A CROSS SECTIONAL STUDY TO EVALUATE NEEDLE STICK AND SHARP INJURIES AND THEIR RELATED SAFETY MEASURES AMONG HEALTH CARE WORKERS IN SHERI- KASHMIR INSTITUTE OF MEDICAL SCIENCES, SOURA SRINAGAR J &K, INDIA

Firdousa Jan, Manzoor Ahmad Para, Zulifkar Ali, Maharaj Singh, Syed Umar and Mujtaba ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 05 December 2019 Final Accepted: 07 January 2020 Published: February 2020 Background: Needle stick and sharp injuries are common in health care workers. They are always exposed to an increased risk of needle stick and sharp injury because of their competitive work environment and work related stress. They are one of the main ways of transmitting large numbers of pathogenic micro organisms in health care institutions. These injuries caused pose a risk of blood borne pathogens among health care workers. lack of knowledge regarding transmission of blood born diseases and safety measures can make the health care workers and also the patients at risk of transmission of infectious diseases like HIV, Hepatitis B and Hepatitis C. Needle stick and sharp injuries are not reported to concerned department of a hospital, hence the aim of the study was to evaluate the needle stick and sharp injuries and other related factors among health care workers in selected areas of SKIMS for effective protection. Methods: A cross sectional study design was chosen. Sample of 120 health care workers were selected by using simple random technique. Data was collected by self structured questionnaire. Results: It was observed that doctors have got the highest occurrence of NSI and sharp injuries (52.5%). recapping of needle (42.5%) was the most common cause for NSI among nursing staff, injection manipulating sharp in patient among doctors (32.5%), and transferring of body fluid from the syringe(35%) was found common incident in technicians. Only staff nurses (2.5%) had reported NSI to their concerned supervisors. The major reasons for not reporting NSI were increased workload(72.5% doctors , 62.5 nurses ) and lack of knowledge about reporting the injuries (37.5% technicians) injuries. 65% of doctors had good knowledge regarding NSI. (55%) staff nurses had average levelof knowledge and technicians (67.5%) had poor levelof knwedge regardng NSI. Before disposing of the sharp boxes maximum doctors( 20%)ensure that the box is secured and correctly assembled, staff nurses(20%) make sure that it is properly labeled before disposal and the maximum technicians(17.7%) says that before disposing of sharp box it should be locked up until it is collected. After administration of injection to patients doctors (70 %) and staff nurses (60%) destroy the needles, where as technicians (67.5%) re-sheath the needle. Doctors (27.5% ) and (35%)staff nurses use gloves while separating the needle from syringe were as (30%) Of technicians

Background: Needle stick and sharp injuries are common in health care workers. They are always exposed to an increased risk of needle stick and sharp injury because of their competitive work environment and work related stress. They are one of the main ways of transmitting large numbers of pathogenic micro organisms in health care institutions. These injuries caused pose a risk of blood borne pathogens among health care workers. lack of knowledge regarding transmission of blood born diseases and safety measures can make the health care workers and also the patients at risk of transmission of infectious diseases like HIV, Hepatitis B and Hepatitis C. Needle stick and sharp injuries are not reported to concerned department of a hospital, hence the aim of the study was to evaluate the needle stick and sharp injuries and other related factors among health care workers in selected areas of SKIMS for effective protection. Methods: A cross sectional study design was chosen. Sample of 120 health care workers were selected by using simple random technique. Data was collected by self structured questionnaire. Results: It was observed that doctors have got the highest occurrence of NSI and sharp injuries (52.5%). recapping of needle (42.5%) was the most common cause for NSI among nursing staff, injection manipulating sharp in patient among doctors (32.5%), and transferring of body fluid from the syringe(35%) was found common incident in technicians. Only staff nurses (2.5%) had reported NSI to their concerned supervisors. The major reasons for not reporting NSI were increased workload(72.5% doctors , 62.5 nurses ) and lack of knowledge about reporting the injuries (37.5% technicians) injuries. 65% of doctors had good knowledge regarding NSI. (55%) staff nurses had average levelof knowledge and technicians (67.5%) had poor levelof knwedge regardng NSI. Before disposing of the sharp boxes maximum doctors( 20%)ensure that the box is secured and correctly assembled, staff nurses(20%) make sure that it is properly labeled before disposal and the maximum technicians(17.7%) says that before disposing of sharp box it should be locked up until it is collected. After administration of injection to patients doctors (70 %) and staff nurses (60%) destroy the needles, where as technicians (67.5%) re-sheath the needle. Doctors (27.5% ) and (35%)staff nurses use gloves while separating the needle from syringe were as (30%) Of technicians

