Article Index
Assessment of needle stick
Abstract
Abstract
Subjects and Methods
Results
Discussion
References
Tables
الملخص العربي
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The Egyptian Journal of Community Medicine    -  Vol.26  -   No.1  -  January 2008

Assessment of needle stick injuries and related knowledge among health care workers participating in an infection control-training program at El Minia University Hospital.

Eman M. Mahfouz1, Fadia Abdel-Hamid Mossalam1, Safaa M. Abdel-Rahman2, Sahar A. Abood2, and Sayed F. Abdelwahab3,§
Departments of Public Health and Preventive Medicine1, Nursing Administration2, and  Microbiology and Immunology3,  Faculties of Medicine1,3 and Nursing2, Minia University, Minia 61511, Egypt.


A total of 278 physicians and 56 dentists participated in this study. Dentists were younger than physicians, and had a slightly higher knowledge score than physicians. We found that 63.2 % of the participating physicians and dentists experienced at lease one needle stick during their practice. About 61% and 71.4% of the physicians and dentists experienced at lease one needle stick during their practice, respectively, suggesting that dentists were more likely to be exposed to needle stick injuries than physicians....



Abstract

Background:
Needle stick injuries are an important and continuing cause of exposure to serious and fatal diseases among health care workers (HCWs) who suffer daily accidental occupational exposure to needle stick injuries during the course of their role of caring for patients.

Aim of the study:
to determine the burden of needle stick injuries, its causes and knowledge related to it among HCW participating in an infection control training program at Minia University Hospital (MUH).

Methodology:
A well-structured pre- and post-training questionnaires about general infection control knowledge was used and included also 10 basic knowledge questions and inquiries about incidents of needle sticks, its frequency and cause, and history of hepatitis B vaccination.

Results:
A total of 278 physicians and 56 dentists participated in this study. Dentists were younger than physicians, and had a slightly higher knowledge score than physicians. We found that 63.2 % of the participating physicians and dentists experienced at lease one needle stick during their practice. About 61% and 71.4% of the physicians and dentists experienced at lease one needle stick during their practice, respectively, suggesting that dentists were more likely to be exposed to needle stick injuries than physicians. The overall mean of needle stick injuries per year among the participants was 4.42 (±1.83). However, the average numbers of sticks were 4.51 (±1.87) and 4.03 (±1.77) among the participating physicians and dentists, respectively.  Self-inflicting injuries during bending or recapping of a used needle was the most frequent cause of needle sticks (41% for physicians and 59% for dentists). Nearly 72% of the participants were categorized as excellent in basic knowledge regarding infection control. Also, knowledge of needle stick management significantly improved by 63.3% and 7.8% post-training among dentists and physicians, respectively. Importantly, as the knowledge score increases, the liability to be injured by needles decreased. On the other hand, physicians were three times more likely to be vaccinated against Hepatitis B virus (HBV) than dentists although the overall vaccination rate was very low (15.2% vs. 4.2% among physicians and dentists, respectively).

Conclusion:
needle stick injuries are common among HCW of MUH and recapping and bending of needles are prevalent inappropriate practices that increase the likelihood of needle sticks. Ensuring that HCW are properly trained on safe use and disposal of sharps will make this practice safer.

Key words:
needle-stick injuries, health care workers, vaccination, recapping, and infection control



Introduction

Thousands of healthcare workers (HCWs), around the world, suffer daily
accidental occupational exposure to needle stick injuries during the course of their role of caring for patients. These injuries can result in a variety of serious and distressing consequences.  They represent a major risk factor for transmitting blood borne pathogens including hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The most important response to this risk is to prevent as many of these injuries as possible, by constantly educating HCWs on the best methods for preventing injuries, by improving the safety of equipment and by working towards the optimal occupational health and safety environment1.  A needle stick injury is defined as any injury, either self-inflicted and/or ‘other’ inflicted, whereby the skin is punctured or lacerated.  The needle involved must be a used needle, having been used by the doctor him/herself or left exposed by another staff member. The skin may have been punctured or scraped2.

