Investigation of the Attitudes towards Needlestick and Sharps Injury among Nursing Students

Abstract

Aim: This research was conducted to compare the attitudes towards needle stick and sharps injury among nursing, the effects of related training and hospital practices. Method: The study utilized a quasi-experimental design with pretest-postest control group. It was conducted at a university between April and June, 2017. The participants were 84 students who were divided into experimental (n=42) and control (n=42) groups. Data were collected through the Demographic Characteristics Form and Attitudes Scale about Healthcare Personnel's Safe Use of Needlestick and Sharp Medical Objects. Results: There was an increase in the experimental group students' mean scores after the training they received, this difference was not statistically significant (p>0.05). Conclusion Injuries can be decreased by being careful and taking precautions about the use of needlestick and sharp medical objects. In addition, theoretical and practical trainings should be designed in order to be protected from needlestick and sharps injuries.

Full text

International Journal of Caring Sciences January-April 2018 Volume 11 | Issue 1| Page 178
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Original Article
Investigation of the Attitudes towards Needlestick and Sharps Injury
among Nursing Students
Senay Karadag Arli, PhD
Assist Professor, Department of Nursing, Agri Ibrahim Cecen University School of Health, Turkey
Ayse Berivan Bakan, PhD
Assist Professor, Department of Nursing, Agri Ibrahim Cecen University School of Health, Turkey
Correspondence:
Assist Professor Dr. Senay Karadag Arli Department of Nursing, Agri Ibrahim Cecen
University School of Health, Turkey, E-mail: senay1981@ yahoo.com sarli@agri.edu.tr
Abstract
Aim: This research was conducted to compare the attitudes towards needle stick and sharps injury among
nursing, the effects of related training and hospital practices.
Method: The study utilized a quasi-experimental design with pretest-postest control group. It was conducted at
a university between April and June, 2017. The participants were 84 students who were divided into
experimental (n=42) and control (n=42) groups. Data were collected through the Demographic Characteristics
Form and Attitudes Scale about Healthcare Personnel’s Safe Use of Needlestick and Sharp Medical Objects.
Results: There was an increase in the experimental group students’ mean scores after the training they received,
this difference was not statistically significant (p>0.05).
Conclusion Injuries can be decreased by being careful and taking precautions about the use of needlestick and
sharp medical objects. In addition, theoretical and practical trainings should be designed in order to be protected
from needlestick and sharps injuries.
Key words: healthcare personnel; needlestick and sharps injuries; prevention, training
Introduction
It is common for healthcare personnel to be
exposed to blood-borne pathogens in hospitals.
With the treatments and care interventions they
apply, healthcare personnel forms an important
risk group especially in terms of some blood-
borne infectious diseases. (Dulon et al., 2017).
According to needlestick and sharps injuries
reports, this proportion ranges between 1.4 and
9.5 for 100 healthcare personnel yearly
(Elseviers et al., 2014).
Healthcare personnel can be contaminated with
the effects of infections while providing health
services. Although the rate of percutaneous
injuries decreases significantly due to such
factors as using disposable medical materials,
bloodletting through vacuum tubes, and throwing
needlestick and sharps to impenetrable infected
sharps bin, the ratio is still high and maintains its
importance (Ayranci and Kosgeroglu, 2007;
Dulon et al., 2017; Ozlu et al., 2016).
A study conducted in Turkey reported that 46.1%
of nurses get injured 1 to 5 times in a year, 40,6
% have needlestick injuries, and 32,5% get
injured due to broken ampule pieces (Ozlu et al.,
2016). A study conducted with 526 African
nurses and midwives indicated that the most
important risks with needlestick and sharps are
lack of training, long working hours exceeding
40 hours, closing needle covers after use, and
holding needles without gloves (Hamlyn and
Easterbrook, 2007).
Some studies on needlestick injuries report that
among the healthcare personnel, nurses are the
most vulnerable ones to injuries (Manzoor et al.,
2010; Motaarefi et al., 2016). Injuries related to
blood and body fluid contagion or to materials
contacted them are a source of serious health
problems in health institutions (Clarke, Schubert
and Körner, 2007). Important diseases that have
potential contagion in needlestick and sharps
injuries include HIV, HBV and HCV (Koc,
2013; Ulutasdemir et al., 2015;). HIV
transmission risk due to needlestick-sharps is less

