Prevalence of injuries and reporting of accidents among health care workers at the University Hospital of the West Indies.

IJOMEH 2010;23(2) 133
O R I G I N A L P A P E R S
International Journal of Occupational Medicine and Environmental Health 2010;23(2):133 – 143
DOI 10.2478/v10001-010-0016-5
PREVALENCE OF INJURIES AND REPORTING
OF ACCIDENTS AMONG HEALTH CARE WORKERS
AT THE UNIVERSITY HOSPITAL OF THE WEST INDIES
KURT VAZ1, DONOVAN MCGROWDER1, TAZHMOYE CRAWFORD2,
RUBY LISA ALEXANDER-LINDO2, and RACHAEL IRVING2
1 The University of the West Indies, Kingston, Jamaica
Department of Pathology, Faculty of Medical Sciences
2 The University of the West Indies, Kingston, Jamaica
Department of Basic Medical Sciences, Faculty of Medical Sciences
Abstract
Objectives: This study investigated the knowledge, awareness and practices of health care workers towards universal
precautions at the University Hospital of the West Indies. The study also examined the prevalence of injuries ex-
perienced by health care workers, as well as incidence of accidents and compliance with post-exposure prophylaxis.
Materials and Methods: A cross sectional survey was conducted in September and October 2007. A 28-item self-admin-
istered questionnaire was provided to two hundred health care workers including medical doctors, medical technolo-
gists, nurses and porters to assess knowledge and practices regarding universal precautions, prevalence of injuries and
incidence of accidents. Results: Almost two-thirds (62.3%) of the respondents were aware of policies and procedures
for reporting accidents while one-third (33.2%) were unsure. All nurses were aware of policies and procedures for re-
porting accidents, followed by medical doctors (88%) and medical technologists (61.2%). The majority (81.5%) of the
respondents experienced splashes from bodily fluid. Over three-quarters of medical doctors (78%) and two-thirds of
nurses (64%) reported having experienced needle stick injuries, while the incidence among medical technologists was
remarkably lower (26%). The majority of the respondents (59%) experienced low accident incidence while just over
one-tenth (14%) reported high incidence. Eighty four respondents reported needle stick injuries; just under two-thirds
(59.5%) of this group received post-exposure treatment. Conclusions: The study found that majority of health care
workers were aware of policies and procedures for reporting accidents. Splashes from body fluids, needle stick injuries
and cuts from other objects were quite prevalent among health care workers. There is a need for monitoring systems
which would provide accurate information on the magnitude of needle stick injuries and trends over time, potential risk
factors, emerging new problems, and the effectiveness of interventions at The University Hospital of the West Indies
and other hospitals in Jamaica.
Key words:
Health care workers, Needle stick injuries, Knowledge, Awareness
Received: November 25, 2009. Accepted: March 1, 2010.
Address reprint request to D. McGrowder, Department of Pathology, Faculty of Medical Sciences, The University of the West Indies, Mona, Kingston 7, Jamaica
(e-mail: dmcgrowd@yahoo.com).
INTRODUCTION
Health care workers (HCWs) who are exposed to needles
in their clinical activities are at increased risk of acquir-
ing needle stick injuries which may lead to serious or fa-
tal infection with blood-borne pathogens such as hepa-
titis B virus (HBV), hepatitis C virus (HCV) or human
immunodeficiency virus (HIV) [1]. Needle stick injuries
can be prevented by applying universal precautions as
a safety measure [2]. The term universal basic precaution
was introduced in 1985 by Garner [3]. It was defined as
the prevention of transmission of blood borne pathogens
like HIV through a strict respect by health workers of

O R I G I N A L P A P E R S K. VAZ ET AL.
IJOMEH 2010;23(2)134
contracting HIV. The prevalence of occupational HIV
is 0.3% after parenteral exposure, as opposed to 0.09%
after mucosal exposure [12].
A number of studies from developing countries have ex-
amined knowledge, attitude and compliance of medical
doctors towards the standard precautions and their views
for better compliance [13,14]. This study investigated the
knowledge, awareness and practices of health care workers
towards universal precautions at The University Hospital
of the West Indies (UHWI). It examined the prevalence of
injuries experienced by health care workers, as well as the
incidence of accidents and compliance with post-exposure
prophylaxis.