All HCW who perform invasive procedures with sharp instruments are at risk for needle stick injury. However, the operating-room setting presents the greatest risk3. The injuries are mainly related to cleaning of instruments, recapping of needles and administering local anesthesia.  Most exposure incidents occur in patient rooms (37%), with incidents in operating rooms (16%), emergency departments (7%) and intensive care units next in order of incidence (6%). However, only a few needle types and other sharp devices are associated with the majority of injuries. In this regard, syringes are the most commonly identified sharp object causing the injuries4.
If a needle has been used in a patient, potentially infectious body material can be transferred to the HCW who is injured while performing his/her duty as reported by the National Institute for Occupational Safety and Health NIOSH Alert, 19995. Five activities are identified with needle stick injuries. These include: 1) Disposing of needles, including the collection and disposal of materials used during patient care procedures; (2) administration of injections; (3) blood drawing; (4) recapping of needles and (5) handling of trash and dirty linens (called “downstream injuries,” that usually involve the housekeeping department). In this regard, the causes of percutaneous injuries with hollow-bore needles in a Centers for Disease Control (CDC) surveillance of hospitals by percentage of total percutaneous injuries (n=3,057) in June 1995-July 1999 were as follows: Manipulating needle in patient (27%), disposal-related causes (12%), handling/passing (11%), cleanup (11%), improper disposal (10%), collision with HCW or sharp (8%), IV line-related causes (8%), handling/transferring specimens  (5%), recapping (5%) and others (4%)5. In another report, the majority (59.3%) of 137 HCW always recapped needle after use. Among those, the mean knowledge score was 3.86. In addition, almost a third of all respondents (31.9%) admitted always recapping used needles7  and about one-fourth to one-third of the respondents had experienced needle stick injury in the previous 3 months8.  Furthermore, the prevalence of needle stick injuries among 285 Malaysian HCW was 24.6% involving 71 cases of which 48.0% were doctors, 22.4% were medical students, and 18.7% were nurses and the difference was statistically significant9.
Needle stick injuries are an important and continuing cause of exposure to serious and fatal diseases among HCW. Past studies of needle stick injuries have shown that 10% to 25% occurred when re-capping a used needle10. In this regard, it was reported that HCW experienced between 600,000 and 800,000 exposures to blood, thousands of known injuries, and thousand more unreported injuries place HCW in all settings at risk11. HCV, which is a major health problem in Egypt, is the most frequent infection resulting from needle stick and sharps injuries with a transmission rate of 2.7%-10%12. While no precise national data are available, hundred thousands of needle stick and other percutaneous injuries occur among HCW annually. It is believed that as many as half of these incidents are not reported and that physicians underreport needle stick injuries by as much as 90%13.  In this regard, most of HCW in Egypt were not appropriately trained on the ways of reducing their risks acquired through occupational exposure. A 2002 survey of Egyptian HCW14  revealed unsafe practices in the use and disposal of sharps and determined that HCW were frequently exposed to needle stick injuries. Of the 1485 HCW interviewed in an Egyptian study, 529 (35.6%) were exposed to at least 1 needle stick injury during the past 3 months with an estimated annual number of 4.9 needle sticks per worker. The most common behavior associated with needle stick injuries was recapping. Overall, 64% of HCW disposed off needles unsafely in non-puncture proof containers and 15.8% of them reported receiving 3 doses of HBV vaccine14.
A needle stick injury occurs when the skin of a HCW is injured by a needle while performing their duties15. Increasing scientific data indicate that the introduction of safer needle devices especially in combination with a comprehensive educational and training process could result in significant declines in the incidence of needle stick injuries. In this regard, better training, care during cleaning of instruments, avoiding hazardous practices such as recapping needles and development of safer needles may prevent injury and disease6,16.