Conclusions:
The study revealed a high prevalence of needle stick and sharp injuries. There is a need of some supportive measures such as improving injection practices, planning training programmes targeting safe handling and disposal of sharp objects and reporting of incidents to concerned authorities are essential for the effective prevention of these incidents among studied health care workers.

Introduction:-
Occupational exposure to blood means sticking sharp objects into the body mucosa contact with blood secretions. 1 Percutaneous injury with blood and body fluids through contaminated needles and sharp and cutting tools is one of the most important occupational hazards, which is the cause of mortality and morbidity due to infection with blood transmitted pathogens among health care workers (HCWs) 2 .certain work practices such as administering injections , blood sampling, recapping and disposing needles, handling trash , during the transfer of body fluid from a syringe to a specimen container are measure activities causing needle stick and sharp injuries. 3 Needle stick and sharp injuries pose the greatest risk of occupational transmission of serious blood born infections such as hepatitis B virus(HBV), hepatitis C virus(HCV) and human immunodeficiency virus (HIV) to health cae workers and patients.
According to a WHO study, the annual estimated proportions of health-care workers (HCW) exposed to bloodborne pathogens globally were 2.6% for HCV, 5.9% for HBV, and 0.5% for HIV, corresponding to about 16,000 HCV infections and 66,000 HBV infections in HCW worldwide. World Health Organization (WHO) estimates that about 3 million of HCWs are at risk of occupational exposures to blood-borne viruses each year, and 90% of these infections occur as a result of exposures in developing countries. 5 In another report, the risk of transmission through serum after a percutaneous injury with a patient with hepatitis B was reported between 6% and 30%, and depending on the HBe Ag level, it was from 1% to 3% for hepatitis C and approximately 0.3% for HIV . 6 The average risk of transmission of HIV to a health care worker after percutaneous exposure to HIV-infected blood has been estimated as 3 in 1000. 7 The risk of exposure to NSI by HCWs varies in different section of the hospital and from one type of procedure to the other. 8 Studies have shown that injuries caused by sharp and cutting tools occur mostly among the female employees, anesthesia technicians, and surgeons, employees with long working hours, employees doing recapping tasks, those who do not wear gloves and employees not appropriately trained regarding risk procedures . 9 The most important factors involved in NSIs events are the knowledge level of blood-borne diseases and standard precautions and adherence to observe them. 10 In the Health care sector, although nurses and doctors are more exposed to NSIs, many HCWs did not have sufficient level of knowledge to protect themselves from injury and they did not take the necessary precautions. 11 In India, authentic data on NSI are scarce. However, several studies consistently found that a very high proportion of HCWs receive NSI while performing their work, both in India and internationally. Factors associated with an increased risk of occupational exposure of NSI differ from place to place. While developed countries are busy with designing new protective devices and improving their policies, the developing world still struggles with the lack of basic equipment, inadequate policies and poor adherence to them Many of these injuries could have been easily avoided if suitable preventive measures has been introduced earlier Knowledge on the transmission of blood borne disease in health care facilities is very limited and unsafe practices are common. Additionally there is a lack of regulation and polices to protect health care workers from exposure. 12 Thus, the present study aimed to determine the prevalence and factors related to NS and sharp injuries, knowledge regarding needle stick and sharp injuries ,and safety measures taken by health care workers in a tertiary care hospital SKIMS.
Objectives:- 1. To evaluate the frequency and other factors related to needle stick and sharp injuries among health care workers. 2. To assess level of knowledge regarding needle stick and sharp injuries and related safety measures among health care workers

Materials and Methods:-
This cross-sectional study was conducted from April 2018 to October 2018 among a random sample of 120 health care workers. The study inclusion criteria were only health care Workers who were at risk of NSI with at least 6 months job experience. Among 160 health care workers 120 participated in the study which consisted of 40 doctors,40 nurses, and 40 technicians and they were selected randomly using table of random numbers and interviewed using semi-structured questionnaire after obtaining proper consent. The questionnaire consisted of information related to socio-demographic variables, frequency of NSI and related factors, reporting of needle stick and sharp injuries, knowledge regarding NSI, and safety measures related to needle stick and sharp injuries. The questionnaire was distributed to study participants and the collected data was analyzed using SPSS with the help of statistical methods.

