Instruments causing sharp injuries in dental students 

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... measures to be undertaken to prevent such injuries through improvement in knowledge, attitude and practice. The aim of this study was to assess the occupational exposure to sharp instrument injuries among medical, dental and nursing students in Mahatma Gandhi Mission’s Campus, Navi Mumbai, India. The objectives of this study were as follows: 1. To determine the demographic profile of all health care students in Mahatma Gandhi Mission’s Campus. 2. To determine the prevalence of sharp instrument injuries in terms of cases and episodes among dental, medical and nursing students. 3. To determine the procedures and instruments, such as hollow-bore needle, suture needle, intravenous catheters, scalers, burs, orthodontic wires and scissors causing sharp instrument injury among dental, medical and nursing students. 4. To assess the rate of reporting and the management of sharp instrument injuries among all the health care students. 5. To evaluate the knowledge about sharp instrument injuries and protective measures taken to prevent such injuries among all the health care students. 6. To make recommendations to the institutional authorities about measures to be initiated to reduce such sharp instrument injuries among the health care students. This survey was a cross-sectional study which was carried out among 700 health care students during their clinical training at Mahatma Gandhi Mission’s Campus, Navi Mumbai from May 2012 to July 2012. The health care students included in this study were medical, dental and nursing students respectively. The proposal, including ethical views was approved by the Ethics Committee. The study consisted of a self-administered questionnaire adapted from a previous survey instrument. 9 A 1-year recall period was used throughout the questionnaire. In this study, sharp instruments included hollow-bore needle, suture needle, intravenous catheters, scalpels and scissors. Cases of sharp instrument injuries were the number of participants who had at least one experience of such injuries and the episodes were the number of injuries that were experienced by the participants. The participants were informed about the purpose of the study and a written consent was obtained from them. The questionnaire was pretested on a random sample of 65 participants to ensure predictability, validity and interpretation of responses. The reliability of the questionnaire was assessed using Cronbach’s alpha ( α = 0.831). Strict confidentiality of the participant's information and responses was ensured and the filled questionnaire was collected on the same day which was then subjected to statistical analysis. The data was presented using frequency tables, descriptive statistics and graphs. Further statistical analysis was done using Chi-square test for association between attributes. The analysis was performed using statistical package for social sciences, SPSS, version 17. Alpha was set at 5% level. Demographic profile: Of the 700 questionnaires, 627 (89.5%) were completed and returned. Among the 627 participants, 306 (48.8%) were dental students, 232 (37%) were medical students and 89 (14.2%) were nursing students. The mean age in years was 22.17 (± standard deviation, 1.870) among the students. The sex distribution among the health care students revealed that (474/627) 75.6% were females and 153 (24.4%) were males (Table 1). During the clinical training in the past 1 year, 412/627 (65.7%) were the cases of sharp instrument injuries among dental, medical and nursing students respectively. Out of 231/306 (75.4%) of the dental students had experienced sharp instrument injuries in the past 1 year. Majority 80/231 (34.6%) of the episodes of sharp instrument injuries were more than two, followed by 76/231 (32.9%) of one episode and 75/231 (32.4%) of two episodes of such injuries were reported (see Table 1). Among the medical students, 113/232 (48.7%) had experienced sharp instrument injuries in the past 1 year. Two episodes of such injuries were reported by 47/113 (41.5%) of the medical students followed by 44/113(38.9%) episode of one injury and 22/113 (19.4%) reported of more than two episodes respectively (Table 1). Of the 89 nursing students who participated in this study, 68/89 (76.4%) were the cases of sharp instrument injuries in the past 1 year. Two episodes of the injury were commonly reported by 41/68 (60.2%) of the nursing students followed by 15/68 (22%) of one episode and 12/68 (17.6%) of more than two episodes respectively. (Table 1) In the present study, 121/231(52.3%) of the sharp instrument injuries among the dental students occurred during administration of local anesthetic injection followed by 65/ 231 (28.1%) while handling instruments and 38/231 (16.4%) during scaling and polishing (Table 2). Majority of the sharp instrument injuries 162/231 (70.1%) were commonly caused by hollow-bore needle followed by 134/231 (58%) of the injuries by