The choice of the current article topic stems from the researchers being involved in the training of HCW of Minia University Hospital (MUH) on basic aspects of infection control in the health care environment. The subject of needle stick injuries as a major stressful working experience was the Theme that was oftenly raised. The reporting of a needle stick injury is necessary and one would expect, therefore, that all injuries that occur in the workplace will be reported. However, literature suggests that the phenomenon is widely underreported.  Unfortunately there is no way of accurately estimating the underreporting of a needle stick injury.
The research question that was raised is “how much is the toll of needle stick injury among the HCW of MUH and what is the prevailing knowledge regarding infection control in general and needle stick injury in particular among participating healthcare providers?”

Aim of the study:

the primary objective of this study was to determine rate of needle stick injuries among health care providers. Secondary objectives examined the causes of needle stick injury such as recapping, patient movement ...etc. The last objective was assessing the change in knowledge of HCW before and after training regarding infection control procedures in general with a special emphasis to needle sticks.



Subjects and Methods

This study was conducted at MUH in the period from January 2006 till January 2007.
Subjects:
There are two different categories of subjects who participated in this study including physicians from MUH and Ministry of Health and Population (MOHP) Directorate Hospitals in Minia Governorate and dentists from Minia University Dental Hospital. Two categories of infection control training programs were developed. These programs were designed to enhance the awareness, understanding, behavior and skills of HCW based on needs assessment.  The first program was conducted in 4 sessions for four different days for physicians. The physicians’ training program was implemented as 10 hours of each of theoretical lectures and practical sessions. The second program was conducted in 3 sessions for three days for dentists. The dentists’ training program was implemented as 8 hours of theoretical lectures and 7 hours of practice.
Implementation of the program:
The training topics included most if not all of the following subjects: nosocomial infection, general principles of epidemiology, aseptic techniques, hand hygiene, injection safety, disinfection and sterilization, guidelines for prevention of devices related infections, personal protective equipment, nosocomial infection surveillance and outbreak investigation, antibiotic policy, exposure policy, immunizations of HCW, isolation precautions in hospitals, environmental cleaning, safe laundry, waste management, infection control in special units, the role of microbiology lab, and safe dentistry.
Six training workshops on basic aspects of infection control were conducted during the project. Each workshop was conducted for a total of 20 hours (physicians) or 15 hours (dentists) of theoretical and practical topics related to infection control practice. The detail of these workshops is as follows: First training workshop was conducted for physicians of MUH (38 physicians, March 2006). Second training workshop was conducted for physicians (40 physicians from MUH and MOHP Directorate in Minia, May 2006). Third training workshop was conducted for physicians in the final training year (house officers), physicians of the Faculty of Medicine, and physicians from MOHP Directorate in Minia (70 physicians,  July 2006). Fourth training workshop was conducted for physicians of MUH (65 physicians, September 2006). Fifth training workshop was conducted for dentists at the Faculty of Dentistry (56 dentists, December 2006, Minia University Dental Hospitals). Sixth training workshop was conducted for physicians of MUH (65 physicians, January 2007). The training course booklet, project magazine, a block note, a pen and other materials were disseminated to the trainees at the workshops. In addition, the trainees were assessed by questionnaires at the beginning and the end of each workshop. The total number of trained physicians was 278 while that of dentists was 56. 
Data collections:
The necessary approvals were secured from the Deans of Faculties of Medicine and Dentistry at Minia University and from the Director of the MOHP Directorate in Minia.  A pilot study was conducted  to test the questionnaire for clarity, completeness and validity and to determine the time involvement. The purpose of the study was explained to HCW.  It took about 25-30 minutes for most of the member to fill the form. Then, the questionnaires were updated and conducted on the participants.
Questionnaires were used to collect two types of data from subjects in this study from physicians and dentists. These data were collected before (pre-) and after (post-) training and included:
1) Socio-demographic characteristics of study subjects including sex, age, qualification, years of experiences and other personal data were obtained.
2) Basic knowledge questions and a scoring system for data collected were implemented. A total of 10 questions were used to assess the basic knowledge of the trainees.  A score of one was given for each correct answer and a zero for incorrect answer with best basic knowledge score being 10.
3) Knowledge assessment questions: The questions were developed by the researchers to collect data related to assess physicians’ and dentists’ knowledge related to infection control among the trainees in their different health service settings. Questions consisted of 50 and 45 questions for physicians and dentists, respectively, ranging from matching, multiple choice to right or wrong answer question
4) Questions assessing past experience of needle-stick injuries included the frequency of its occurrence, the associated circumstances and practices.