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than HBV. HIV transmission risk due to
needlestick is 0.3%, and HBV transmission risk
is 30% (Koc, 2013; Smith et al., 2006). Nurses
encounter several occupational risks that include
fewer number of workers available, start to work
at early ages, long and busy working hours, and
needlestick and sharps injuries caused by
medicine implementations (Kevitt and Hayes,
2015; Parsa-Pili, Izadi, Golbabaei, 2015).
Therefore, it is considered that nurses’
knowledge about needlestick and sharps injuries
and ways of protection could be increased
specifically when they are students so that their
awareness could be raised before they start
working.
This study aims to compare the attitudes towards
needle stick and sharps injury among nursing
students who were given a specific training and
who were not. The study also seeks answers to
the question “Is the specific training on blood
and blood-borne diseases, needlestick and sharps
injuries, and waste management of sharp objects
as effective as curriculum-based information and
practice at hospital”.
Methods
Desıgn and Sample Sıze
This study, which utilized quasi-experimental
design with pretest-posttest groups, aims to
compare students’ needlestick and sharps injury
attitudes before and after the training they were
provided. The study was conducted at a
University Health High School between April
and June, 2017.
Target population of the study was 123 students
who were enrolled in the Nursing Department of
a University Health High School. The sample
was 84 students who were divided into
experimental (n=42) and control (n=42) groups.
No randomization was performed for the
identification of the experimental and control
groups. The experimental group was composed
of first year students who had practice experience
at hospital and who did not receive any specific
training on sharps injuries and waste
management of sharps.
The control group involved students who
received curriculum-based information about the
aforementioned topics, who had practice
experience in hospitals for a period between 65
and 115 days, and who did not receive any
specific training about blood-borne diseases,
needlestick and sharps injuries, and waste
management of needlestick and sharps.
Procedure
Pre-test data were collected by the researchers
through face to face interviews administered in a
classroom environment. A three-hour special
training on blood-borne diseases, needlestick and
sharps injuries, and waste management of
needlestick and sharps was given to the
experimental group by one of the researchers.
The training, which was face to face and
interactive, was administered in a classroom
environment.
The section about waste management was given
practically. Posttest data were collected from the
students in the experimental group after they
received a three-hour training on the issue and
had practice at hospital for two weeks-24 hours
in total. Posttest data were collected in classroom
environment through face to face interviews,
using the same data collection tools. The control
group was administered the posttest data
collection tools simultaneously.
Participants and ethical consideration
The students who participated in the study were
informed about the study, and written and verbal
consent was obtained from those volunteered to
participate in the study. Ethical committee
approval was obtained from the institution where
the study was conducted.
Instruments
Demographic Characteristics Form
The 9-item Demographic Characteristics Form
was developed by the researchers in line with the
related literature (Uzunbayir and Esen, 2011;
Hambridge, Nichols, and Endacott, 2016).
Attitudes Scale about Healthcare Personnel’s
Safe Use of Needlestick and Sharp Medical
Objects
The questionnaire was developed by Uzunbayir
and Esen (2011) and its reliability and validity
was performed (Cronbach’s alpha=0.80).
Cronbach’s alpha value was found 0.81 in this
study. The scale has 25 items and three subscales
that identify cognitive, affective and behavioural
attitudes. It is rated on a 5 point Likert scale, and
the scores range between 25 and 125. Besides,
Items 3,7,10,12,13,16,17,18,21, and 23 are
negative statements. “Totally agree” option takes
the lowest score in these items. There is no cut-

