Prevalence of Sharps Injuries among Nursing Staff at hospitals in Kirkuk city

: 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
Health care workers are exposed to simple and deadly microorganism frequently due to the incorrect use of needles, syringes and sharp instruments. These pathogens can cause serious diseases that may lead to death. Nursing staff are the health care workers most vulnerable to infectious diseases. Every year, hundreds of thousands of health care workers are exposed to deadly diseases like HIV and hepatitis C through needles stick and sharps injuries. With today's technology, nurses no longer need to face such high risks (1) . According to World Health Organization, three million people are annually affected by needle stick injury, of which 90% are occurred in developing countries (2) . Sharp instruments used by nurses include syringes needle, sutures needle, glass materials, cannula needles, surgical blades and other sharp instruments causing injuries and wounds. Repeated injuries to nursing staff causes stress in their job. Researches demonstrate that being exposed to infectious diseases and needle stick injuries cause stress to the nurses (3) . National Occupational Safety Association of America introduced nursing as the head of the 40 top stressful professions. Various stressful factors are propounded in this occupation; for example infectious diseases due to nurses' contact with sharp materials as needle which expose them to the risk of infectious disease due to liquids and blood (4) .

AIMS OF THE STUDY:
1. Assessing the most sharps instruments causing injuries.

2.
To identify factors that leading to sharps injuries.

3.
To identify the protective measures for sharp injuries. 4. Find out the association between sharps injuries and some demographic data of the nurses.

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 to assess Prevalence of sharps injuries and its protective measures for nursing staff at Kirkuk city hospitals. A non-probability (convenience sampling) of (166) nursing staff 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 (6) items, part ΙΙ: the Equipment associated sharps injuries (5) items the participant chooses the most equipment associated sharps injuries. Part ΙΙΙ: Factors associated with sharp injuries (11) items. And part ΙΙΙΙ: Availability of protective measures for sharp injuries (8) items. The data were collected through the use of selfadministration technique from the period 1st April 2020 to 1st May 2020. Informed consent was granted from nurses for participation in the present study was obtained.
The results were analyzed through the use of Statistical Package for Social Science (SPSS) version 20. The statistical procedures which were applied for the data analysis and assessment of the results include the following: descriptive statistics (frequencies, percentages) and statistical inferential (chi-square test) in order to find the association between sharps injuries and some demographic data.   This figure shows that most factors that cause sharps injuries were (Frequent injectable drugs, inadequate training sessions, crowded patients, and inappropriate report after injuries).  Table 2 shows that most protective measures to prevent sharps injury were not available.  This table shows that there is significant difference between (age and educational level) and factors associate with sharp injuries at P-value (≤ 0.05), the results also shows that the difference between (Gender and training session) was not significant at P-value (≤ 0.05).

DISCUSSION:
Sharps injuries and its protective measures are important occupational hazards leading to infections with blood borne pathogens; such as HBV, HCV, or HIV (5) . The study aims to assess the prevalence of injuries resulting from sharp instruments, the samples of the study were nursing staff working in the clinical places in which medication are administered and nursing interventions performed, through nursing interventions, nurses may experience injuries and wounds resulting from sharp instruments. Injuries caused by sharp instruments are mostly caused by syringes needles, suture needles, glasses, and surgical scalpels that are frequently used by nurses in their work. Accidental sharp injury and needle stick were most frequent in wards, it is important to improve the knowledge about the prevalence and reasons for such injuries to find ways to prevent the injuries (6) . Repeated handling of drugs and sharp instruments may lead to the transmission of a microbial infection that the nurses contract while they are working. The results of the study concluded that the most common sharp instruments that lead to wounds and injuries were syringe needles and glasses such as ampules due to the frequent uses of medications prescribed to patients, the large number of patients, the lack of educational programs related to sharp injuries, in addition to the lack of provision of safety tools when administering medications and mishandling of ampoules and Glass tools, which leads to frequent injuries among the nursing staff. This results in line with the study of (7) that disposable syringes were the most common medical equipment that caused sharp injuries. As stated by Galougahi needle stick injury is defined as a penetrating wound typically induced by a needle point or other sharp instrument or object which could be infected with another person's secretions (8) .
The results of the study concluded that the absence of a special program for reporting injuries, the limited availability of vaccines for the injured, and the lack of use of a personal protection equipment leads to the continuation of injuries with their increasing cases. The risk of transmitting infection from patients to health workers, especially the nursing staff is toolborne diseases especially hepatitis B virus infection, hepatitis C virus, and acquired immunodeficiency disease (AIDS).
The results also showed that there is a significant relationship between age and academic level with the factors associated with sharp injuries. And that the relationship between sex and training sessions with the factors associated with sharp injuries was not significant.

CONCLUSIONS
The study concluded that the majority of nursing staff reported that most equipment causing sharps injuries were Syringe needles and glasses tools. And most factors cause's sharps injuries in the hospitals were frequent injectable drugs, inadequate training sessions, crowded patients, and inappropriate report after injuries. Also the protective measures to prevent sharps injury in the hospitals were mostly not available.