Statistical analysis:
All data of the study were fed into an IBM-Compatible personal computer. SPSS-15 (statistical software) was used for statistical analysis. Comparison between groups of variables was done by Chi-square (for non-parametric data). P value was considered significant when P <0.05.



Results

This study was conducted at MUH in the period from January 2006 till January 2007 and there were two different categories of trainees participating in this study. These included physicians from MUH and MOHP Directorate Hospitals in Minia Governorate and dentists from Minia University Dental Hospital. As shown in Figure 1A, the participating dentists were younger than physicians, where the mean age of dentists was 23.2 years ± 0.8; (SD) as compared to that of physicians (28.2 years ± 6.6).  Importantly, as depicted in Table (1), nearly two thirds (61.5%) of the physicians attending the infection control training program were previously exposed to some sort of needle stick injuries during their practice. On the other hand, the dentists were more likely to be exposed to needle stick injury than physicians, where 71.4% of them were exposed to these incidents.  However, dentists were exposed to a lower number of needle stick injuries per year as compared to physicians (Figure 1B). Around 63% of the participating HCW were previously exposed to some sort of needle stick injuries. In this regard, the overall mean of the number of needle stick injuries per year among the participants was 4.42 (±1.83). The average numbers of sticks per year for physicians and dentists were 4.51 ± 1.87 and. 4.03 ± 1.77, respectively. In addition, dentists had a slightly higher knowledge score (Figure 1C) than physicians (7.4 ± 2.1 vs. 7.1 ± 2.4, respectively). In summary, dentists were more likely to be exposed to needle stick injuries than physicians but the total number of sticks was higher in the physicians group.

As shown in Table (2), 43.3% and 41.3% of the participating physicians and dentists were stuck one- to- two times by needles during their practice, respectively with an average of 43.25%. Also, 39.9% and 49% of the participating physicians and dentists were stuck with needles from three to five times, respectively with an average of 39.9%. In addition, only 16.8% and 7.8% of the participating physicians and dentists were exposed more than five times to needle stick injuries with an average of 15.22% (Table 2).

Table (3) demonstrates the various causes leading to needle sticks among physicians and dentists. It clearly shows that self-inflicting injury was the leading cause of needle stick injuries (41% for physicians and 58.9% for dentists) with an overall average of 47.5, followed by causes related to manipulating needles in patients as patients movements (37.4% for physicians and 26.8% among dentists) with an overall average of 35.6 and other causes which represented 21.6% and 14.3% of injuries among physicians and dentists, respectively. In summary, as shown in Table 3, overall, self inflicting injuries represent the main cause of needle stick injuries among the participants followed by reasons related to manipulating the needle in the patient.
Using a set of 10 questions encompassing basic knowledge of participating physicians and dentists, each correct question answer was counted as one point. A score was made for each participant and were assigned to be good, fair, or poor knowledge score according to a pre-specified range (Table 4). As previously mentioned, dentists had a slightly higher knowledge score (Figure 1C) than physicians (7.4 ± 2.1 vs. 7.1 ± 2.4). However, as shown in Table (4), the majority of participating physicians (73%) had excellent basic knowledge scores as compared to 67.9% of dentists, while those with a fair score represented 17.3% and 26.8% of the participating physicians and dentists, respectively.  On the other hand, physicians had a higher rate of poor knowledge score than dentists (9.7% vs. 5.4%). Overall, out of total 334 participating physicians and dentists, nearly 72% were categorized as excellent in basic knowledge regarding infection control, about 19% categorized as fair and almost 9% as poor. These data suggest that the basic knowledge score about infection control among participating physicians and dentists is high.