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off point for the scale, higher scores indicate
safer use of needlestick and sharps (Uzunbayir
and Esen, 2011).
Data analysis
Data were analysed in SPSS statistical package
programming, using numbers, percentages, chi-
square tests, independent groups t-test, and
paired samples t-test.
Results
Control variables of the study are age, gender,
type of high school students graduated from,
needlestick and sharps injuries, type of injury,
blood and blood-borne diseases, previous
curriculum-based education about blood and
blood-borne diseases, needlestick and sharps
injuries, and waste management (Table 1).
Table 1. Control Variables of the Study
Experimental
Group
Control
Group
N
%
N
%
x
2
P
Gender Female 21 50 24 53.6 .431 >0.05
Male 21 50 18 42.9
Type of High School
Vocational School of
Health 3 7.1 2 4.8 .213 >0.05
Other 39 92.9 40 95.2
Previous curriculum-based education
blood and blood-borne diseases
Yes 14 33.3 31 73.8 13.832 <0.05
No 28 66.7 11 26.2
Previous curriculum-based education
about needlestick and sharps injuries
Yes 9 21.4 26 61.9 14.155 <0.05
No 33 78.6 16 38.1
Previous curriculum-based education
about waste management of
needlestick and sharps
Yes 9 21.4 31 73.8 23.100 <0.05
No 33 78.6 11 26.2
Getting needlestick and sharps injuries Yes 7 16.7 24 57.1 14.775 <0.05
No 35 83.3 18 42.9
Reason for injury
Needlestick 4 57.2 9 37.5
4.878 >0.05
Breaking the ampule 3 42.8 12 50.0
Other - - 3 12.5
X
±SD
X
±SD
Age 19.95±1.79 21.31±1.35 t:-
3.915 <0.05

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Table 2. Students’ awareness of their own case about Hepatitis B
Experimental Group Control Group
Case about Hepatitis B
Natural immunity 1 2.4 21 50.0
Vaccinated 6 14.3 14 33.3
Do not know 35 83.3 7 16.7
Table 3. Comparison of the Scale Mean Scores Before and After the training
Experimental Group Control Group
Attitudes Scale
about Safe use
of Needlestick
and Sharp
Medical
Objects
Pretest
X
±SD Posttest
X
±SD t p Pretest
X
±SD Posttest
X
±SD t p
111 ± 8.53
112 ± 9.25 -.729 .470
112 ± 7.87
112 ±
7.27 -.683 .498
Table 4. Comparison of Pretest-Posttest Scale Mean Scores of the Experimental and
Control Groups
Attitudes Scale about Safe use of
Needlestick and Sharp Medical
Objects
Experimental
Group
X±SD
Control Group
X±SD
t P
Pretest 111 ± 8.53
112 ± 7.87
-.452 >0.05
Posttest
112 ± 9.25
112 ± 7.27
-.262 >0.05
It was found that 83.3% of the students in the
experimental group and 16.7% of the students in
the control group did not know their own case
about Hepatitis B (Table 2).
Mean scores that experimental group students
got from the attitudes scale about safe use of
needlestick and sharps injury were 111 ± 8.53 in
the pretest and 112 ± 9.25 in the posttest. There
was an increase in the experimental group
students’ scale mean scores after the training
they received, but this difference was not
statistically significant. Mean scores for safe use
of needlestick and sharps injury attitudes of the
students in the control group were found 112 ±
7.87 in the pretest and 112 ± 7.27 in the posttest.
No significant differences were detected between
the pretest and posttest mean scores of the
control group students (p>0.05; Table 3).
Pretest data show that the scale mean score was
112 ± 7.87 in the control group, which was
higher than the experimental group. However,
this difference was not statistically significant
(p>0.05). Posttest results indicated no
statistically significant differences between the