Results:-
There were 120 complete questionnaires out of the target 160 respondents.  -8 shows the most recent incident of needle stick and sharp injuries in last 12 months the findings of the present study revealed that recapping of needle (42.5%) was the most common activity responsible for needle stick injury followed by improper disposal of sharp instruments(20%) among staff nurses, injection manipulating sharp in patient was the most common procedure (32.5%) followed by recapping (25%) was found highest among doctors. The NSI caused by transferring of body fluid from the syringe(35%) was found common in technicians. According to table 9 and 10, Only staff nurses (2.5%) had reported NSI to their concerned supervisors. The major reasons for not reporting NSI were increased workload in doctors (72.5%), staff nurses (62.5%) and lack of knowledge about reporting the injuries in technicians ( 37.5% ).  Table 13 shows that before disposing of the sharp boxes maximum doctors( 20%)ensure that the box is secured and correctly assembled, maximum staff nurses(20%) make sure that it is properly labeled before disposal and the maximum technicians(17.7%) says that before disposing of sharp box it should be locked up until it is collected and should or should wait until the next box is available.

Conclusion:-
Overall, the result of this study revealed that needle stick injury occurred at a higher rate when compared to other studies, and consequently the risk of blood-borne infection via needle stick injury might be higher. The majority of the needlestick and sharp injuries occurred among doctors, most events occurring during the recapping of used needles. improper disposal of sharp instruments among staff nurses, injection manipulating sharp in patient was the most common procedure followed by recapping among doctors. The NSI caused by transferring of body fluid from the syringe was found common in technicians. As per as the reporting of NSI is concerned,only staff nurses had reported NSI to their concerned supervisors. The major reasons for not reporting NSI were increased workload and lack of knowledge about reporting the injuries. Doctors had good knowledge regarding NSI. staff nurses had average levelofknowledge and technicians had poor levelof knwedge. doctors as well as nurseswho had historyof needlle stick injuries knew that HIV,Hepatitis B and Hepatitis C can be transmittedthough the needle stick. Before disposing of the sharp boxes maximum doctors ensured that the box is secured and correctly assembled, staff nurses made sure that it is properly labeled before disposal and the maximum technicians locked up until it is collected or waited until the next box was available. After administration of injection to patients maximum doctors and technicians re-sheath the needles and staff nurses destroyed the needles after administration of injections. Doctors and staff nurses use gloves while separating the needle from syringe were as technicians separate needle bare handed. Majority of doctors and nurses have received vaccination in the past but not completed the all three doses, majority of technicians have even not received vaccination. None of them have received Hepatitis Booster dose. Majority of health care workers have not checked the antibody titers after Hepatitis B vaccination.

Recommendations:-
The recommendations from the study are: • An on-going education programme on safe working practices including safe handling and disposal of sharp objects should be designed with periodic evaluation of such programme.
1. An administrative policy prohibiting the recapping of needles must be instituted.
2. health care workers should be involved in the evaluation and selection of an appropriate needleless safety device, training and on-going training in its appropriate use, as well as on-going evaluation of the usability and acceptability of such a device. 3. Staff members should be involved in the planning of systems to improve the reporting of needlestick injuries so that appropriate protective measures can be taken. 4. Measures should be put in place to ensure that the recommended course of hepatitis B vaccination is followed; this should include exploring how checking of antibody to hepatitis surface antigen could be made possible, and providing this at a subsidized rate should be considered, given the importance of the knowledge of one's immunity to the success of this immunization.
Part-a demografic distribution          Part-iii rd :-Knowledge regarding nsi.