Knowledge regarding needle stick injuries and nosocomial infection among physicians and dentists pre- and post-infection control training intervention was assessed by pre- and post-training questionnaires. In this regard, the knowledge of physicians about the correct disposal of needles after usage was significantly changed by 18.7% post training P= 0.000. On the other hand, knowledge regarding correct dry heat sterilization of equipment changed significantly by 17.8% pot training P=0.02 (Table 5). Also, management of needle stick injury knowledge was significantly improved by 7.8% post-training activity P=0.02.  The knowledge regarding whether to clean the site of injection with 70% alcohol was changed by 12% after intervention P= 0.02.    
As also shown in Table 5, the knowledge of dentists regarding correct disposal of needles after usage was significantly changed from 30.6% pre training to 100% post intervention P= 0.000, while knowledge regarding correct dry heat sterilization of medical equipment changed significantly  by 18.7% after intervention (from 27.1% to 45.8) P= 0.04. In addition, management of needle stick injury knowledge was significantly improved by 63.3% post-intervention.  Moreover, knowledge regarding correct cleaning of site of injection with 70% alcohol changed from 18.4% to 38.3% after training P= 0.06.

As shown in Table (6), as the knowledge increases, the liability to be injured by needles decreased P= 0.04. In addition, as clearly shown in Table (7), as knowledge score increases, the health providers were less likely to be the main cause of needle stick injuries (48.2% of poor score vs. 36.0% of excellent score) P= 0.03. It was, also, found that needle stick injuries caused by patient's sudden movement were higher among health providers having good knowledge than those with either poor or fair knowledge in comparison to their own faults (Table 7).

As depicted in Table (8), physicians were three times more likely to be vaccinated against HBV than dentists (15.2% vs. 4.2%). Nevertheless, vaccination rate among both groups are considered to be very unsatisfactorily low.