scalers and 70/231 (30.3%) by orthodontic wire respectively (Fig. 2). Among the medical students, intramuscular or intravenous injection was found to be most common procedure associated with 70/113 (61.9%) sharp instrument injuries followed by 21/113 (18.5%) injuries during blood withdrawal and 12/113 (10.6%) while handling instruments (Table 2). Hollow-bore needle was the most common instrument causing 91/113 (80.5%) of sharp instrument injuries followed by 61/113 (28%) of injuries by intravenous catheters and 30/113 (14%) injuries by scalpels respectively (Fig. 3). Out of 50/68 (73.5%) of the sharp instrument injuries among nursing students occurred during intramuscular or intravenous injection followed by 11/68 (16.1%) during blood withdrawal procedure (Table 2). Hollow- bore needle was the common instrument causing 55/68 (80.8%) of the injuries among the nursing students (Fig. 4). Among the 412 health care students who had experienced sharp instrument injuries in the past 1 year, 319 (77.4%) of the students did not report the incident of the injury. Of the 319 students who did not report the incident of injury, 153 (47.9%) students did not know how to report the injury followed by 108 (33.8%) students thought that the injury was only minor so it was not to be reported. The other reasons for not reporting are given in Table 3. It was also found that 174/412 (42.2%) of the injuries had occurred while working on a patient in the clinical setting. Only 142/412 (34.4%) of the health care students had taken postexposure prophylaxis (PEP) after the injury. A total of 234/412 (37.3%) of the students had received PEP for hepatitis B and 135/627 (21.5%) had received PEP for tetanus. The health status of the students after the sharp instrument injury was found to be normal in 349/412 (84.7%) students whereas 62/412 (15%) students suffered from mental distress. None of the students had reported of chronic illness following sharp instrument injuries in this study. In the present study, only 250/627 (39.8%) of the health care students could correctly define sharp instrument injury. Among all health care students who participated in this study, needle recapping was practiced by 594/627 (94.7%) of students. Majority of the students 352/627 (56.1%) used both hands to recap needles whereas 242/627 (38.5%) used one hand ‘scoop’ technique. Only 33/627 (5.2%) students avoided recapping needles. A total of 209/627 (33.3%) of the students always use a sharps container to dispose the sharp instrument after use whereas 239/627 (38.1%) leave the sharp instrument on the working tray which creates potential hazards for the workers involved in waste disposal. Protective measures to avoid sharp instrument injuries, such as wearing gloves were practiced by 606/627 (96.6%) of the health care students. Single glove technique was found to be commonly practiced by 593/627 (94.5%) of the students followed by use of facemask by 327/627 (52.1%) students and protective eyewear by only 95/627 (15.1%) of the health care students. Out of 627 health care students who completed the questionnaire, 48.8% were dental students, 37% were medical students and 14.2% were nursing students. The questionnaire was completed by 4.8% second year students, 22.3% third year students, 34.4% fourth year students, 29.7% interns and 8.8% postgraduate students respectively. The mean age of the students was 22.17 years (± standard deviation, 1.870). Majority (75.6%) of the health care students in the Mahatma Gandhi Mission’s Campus were females. Sharp instrument injuries are a major concern among health care students during their clinical training. The first case of needle-stick injury was reported in 1828. 10 In the present study, majority of the cases of sharp instrument injuries were 76.4% among nursing students followed by 75.4% among dental students and 48.7% among medical students respectively. In a study conducted in Western Ontario University, Canada, nonsterile occupational injuries were reported by 82% of the dental students, 57% of the medical students and 27% of the nursing students respectively. 11 Similar results were reported in a study by Askarian et al in which 73.7% of the dental students and 72.1% of the medical and midwifery students had experienced needle-stick injuries. 12 Hollow-bore needles are devices which have commonly been associated with transmission of blood-borne infections because a larger volume of blood remains inside the bore of the needle as compared to solid core needle, such as suture needle. 13 In our study, dental students most frequently reported 70.1% of the sharp instrument injuries by a hollow- bore needle followed by 58% of the injuries by scaler and 30.3% of the injuries by orthodontic wire. Hollow-bore needle was also the most common cause of sharp instrument injuries among medical and nursing students followed by intravenous catheters. Similar study in Malaysia (2012) showed that 97% of the injuries were caused by hollow- bore needles among medical students. 14 In an ...