NSSI rate reported were first year resident physician 45%, interns 26% and housekeeper 12.3%). Conclusion: NSSIs is an important occupational hazard among health workers in their daily working. More emphasis must be put on investigating methods and strategies to reduce NSSIs. Safety devices must be used more by HCWs to reduce NSSIs along with planning educational and training programs with close monitoring to practices.
    • "Healthcare workers (HCWs) are at a risk of exposure to blood and other body fluids that can transmit various bloodborne pathogens (BBPs) like human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV).[1] Cutaneous and mucocutaneus exposure to blood can occur through various incidents such as injury by contaminated sharp instruments or as a result of splash of blood or other body fluids into eyes, nose, or mouth.[1] Non-sterile injections, accidental needle sticks, and improper recycling of needles and syringes can transmit BBPs.[2] Needle stick injuries (NSIs) can cost a lot for diagnostic tests, prophylaxis that is about $118 to $591 million in the United States, annually, excluding the costs from possible infection by BBPs.[3] "
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    ABSTRACT: One of the serious occupational concerns in health care workers (HCWs) is exposure to blood/body fluids that can transmit blood borne pathogens such as human immunodeficiency virus and hepatitis B and C viruses. We are reporting the effects of training course and surveillance on the rate of needle stick injuries (NSIs) among HCWs at an educational hospital in Iran. To evaluate the effects of training course on the rate of NSIs and its reporting. We selected two hospitals (A&B) based on their similarities in wards and facilities then asked the managers of these two hospitals to participate in our study. We established a new occupational health center and conducted a training course at hospital A on 2010 and compared it with control group (hospital B). The data from 2009 to 2011 was collected, analyzed to compare pre and post intervention rates. DURING STUDY PERIOD NURSES SUSTAINED THE HIGHEST NUMBER OF INJURIES (HOSPITAL A: n=80; 66.1% and hospital B: n=64; 35.4%). The incidence rate of NSIs in hospital A was 7.16 NSI/100FTE/YEAR before the intervention which was increased to 12.06 after the intervention. In hospital B this rate was 6.05 during three years. The study revealed remarkable increase in the incidence rate of NSIs after the intervention. This is being achieved by meticulous surveillance, training course and improving awareness.
    International journal of preventive medicine 11/2013; 4(11):1236-1242.
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    • "Risk assessment data on non-hospital based HCWs such as HCWs from FLCF are sparse throughout the world [Helfgott et al., 1998; Lee, 2009; Talas, 2009; Zafar et al., 2009]. Studies have shown that HCWs working at FLCFs (non-hospital based HCWs) are directly at risk of BBPs exposure at rates comparable to hospital based HCWs [van Wijk et al., 2006; Gershon et al., 2007; Lee, 2009], while risk factors and barriers to protection may be very different for FLCFs in terms of unavailability of onsite infection control and employees health programs in these smaller facilities. "
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    ABSTRACT: Background: We assessed the frequency and predictors of sharp injuries (SIs) among health care workers (HCWs) at first level care facilities (FLCF) in rural Pakistan. Method: HCWs working at public clinic (PC), privately owned licensed practitioners' clinic (LPC) and non-licensed practitioners' clinic(NLC) were interviewed on universal precautions (UPs) and constructs of health belief model (HBM) to assess their association with SIs through negative-binomial regression. Results: From 365 clinics, 485 HCWs were interviewed. Overall annual rate of SIs was 192/100 HCWs/year; 78/100 HCWs among licensed prescribers, 191/100 HCWs among non-licensed prescribers, 248/100 HCWs among qualified assistants, and 321/100 HCWs among non-qualified assistants. Increasing knowledge score about bloodborne pathogens (BBPs) transmission (rate-ratio (RR): 0.93; 95%CI: 0.89-0.96), fewer years of work experience, being a non-licensed prescriber (RR: 2.02; 95%CI: 1.36-2.98) licensed (RR: 2.86; 9%CI: 1.81-4.51) or non-licensed assistant (RR: 2.78; 95%CI: 1.72-4.47) compared to a licensed prescriber, perceived barriers (RR: 1.06; 95%CI: 1.03-1.08), and compliance with UPs scores (RR: 0.93; 95%CI: 0.87-0.97) were significant predictors of SIs. Conclusion: Improved knowledge about BBPs, compliance with UPs and reduced barriers to follow UPs could reduce SIs to HCWs.
    American Journal of Industrial Medicine 04/2013; 56(4). DOI:10.1002/ajim.22117 · 1.74 Impact Factor
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