Discussion

We showed that a total of 278 physicians and 56 dentists participated in this study of whom 63.2 % experienced at lease one needle stick during their practice and the overall mean of needle stick injuries per participant was 4.42 (±1.83). The average numbers of sticks among the participating physicians and dentists were 4.51 (±1.87) and 4.03 (±1.77), respectively.  Self-inflicting injuries during bending or recapping of a used needle was the most frequent cause of needle sticks (41% for physicians and 59% for dentists). On the other hand, nearly 72% of the participants were categorized as excellent in basic knowledge regarding infection control. Also, knowledge of needle stick management significantly improved by 63.3% and 7.8% post-training among dentists and physicians, respectively. Several aspects of these findings warrant further discussions.
Needle stick injury has received renewed attention in the past 3 years. Perhaps it may be the primary reason in the emergence of new technologies and devices that are easier to use and function much more reliably. Associated with this attention is the increasing scientific data indicating that the use of needle stick prevention devices reduces its incidence. Over 80% of needle stick injuries can be prevented with the use of safer needle devices17, which, in conjunction with worker education and work practice controls, can reduce injuries by over 90%11. These safe needles are very expensive to be used in our community. Therefore, training and education of HCW on basic aspects of infection control and safe sharps handling represented a fundamental goal of the infection control training program conducted at MUH in the period from July 2005 to January 2007. 
In our study, out of 56 participating dentists with a mean age 23.2+0.8 years, 71.4% had experienced at least one needle stick injury with a mean of 4.03 injuries per dentist. On the other hand, of 278 participating physicians with a mean age 28.2+6.6 years, 61.5% were previously exposed to at least one needle stick injury during their practice with an annual mean of 4.51 injuries per physician. On average, 63.2 % of the participants were exposed to some sort of sharps injury during their practice. This is slightly lower than what was reported by others3, where 582 of 699 (83%) respondents, experienced at least 1 needle stick injury, with a mean of 3.8 injuries per resident and this could be explained by the fact that residents were recently practicing and did not get enough skills to handle sharps. On the other hand, these rates are higher than that reported in a similar study conducted in Egypt14, where only 35.6% were exposed to at least 1 needle stick injury during the past 3 months with an estimated 4.9 needle sticks per worker per year, which is very close to our average of 4.42 sticks per trainee.
In our study, self-inflicting injuries  during recapping or bending the needle after use was the most  encountered cause leading to needle sticks  (41% for physicians and 58.9% for dentists), followed by some one else as the cause e.g. as the patient moves (37.4% for physicians and 26.8% among dentists). Also, dentists had a slightly higher knowledge score than physicians (7.4 vs. 7.1 for dentists and physicians, respectively). In addition, out of the total 334 participating physicians and dentists, nearly 72% were categorized as excellent in basic knowledge regarding infection control, about 19% categorized as fair and almost 9% as poor. In previous reports, the mean knowledge score was 3.83, 6  and it was stated that 67% of the residents were self inflicted by needle stick injuries, which is higher than what we found in this study.  This variation again can be explained by lack of experience of residents as compared to our heterogeneous group of recent and old graduates as indicated in the mean age of the trainees. Another recent study6, found that the majority (59.3%) of 137 HCW from Pakistan always recap the needle after its usage.

In This study, physicians were three times more likely to be vaccinated against HBV as do the dental trainees (15.2% vs. 4.2%, respectively). Nevertheless, vaccination rate among both groups are considered to be very unsatisfactorily low. This is comparable to a similar study conducted at the MOHP in Egypt14, where HBV vaccination coverage was found to be only 14% among the HCW surveyed in another study in Egypt. Vaccination against hepatitis B started to be obligatory for Egyptian children since 1997 and should not be a problem in the health care delivery process in the near future. However, immediate mass vaccination of the current HCW providing healthcare service to our community should be sponsored by the higher authorities to protect the HCW themselves and also their patients for this highly infectious pathogen (HBV).

Conclusions
Our study highlights several important issues: First, needle stick injuries are common among HCW of MUH. Second, the practice of recapping and bending needles is prevalent among HCW and increases the likelihood of needle stick injuries. Third, basic knowledge score is considerably high despite the low rate of HBV vaccination. Fourth, positive change of knowledge regarding needle stick after training is significant and promising.

Recommendations

On the light of the results, the following are recommended: First, training programs and educational sessions must be provided upon initial employment of HCW and at regular intervals thereafter. Second, educational programs on infection control should be incorporated into the general training of medical, dental and nursing students. In this regard, continuous education on- and the application of standard infection control precautions must be made available to all HCW who may be exposed to blood or other body fluids potentially contaminated with blood-borne pathogens to ensure that HCW are properly trained on the safe use and disposal of needles. Third, healthcare institutions should apprise themselves of developments in safety devices, e.g. needle-less technology and should invest in appropriate devices related to the pattern of risk within their organization or modify work practices that pose a needle stick injury hazard to make them safer. Fourth, all HCW who perform exposure-prone procedures and all medical, dental, nursing and midwifery students must be immunized against HBV, unless immunity to HBV as a result of natural infection or previous immunization has been established. In addition, records of immunization of HCW should be maintained on a confidential basis. Fifth, promotion of safety awareness in the work environment and establishment of procedures for encouragement of reporting and timely follow up of all needle sticks and other sharps-related injuries should be applied.