MATERIALS AND METHODS
This study was conducted in September and October 2007
at The University Hospital of the West Indies. The study
was granted ethical approval by the University of The
West Indies/University Hospital of the West Indies Eth-
ics Committee. The University Hospital of the West In-
dies (UHWI) in Jamaica is the major teaching hospital,
with approximately 500 beds. It is one of two large gen-
eral hospitals serving the Kingston Metropolitan Area
(population = 1 160 204). It is a referral centre for the
island (population approximately 2.8 million) and pro-
vides services in community health, surgery, obstetrics
and gynaecology, paediatrics, psychiatry and general care.
The UHWI employs approximately 370 medical doc-
tors, 600 nurses, 80 medical technologists and 150 porters
as members of its healthcare team. The study population
consisted of fifty (50) members randomly selected from
each group from the healthcare team making the sample
size for this study of 200 employees. All subjects signed the
free and informed consent form.
This study was a random, descriptive cross-sectional sur-
vey. A structured questionnaire was prepared by the au-
thors. The health care workers included in the study were
those in close contact with the patients for at least three
years. These occupational groups of medical doctors, nurs-
es, medical technologists and porters were chosen because
they had direct contact with patients, specimens (blood,
rules concerning care and nursing [3]. Gerberding et al. [4]
also defined universal precaution as the routine use of ap-
propriate barriers and techniques to reduce the likelihood
of exposure to blood, other body fluids and tissues that
may contain blood borne pathogens. The implementation
of education, universal precautions, elimination of needle
recapping, and use of sharps containers for safe disposal
have reduced needle stick injuries by 80%, with additional
reductions possible through the use of safer needle de-
vices [5,6].
The safe handling and disposal of needles and other sharp
instruments forms part of an overall strategy of clinical
waste disposal to protect staff, patients and visitors from
exposure to blood borne pathogens [7]. In 2003 the Na-
tional Audit Office found that needle stick injuries ranked
alongside moving and handling, falls, trips and exposure
to hazardous substances as the main types of accidents
experienced by National Health Service (NHS) staff [8].
Needle stick injuries are the commonest route by which
blood borne viruses and/or infections such as HIV and
hepatitis B and C viruses are transmitted from patients to
health care workers. Such infections serve as high occupa-
tional risks and threats to health care workers, especially
where basic rules of occupational safety and health are not
implemented.
The National Institute for Occupational Safety and Health
(NIOSH), USA, defines needle stick injuries as injuries
caused by objects such as hypodermic needles, blood col-
lection needles, intravenous (IV) stylets and needles used
to connect parts of IV delivery systems [1]. Potential expo-
sure is not limited to needle sticks alone because manipu-
lation of other sharp instruments or mucous membrane
exposure to infected body fluids can also result in trans-
mission of infectious diseases [9]. The risk of pathogen
transmission from infected persons to non-immune per-
sons through an injury with a sharp instrument has been
estimated to be 6–30% for hepatitis B virus, 5–10% for
hepatitis C virus, and 0.3% for HIV [10]. The risk of con-
tracting acute hepatitis C virus infection due to a needle
prick injury is approximately 15% [11]. It is estimated
that the risk of contracting hepatitis B virus infection due
to a needle prick injury is 100 times higher than that of

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IJOMEH 2010;23(2) 135
Participants were asked about sharps injuries and other
blood and body fluid exposures. Initially they were asked
whether they had ever been stuck or cut (or had blood or
body fluids come in direct contact with their eyes, mouth,
or broken skin) when carrying out their duties. Then they
were asked the number of times they had experienced
a sharps injury. Those who reported having experienced
at least one sharps injury or other blood and body fluid ex-
posure were asked to consider the most recent event and
respond to open-ended questions that elicited detail on
the timing of and circumstances leading up to the event,
and associated risk factors. The biological exposure com-
prised exposures to blood, urine, sputum, faeces, ascetic
fluid, pleural fluid and cerebrospinal fluid. Chemical ex-
posure included exposure to concentrated and/or dilute
acids, formaldehyde, bleach and other cleaning agents,
toluene, xylene, radioactive isotopes and other chemicals.
The frequency of both the biological and chemical expo-
sures was assessed.
General reporting was investigated with questions about
respondents’ awareness of policies/procedures for report-
ing of accidents.
It took approximately 15 minutes to complete each ques-
tionnaire. Before administration, the purpose of the study
was explained to respondent and confidentiality assured. In
this study needle stick injury was defined as percutaneous
injury caused by hollow-bore needles. In order to further
analyze the prevalence of accidents (that respondents ex-
perienced) a variable was computed and recoded to reflect
none (0), low (1–2), moderate (3) and high (4 and more)
prevalence of accidents. Relationships between accident
prevalence were then explored with age, gender, occupa-
tion type and years of service.