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experimental and control groups (p>0.05; Table
4).
Discussion
Review of the studies at national and
international level indicates large proportions of
needlestick and sharps injuries among nurses and
nursing students (Costigliola, 2012; Hambridge,
2011; Hambridge, Nichols, and Endacott, 2016;
Lukianskyte, Gataeva, and Radziunaite, 2011;
Ozer and Bektas, 2012).
A study reports that 51% of the nurses got
injured while they were closing the needle cover,
and 49% got injured while breaking the ampule.
Besides, it was highlighted in the same study that
carelessness, haste, and work overload were the
factors that caused needlestick and sharps
injuries (Lukianskyte, Gataeva, & Radziunaite,
2011).
Another study indicates that 30 % of nursing
students got needlestick and sharps injuries at
least once (Karatas, Celik and Koc, 2016). In line
with these results, 57.1% of the nursing students
in the control group were found to be exposed to
needlestick and sharps injuries. This finding is
considered to result from the fact that the
students in the control group had longer hospital
practice experience and more practice
opportunities in comparison to experimental
group students.
Studies show that majority of percutaneous
injuries were experienced while closing the
needle cover after the treatment or while taking
the needle from the injector (Kaweti, and
Abegaz, 2016; Costigliola et al., 2012; Dulon et
al., 2017). Irmak and Baybuga (2011) report that
the most common injuries were caused by
needlesticks (54.0%), and mainly during IV/IM
injection interventions (60%).
Celik, Akduman and Kıran (2010) point that
majority of students got injured while they were
taking the medicine from ampule/bottle to the
injector (81.2%) and while closing the needle
cover after injection (19.1%).
Another study reports that 47.3 % of nursing
students got injured from needlestick, and 37.8 %
got injured from ampule breaks while they were
preparing the medicine (Unver, Tastan, and
Coskun, 2012). The present study also found that
the students got injured mostly when they were
breaking the ampule, which is considered to
result from students’ using a wrong technique
while breaking the ampule and failing to take
protective measures.
In their study conducted with students from
different health departments, Askarian and
Malekmakan (2006) found that 13.8% of the
participants was not vaccinated against Hepatitis
B. Besides, Talas (2009) found that 32.3% of the
nursing students was not vaccinated against
Hepatitis. This study also revealed that 83.3% of
the nursing students especially in the
experimental group did not know their case about
Hepatitis B. This finding indicates that the
students are under great risk in terms of catching
Hepatitis B, which could be due to the fact that
they were freshmen students.
The reasons for the fact that there are no
differences between the mean scores of the
experimental and control groups in terms of the
scores they obtained from attitudes scale about
safe use of needlestick and sharps are varied.
These include the facts that the training was
verbal and semi-practical; it was given just once;
and the students did not have sufficient clinical
experience as they were freshmen students. Safe
use of needlesticks and sharps could be enhanced
by increasing the frequency of the trainings,
observing students individually during the
trainings, and equipping them with sufficient
clinical skills.
Particularly the healthcare personnel, due to the
nature of the work they do, will maintain to be
under serious risk (Pathak et al., 2012).
Institutions should have policies that will
decrease this risk to minimum, provide the
required instruments, take the necessary
precautions, and check these precautions (Ilhan
et al., 2006; Motaarefi et al., 2016; Ulutasdemir
et al., 2015; Wicker et al., 2008).
Before they start practice at hospitals, students
who receive health education should be given
trainings on hospital infections, universal
precautions, blood-borne infections, reporting
injuries, and prophylaxis issues after contagion.
In addition to these, students’ knowledge should
be assessed before and during clinical practices,
and the trainings should be revised accordingly
(Ozlu et al., 2016; Zhang et al., 2015).
Limitations
Limitation of this study is that the groups are
similar in terms of age, needlestick or sharps
injuries, blood and blood-borne diseases, and
previous curriculum-based education about

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needlestick and sharps and their waste
management. Besides, another limitation is that
the specific training given to the group was semi-
practical and given only once.
Conclusions and Implications for Nursing
Education
This study found that nursing students did not
use needlestick and sharp medical objects safely
at a desired level. As a result, the training given
to the students was found to have no effects on
the attitudes towards safe use of needlestick and
sharps. This case might have resulted from the
facts that the duration allocated to this topic in
the training was quite short, the topics were not
revised, and thus they were forgotten. Given the
importance of this issue, students’ knowledge
should be consolidated and reviewed through
audio-visual materials. It has been determined
that only training or practice is not effective in
this matter. It is recommended that studies
conducted together with training and
implementation are carried out. Besides, nursing
students should be observed well during clinical
practices and provided with feedback about their
correct or incorrect practices.
Nursing students form a high risk group in terms
of needlestick and sharps injuries. Hence, it is
very important for them to be trained about
needlestick and sharps injuries. Only this way
can they protect themselves and take precautions.
Nursing curriculum should include information
about occupational accidents and risks in
needlestick and sharps injuries, curriculum
should be designed for protection from
occupational accidents, risks and their legal
aspects; and the efficiency of the training should
be monitored at frequent intervals. Besides,
clinical nurses have important roles in forming a
role model about these issues.
Acknowledgement: The authors would like to
thank all students who participated in the study.
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