KUFA JOURNAL FOR NURSING SCIENCES.VOL.10 No. 2 / 2020

1  Prevalence of Sharps Injuries among Nursing Staff at hospitals in Kirkuk city راشتنا  ثاباصلاا  تجتانلا  نع  ثاودلاا  ةداحلا  يذل  ثاكلاملا  تيضيرمتلا  يف  ثايفشتسم  تنيذم  كىكرك  Dhiaa Alrahman Hussein* Waleed Ibrahim Saad** تصلاخلا :  :ثحبلا تيفلخ ِنَي  ُأ  وقخْح  ضاشٍلأا  تيذعَىا  ونشب  شيغ  ششابٍ  ِييٍاعيى  يف  تياعشىا  ،تيحصىا  تصاخو  ٌقاطىا  يضيشَخىا  ٍِ  هلاخ  ًاذخخسلاا  سشنخَىا  وا  ًاذخخسلاا  ئطاخىا  شبلإى  ثاودلأاو  ةداحىا .   لأا ذه ا :ف  فذهح  تساسذىا  ًىإ  ٌييقح  يذٍ  ساشخّا  ثاباصلاا  تجحاْىا  ِع  ثاودلأا  ةداحىا  اهحاءاشجإو  تيئاقىىا  يذى  ثاملاَىا  تيضيشَخىا  يف  ثايفشخسٍ  تْيذٍ  كىمشم .   :تيجهنملا  تساسد  تيفصو  ٌيَصخب  يَم  يف  ثايفشخسٍ  تْيذٍ  كىمشم  ثاملاَيى  تيضيشَخىا  ةشخفيى  ٍِ  1  / طابش  /  0202  ًخح  1  /  هىييا  /  0202 . ثشيخخا  تْيع  شيغ  تيئاىشع  ( تيثذح  شيغ  تيىاَخحا ) تّىنٍ  ٍِ  111  ضشٍَ  و  تضشٍَ  ٍِ  ِييٍاعىا  يف  ثايفشخسٍ  تْيذٍ  كىمشم  ٍِ  لام  ِيسْجىا . ٌح  ٌيَصح  ُايبخسا  ٍِ  وبق  ثحابىا  قيقحخى  ضاشغا  تساسذىا . ُايبخسلاا  ُىنٍ  ٍِ  تعبسا  ءازجا : ءزجىا  هولاا  ثاّايبىا  تيفاشغىَيذىا  ِيمساشَيى  ،  ءزجىا  يّاثىا  ثاودلاا  ثاذعَىاو  ةداحىا  تببسَىا  ثاباصلإى  حوشجىاو ، ءزجىا  ثىاثىا  وٍاىعىا  تببسَىا  ثاباصلإى  تجحاْىا  ِع  ثاودلاا  ةداحىا  . ءزجىا  عباشىا  شفاىح  ثاءاشجا  تياَحىا  عَْى  ثاباصلاا  تجحاْىا  ِع  ثاودلاا  ةداحىا . ٌحو  عَج  ثاّايبىا  هاَعخساب  تقيشط  ئيَىا  يحازىا  ٍِ  وبق  ثاملاَىا  تيضيشَخىا . ٌح  وييحح  جئاخْىا  ٍِ  هلاخ  قيبطح  وييحخىا  يئاصحلإا  يفصىىا  وييححو  ثاّايبىا  تيئاصحلإا  يىلاذخسلاا .   :جئاتنلا  ثساشا  جئاخْىا  ًىا  ُا  شثما  ثاودلاا  تببسَىا  ثاباصلإى  تجحاْىا  ِع  ثاودلاا  ةداحىا  يه  شبا  ِقاحَىا  ( ثاجّشسىا ) و  تبسْب  ( 20  ،)% و  ثاودلاا  تيجاجزىا  ( تىىبٍا ) و  تبسْب  ( 02  .)%   :جاتنتسلاا  ججخْخسا  تساسذىا  ُا  شثما  وٍاىعىا  تببسَىا  ثاباصلإى  تجحاْىا  ِع  ثاودلاا  ةداحىا  يه  ةشثم  ِقح  تيودلاا  ( 98  )% و  ةشثم  ًضشَىا  ِيذقاشىا  ( 90  )% و  تيق  ثاسوذىا  تيبيسذخىا  ثاملاَيى  تيضيشَخىا .   :ثايصىتلا  : شيفىح  ثاودا  ُاٍلاا  و  تياَحىا  ذْع  وٍاعخىا  عٍ  شبلاا  وا  ثاودلاا  ةداحىا  ثاجّشسىام  ثار  ءاطغىا  يحازىا  و  ةذعاق  تصاخ  لسَى  ءاطغ  شبلاا .   :تيحاتفملا ثاملكلا  ساشخّا ، ثاباصلاا  تجحاْىا  ِع  ثاودلأا  ةداحىا  ،  شيباذخىا  تيئاقىىا  ،  ثاملاَىا  تيضيشَخىا .   ABSTRACT: Background: infectious disease can transmitted indirectly to the health care worker especially nursing staff through multiple or misuse of needles and sharp instruments. Aims of the study: the study aimed to assess the prevalence of sharps injuries and its protective measures for nursing staff at Kirkuk city hospitals. Methodology: A descriptive design was carried out at Kirkuk city hospitals for nursing staff from 1st of February, 2020, up to the 1st of September, 2020. A non-probability (convenience sampling) of (166) nurses both male and female from selected working site in the hospital were selected. The questionnaire was designed by the researcher to achieve the purpose of the study. The questionnaire was consisted of four parts: part Ι: the demographic data of the participants, part ΙΙ: the Equipment associated sharps injuries. Part ΙΙΙ: Factors associated with sharp injuries. And part ΙΙΙΙ: Availability of protective measures for sharp injuries. The data were collected through the use of self-administration technique. They were analyzed through the application of descriptive statistical analysis and inferential statistical data analysis. Results: The results indicated that the most equipment that cause sharp injuries were syringe needles (52%), and glasses such as ampoules (25%). Conclusions: The study concluded that the most factors causing sharp injuries were frequent injectable drugs (89%), the crowded patients (82%), and the inadequate training sessions for nursing staff. Recommendations: Providing the necessary and safety tools to prevent injuries such as syringes with self-cover and a special base for needle cover.