Statistical analysis
Data from the questionnaires were coded and entered
into a micro-computer and analysis done using Statistical
Package for the Social Science (SPSS) for Windows ver-
sion 12.0 software. Strict confidentiality was guaranteed.
All data were stored in computers at a secured location,
with access only to the researchers involved in the study.
The Chi-square test was used to test association between
urine, stool and other bodily fluids etc.) and chemicals
during their routine clinical duties.
A 28-item self-administered structured questionnaire
about knowledge and awareness of universal precautions
in the health care system was devised de novo and tested.
The questionnaires were distributed to the health care
workers together with instructions necessary for comple-
tion. The questionnaire included a full range of response
options designed to identify the practitioner’s knowledge,
awareness and compliance with universal precautions in
the health sector. Prior to distribution of the questionnaire
a pilot study was done with a selected group of health care
workers who were asked to complete the questionnaire
and return with comments. Minor changes were made to
the final instrument.
The questionnaire had three overarching considerations;
namely: demographics (included occupation, age, gender,
and the years of service in the health sector); knowledge
and awareness of universal precautions, which assessed ex-
posure to biological and chemical agents, potential harm
when exposed to these agents and availability and use of
protective equipment; personal experience of accidents
while conducting duties, the reporting of such, awareness
of policies and procedures for reporting of accidents, and
post-exposure prophylaxis.
There were questions on the availability of containers
for safe disposal, availability of disposable syringes and
gloves. Accidental or occupational needle-stick injury was
defined as a prick with a needle during use of the object
for patient care. Accidental splash was defined as a splash
of any body fluid from a patient onto the skin or mucous
membrane. Accidents are hazards to which health work-
ers are exposed. A health hazard is a material substance
or circumstance that poses a danger to human health [15].
Hazards may be physical, chemical, biological, mechani-
cal or psychosocial. Mechanical hazards are very com-
mon in the health sector because of the frequent use of
pointed and sharp instruments such as needles, scalpels
and knives. This results in injuries that expose the workers
to blood borne diseases (biological hazards). Protective
gears include gloves, masks, gowns, eyewear etc.

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followed by needle stick (74%) and cuts from sharp ob-
jects (70%). Burns were the least reported accident (7%)
(Table 2). In addition, the majority of the respondents
who experienced splashes from bodily fluid had the high-
est prevalence of accidents among respondents (81.5%).
There were those who experienced cuts from other sharp
objects and needle stick injuries (43.5% and 42% respec-
tively), while burns were experienced by only 1% of the
respondents (Table 3). There was a significant relationship
non-metric variables. A P-value < 0.05 (two-tailed) was
selected to indicate statistical significance.
RESULTS
The sample consisted of 200 respondents: 65% fe-
males, 32% married, and 77% younger than 40 years.
One-fifth of the respondents spent between 6 to 10 years
in the current occupation, 59.5% less than 6 years
and 11% 20 years or more. Just over one-quarter of the
sample (28.5%) reported no knowledge of universal pre-
cautions. Significantly more males (48.6%) than females
(17.7%) were represented in this category (P < 0.0001).
Less than one-tenth (7.5%) of the respondents was some-
what knowledgeable of universal precautions (Table 1).
Almost two-thirds (64%) of the respondents were very
knowledgeable of universal precautions with significantly
more females (75.4%) than males (42.9%; P < 0.0001).
There is a significant relationship between knowledge of
universal precautions and occupation. Significantly more
nurses (90%), medical doctors (88%) and medical tech-
nologists (70%) were very knowledgeable of universal pre-
cautions compared with only 8% of porters (P < 0.0001).
Almost two-thirds (62.3%) of the respondents were aware
of policies and procedures for reporting accidents while
one-third (33.2%) were unsure. Only 4.5% reported that
no policies and procedures existed. All nurses (100%)
were aware of policies and procedures for reporting ac-
cidents, followed by medical doctors (88%) and medical
technologists (61.2%). Almost all porters were unsure if
any policies and procedures existed (92%) while the re-
maining (8%) reported that there were none. Interest-
ingly, approximately one-third of the medical technolo-
gists (34.7%) reported being unsure of whether any poli-
cies and procedures for reporting accidents existed.
Significantly more of the respondents (P < 0.0001) who
were very aware of universal precautions reported
knowledge of policies and procedures for reporting acci-
dents (84.3%) compared with those who were somewhat
aware (46.7%) or unaware (17.5%).