Acknowledgement:
We would like to thank all members of the infection control project team at MUH and Mrs. Mona Salah El-Deen for her help with the data entry and Mrs. Rania Aly for her help with the data collection.
* Supported by the Higher Education Enhancement Project Fund (HEEPF) at the Ministry of Higher Education (Project # D-026-M0) and Minia University
§Address Correspondence to:
Sayed F. Abdelwahab, PhD
Department of Microbiology and Immunology
Faculty of Medicine, Minia University, Minia 61511, Egypt
Phone/Fax: +20-86-234-2813
Email: This e-mail address is being protected from spambots. You need JavaScript enabled to view it



References

1) Gold, J., and M. Tomkins. 2005. Occupational Post Exposure Prophylaxis for HIV: A discussion paper. For the Technical Meeting for the Development of Guidelines and Policies on Occupational and Non Occupational Post Exposure Prophylaxis (PEP).  World Health Organization/International Labour Organization Geneva, 5th – 7th September 2005:1-19.
2) Moody, R. A. 2002. A Qualitative  Inquiry into doctor’s  Experience after ER A Needle Stick Injury . A thesis submitted in partial fulfilment of the requirements for the degree of Masters Degree in Clinical Psychology Rand Afrikaans University.
3) Makary, M. A., A. Al-Attar, C. G. Holzmueller, J. B. Sexton, D. Syin, M. M. Gilson, M. S. Sulkowski, and P. J. Pronovost. 2007. Needlestick injuries among surgeons in training. The New England journal of medicine 356:2693-2699.
4) Genel, M. 2000. Preventing  Needle stick  Injuries in Health Care Settings  (resolution 430, A-99). Reports of  Council  on Scientific  Affairs. Scientific Affairs – 1 http://www.ama-assn.org/ama/upload/mm/csa.pdf.
5) NIOSH. 1999. Preventing Needle stick Injuries in Health Care Settings. DHHS (NIOSH) Publication No. 2000-108:http://www.cdc.gov/niosh/pdfs/2000-2108.pdf.
6) Janjua, N. Z., M. Razaq, S. Chandir, S. Rozi, and B. Mahmood. 2007. Poor knowledge--predictor of nonadherence to universal precautions for blood borne pathogens at first level care facilities in Pakistan. BMC infectious diseases 7:81.
7) Sadoh, W. E., A. O. Fawole, A. E. Sadoh, A. O. Oladimeji, and O. S. Sotiloye. 2006. Practice of universal precautions among healthcare workers. Journal of the National Medical Association 98:722-726.
8) Doebbeling, B. N., T. E. Vaughn, K. D. McCoy, S. E. Beekmann, R. F. Woolson, K. J. Ferguson, and J. C. Torner. 2003. Percutaneous injury, blood exposure, and adherence to standard precautions: are hospital-based health care providers still at risk? Clin Infect Dis 37:1006-1013.
9) Lee, L., and I. N. Hassim. 2005. Implication of the prevalence of needle stick injuries in a general hospital in Malaysia and its risk in clinical practice. Envirnomental & Preventive Medicine (In Safe Hands Newsletter of the Safe Hands  network, June 2005 Issue 1 Vol 1) 1:33-41.
10) McCormick, R. D., M. G. Meisch, F. G. Ircink, and D. G. Maki. 1991. Epidemiology of hospital sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras. The American journal of medicine 91:301S-307S.
11) Jagger, J. 1996. Reducing occupational exposure to bloodborne pathogens: where do we stand a decade later? Infect Control Hosp Epidemiol 17:573-575.
12) CDC. 1998. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. Centers for Disease Control and Prevention. MMWR Recomm Rep 47:1-39.
13.)EPINET. 1999. Exposure prevention information network data reports. University of Virginia: International Health Care Worker Safety Center.
14) Talaat, M., A. Kandeel, W. El-Shoubary, C. Bodenschatz, I. Khairy, S. Oun, and F. J. Mahoney. 2003. Occupational exposure to needlestick injuries and hepatitis B vaccination coverage among health care workers in Egypt. American journal of infection control 31:469-474.
15)www.ebandolier.com. 2003. Evidence based thinking about healthcare.
16) Shah, S. M., A. T. Merchant, and J. A. Dosman. 2006. Percutaneous injuries among dental professionals in Washington State. BMC public health 6:269.
17) CDC. 1997. Evaluation of Safety Devices for Preventing Percutaneous Injuries Among Health-Care Workers During Phlebotomy Procedures -- Minneapolis-St. Paul, New York City, and San Francisco, 1993-1995. MMWR Morb Mortal Wkly Rep. 46:21-25.