INTRODUCTION
Chickenpox infection is an acute common disease caused by the varicella zoster virus. In general, cases of chickenpox appear among children between the ages of (1 and 14) and when the infection occurs in adolescents or adults the severity is higher than in children. In addition, it is potentially more frequent among immunosuppressed individuals (1,2) .The disease can be benign and self-limiting in children (4, 5, and 6) .In the USA & other temperate climates (90-95%) of individuals acquire varicella zoster virus in childhood, annual varicella epidemics occur in late winter & early spring, in contrast, individuals from tropical countries may not acquire infection until later in life (3) .
According to Aristotle's classification of the earth's climatic zones, Iraq is considered to be located in the temperate zones. Family members who have never had chickenpox have a 90 % chance of becoming infected when another family member in the household is infected (7,4) . Varicella is transmitted from person to person by direct contact, inhalation of aerosols from vesicular fluid of skin lesions of acute varicella or zoster, or aerosolized respiratory tract secretions. Average incubation period: 14-16 days after exposure to rash (range: 10-21 days). Period of contagiousness: 1-2 days before rash onset until all lesions crusted or disappearance of maculopapular rash (typically 4-7 days) (5) .
In 1998, the World Health Organization (WHO) recommended that routine childhood varicella vaccination be considered in countries where the disease is a relatively important public health and socioeconomic problem, where the vaccine is affordable, and where high (85 to 90%) sustained vaccine coverage can be achieved (6,7) . Chickenpox can be treated with antiviral drugs and can be prevented by immunization (varicella zoster vaccine). In the United States, Sharp decreases in morbidity and mortality rates from varicella have been attributed to implementation of vaccination programs (8) .
Chickenpox is considered as a monthly notifiable disease in Iraq .The diagnosis is clinical. Clinical cases attending the primary health care centers all over the country are reported to the surveillance section at communicable diseases control center. Data regarding hospitalization and death are lacking (9, 10) .

AIMS OF THE STUDY
Describing the epidemiology of registered clinical cases of chickenpox from the public health department in Najaf governorate from January 2009 to the end of May 2014, And Verifying the increasing number of incident cases of chickenpox for planning future varicella vaccination in Iraq.

METHODOLOGY
This descriptive study was done at public health department in Najaf directorate of health from first of March to the first of June, 2014. Categorical variables including age groups, gender, and districts distribution, the data was collected from the existing anonymous surveillance of chickenpox from 2009 to 2013. Those monthly records were sent from corresponding surveillance units from six districts in Najaf governorate including; north Najaf, south Najaf, Al-Kufa, Al-manathera, Al-abbassiya and Al-Mishkhab districts. Age classification used in this study was based on age classification used in the surveillance system in Iraq. Case definition used in primary health care centers to diagnose cases of chickenpox is: clinical illness that is characterized by a rash with rapid evolution of macules to papules, vesicles and crusts. All stages are simultaneously present; lesions are superficial and may appear in gropes. Statistical analysis: Microsoft Excel and SPSS version 20 were used for statistical analysis. Descriptive statistic to present frequency distribution by age and gender, districts distribution and seasonal variation, Chi Square was applied for categorical association at level of significance α = 0.05.     Table 1 showed during 2014; there were 3004 cases in the first fifth months of the year. There is significant difference in age distribution of the registered cases. Most cases (75%) occurred in those with age group 5-14 years (P = 0.0001) versus only 3.05 % in those over 45 years.        In Taif -Saudi Arabia, a descriptive study was done to show incidence of chickenpox cases over the period of five years starting Jan. 1st 2007 till Dec.31th 2011 revealed that a total of 3,382 incident cases with Varicella during this period (13) .