The majority of the respondents knew a health care work-
er who experienced splashes from bodily fluids (86.5%)
Table 1. Demographic characteristic of sample
Variable N %
Gender
male 70 35.0
female 130 65.0
Marital status
single 129 64.5
married 63 31.5
divorced/separated 3 1.5
other 5 2.5
Age group [years]
17–29 104 52.0
30–39 50 25.0
40–49 25 12.5
50–59 15 7.5
60+ 6 3.0
Occupational type
medical technologist 50 25.0
doctor 50 25.0
nurse 50 25.0
porter 50 25.0
Years of service
less than 1 year 36 18.0
1–5 83 41.5
6–10 40 20.0
11–15 13 6.5
16–20 6 3.0
20+ 22 11.0
Knowledge of universal precautions
not knowledgeable 57 28.5
somewhat knowledgeable 15 7.5
very knowledgeable 128 64.0

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IJOMEH 2010;23(2) 137
(0 to 5 years — 10.1%; 6 to 15 years — 13.2%; P < 0.0001).
Similarly, greater proportions of older respondents
(P < 0.01) reported high and moderate incidence of ac-
cidents compared with the younger respondents.
The majority of the respondents (59%) reported experi-
encing low accident incidence (1–2 accidents). Just over
one-tenth (14%) reported high incidence (4 or more ac-
cidents) while under one-tenth (8.5%) reported experi-
encing no accidents at all. Almost one-fifth of the sample
(18.5%) reported moderate incidence (3 accidents). There
were no significant gender differences in prevalence rates
of accidents (P > 0.05). Similarly, medical doctors and
nurses reported high levels of accidents (22% and 11%
respectively) compared with medical technologists (12%)
and porters (0%) (P < 0.0001). Significantly more por-
ters (P < 0.0001) reported low incidence of accidents
(98%) compared with medical technologists (60%), nurs-
es (44%) and medical doctors (34%). Significantly more
medical technologists (22%) reported no accidents than
nur ses (8%). Only a small proportion of medical doc-
tors (2%) and porters (2%) reported no accidents.
The findings showed that 84 respondents reported needle
stick injuries and of this number, just under two-thirds
(59.5%) received follow-up medical attention, while 40.5%
received no medical attention. Of the 87 respondents who
experienced cuts from sharp objects, approximately one-
half (54%) received medical attention while 46% did not.
Almost all medical doctors (98%), medical technologists
(96%) and nurses (91.8%) reported that they were aware
of the potential harm associated with hazardous chemicals
while the majority of porters (90%) reported being un-
aware. Medical technologists (42%) reported the highest
frequency of exposure to hazardous chemicals compared
with only 4% of medical doctors. Majority of respondents
who reported low exposure (1–3 times) were medical doc-
tors (80%) followed by nurses (76%).
A significant statistical relationship was found between ex-
posure to biological agents and the type of occupation of
the health care workers [χ2 (df = 9) = 145.509, P < 0.0001],
as well as between exposure to chemical agents and the
type of occupation [χ2 (df = 9) = 192.954, P < 0.0001].
Concurrently, a statistical association was found between
between types of injuries received by respondents and
occupation of health care workers (P < 0.0001). Porters
and medical doctors (96% and 94% respectively) reported
more splashes from bodily fluids compared with nurses and
medical technologists (86% and 50% respectively). Other
significant differences in terms of occupation and accidents
were for cuts from other sharp objects and needle sticks.
For the former, almost two-thirds of the medical doctors
(64%) and nurses (60%) experienced this compared with
medical technologists (38%) and porters (12%). Just over
three-quarters of the medical doctors (78%) and two-
thirds of nurses (64%) reported experiencing needle stick
injuries compared with 26% of the medical technologists.
None of the porters reported experienced needle stick in-
juries.
Significantly more respondents who were employed for
more than 16 years (32.1%) reported high incidence of ac-
cidents compared with those employed for shorter periods
Table 2. Knowledge of types of injuries of other hospital
employees
Injury type
Prevalence
% n
Splashes from blood and body fluids 86.5 173
Needle stick 74.0 148
Cuts from other sharp objects 70.0 140
Slips/Falls 37.0 74
Splashes from hazardous chemicals 26.0 52
Burns 7.0 14
Other accidents 3.0 6
Table 3. Types of injuries respondents experienced
Injury type
Prevalence
% n
Splashes from blood and body fluids 81.5 163
Cuts from other sharp objects 43.5 87
Needle stick 42.0 84
Slips/Falls 10.0 20
Splashes from hazardous chemicals 10.0 20
Other 3.0 6
Burns 1.0 2