RESULTS
In the current study, age distribution of the registered cases occurred mostly in those of age 5-14 years and least in those over 45 years. The explanation of this age distribution 5-14, as it is school age when the disease is highly contagious. In Iraq, 65% of cases of chickenpox occurred in those of age 5-14 years and only 1% in those over 45 years. In Baghdad-Iraq, the highest rate of chickenpox was observed during 5-10 years of life (75% of cases) higher than in the first three years of life while in Saudi Arabia, 78% of cases occurred in children less than 15 years of age (1, 2) . The rise in incident cases of varicella was reported in different countries worldwide such as Latin America and the Caribbean, where the global pooled varicella incidence in subjects under 15 years of age was 42.9 cases per 1000 individuals per year; children under 5 years of age were mainly affected (6,7) .
In Turkey, Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age (8,9) . The age-specific distribution of varicella cases reported by general practitioners is similar between the United Kingdom and Canada (around 85%are in children under 15 years) and is comparable to surveillance data in France (92% of consultations) and Scotland (79%). The highest consultation rate is in 0-4 year olds for Canada and the United Kingdom. Finally, it should be noted that the overall consultation rates are slightly higher in the United Kingdom than in Canada. This is to be expected since varicella cases reported by general practitioners are determined by patient consultation patterns, which partly depend on the primary health care system of each country (10,11) .
A vaccination program for susceptible adolescents and adults could potentially prevent about 30% of varicella deaths and hospital admissions if high coverage could be achieved in these age-groups (12,13) .The USA has a universal varicella-vaccination program and other countries have added varicella vaccine to their childhood immunization schedule e.g., Uruguay, Qatar, parts of Italy and Israel, Taiwan, Germany, Australia, Canada, and South Korea. Many European countries, such as Switzerland, recommend the vaccine for specific risk groups such as immune compromised people, health-care workers, and susceptible adolescents and adults. Availability of a combination MMRV vaccine, recently licensed in the USA, Germany, and Australia and expected in other countries soon, might simplify implementation of childhood varicella vaccination programs in countries considering such programs. In developing countries, the health burden caused by other diseases is higher than that of varicella, so varicella vaccination is a low priority for introduction into their national immunization programs (14) .
A program of varicella vaccination has the potential to change the epidemiology of herpes zoster as well as varicella in Iraq (15,16) . In this study, gender distribution of the cases throughout the years has shown sustained preponderance for the males over females. This might be attributed to the social preference and care for the males in the Iraqi community that leads to seeking health care for the ill male more seriously. In Iraq, regarding gender distribution there was sustained preponderance for the male over females with nearly the same percentage over the years (15,16) . For all years between 1976 and 1985 the rate for males exceeded that for females by a ratio of 1.1:1 by the Royal College of General Practitioners (RCGP).
Although the total number of chickenpox cases varies from 2009 to 2013 , all have shown the same seasonal distribution with two peaks in the year; spring (March, April and May) and early winter (November, December and January) seasons. The largest number of reported cases was in 2011 while the lowest number in 2009. These finding are similar to was reported in Saudi Arabia (12,13) .
In Iraq, seasonal distribution being highest in spring (April, May) season, It shows that the start of rising cases is in December and January (14, 15 and 16 Median Endemic Index of chickenpox cases in Najaf in May from 2009-2013 was 633 and the number of cases in May 2014 was 558. There is a significant difference in distribution of chickenpox cases by months in Taif (KSA) and Najaf (Iraq) with obvious reduction of incidence in Taif 2011 (11,20) . The explanation for this difference, that the Saudi Ministry of Health in 2008 took the proper action and introduced Varicella vaccine as a part of the Expanded Program of Immunization, that might lead to the seen reduction in numbers, possibly together with the fact of reduction of susceptible and the shift in incidence probably to the older age group where complications are more likely to happen and this is the price nations have to pay when such vaccines are introduced during childhood (21, 22 and 23) .

CONCLUSION
This study has provided important epidemiological data about rising trend in the registration of clinical chickenpox cases. The reported cases are still exceeding the median endemic index of the last five years.
Furthermore, most of cases occurred in age group of 5-14 years and the male distribution was slightly more than female. Regarding seasonal distribution, the disease occur in two peaks in the year; spring (March, April and May) and early winter (November, December and January) seasons. Median Endemic Index of chickenpox cases in Najaf necessitates thinking of varicella vaccine to reduce morbidity of the disease.