 



Table (1): Distribution of needle- stick injuries among the participated health care workers


Needle stick

Physicians (n = 278)

Dentists (n = 56)

Total  (n=334)

Yes

171 (61.5%)

40 (71.4%)

211 (63.2%)

No

102 (36.7%)

15 (26.8%)

117 (34.8%)

non respondents

5 (1.8%)

1 (1.8%)

6 (1.8%)

Total

100%

100%

100%


Table (2): Frequency of exposure to needle stick injury among physicians and dentists


Frequency of needle sticks

Physicians

Dentists

Total

1-2 times

43.3

43.1

43.25%

3-5 times

39.9

49.0

39.92%

More than 5 times

16.8

7.8

15.22%


Table (3): Distribution of causes of needle stick injuries


Cause of needle stick

Dentists

Physicians

Total

Self inflicting (During bending or recapping, inappropriate disposal)

58.9%

41.0%

47.5%

Some one else during manipulating needles in patients

26.8%

37.4%

35.6%

Others

14.3%

21.6%

20.4%

Total

100%

100%

100%


Table (4): Knowledge score among participated physicians and dentists


Dentists (N.56)

Physicians (N. 278)

Knowledge level

3 (5.4%)

27 (9.7%)

Poor (0-3 points)

15 (26.8%)

48 (17.3%)

Fair (4-6 points)

38 (67.9%)

203 (73.0%)

Excellent (7-10 points)

100%

100%

Total


Table (5): Knowledge regarding needle stick injury and nosocomial infection among physicians and dentists after infection control training intervention


Knowledge

% change of  knowledge among physicians

Sig.

% change of  knowledge among dentists

Sig.      (p value)

Correct needle disposal

18.7

0.000

69.4%

0.000

Sterilizing of medical equipment

17.8%

0.02

18.7%

0.04

Needle stick injury management

7.8%

0.02

63.3%

0.000

Cleaning site of injection with 70% alcohol

12.0%

0.02

19.9%

0.065

Urinary tract is the most common site of nosocomial infections

27.2%

0.000

68.8%

0.000


Table (6): Relation between the basic knowledge level and the liability to be injured by needle sticks


Total

needle sticks

Knowledge level

yes

No

8.8%

22 (75.9%)

7 (24.1%)

Poor (n=29)

18.9%

45 (72.6%)

17 (27.4%)

Fair (n=62)

72.3%

139 (58.6%)

98 (41.4%)

Excellent (n=237)

100%

62.8%

37.2%

Total (n=328)

P*- 0.047


Table (7) Correlation between knowledge score of participated physicians and causes of needle stick injuries


Total

Cause of needle stick injury

Knowledge level

Someone else

Patients faults

Self inflicted

27 (100%)

4 (14.8%)

10 (37.0%)

13 (48.2%)

Poor

48 (100%)

8 (16.7%)

16 (33.3%)

24 (50.0)%

Fair

203 (100%)

51 (25.1%)

79 (38.9%)

73 (36.0%)

Excellent

100%

22.7%

37.8%

110 (39.6%)

Average

P= 0.03


Table (8): Distribution of hepatitis B vaccination among participated physicians and dentists


HBV vaccination

Yes

No

Total

Dentists

2 (3.6%)

54 (96.4%)

16.8%

Physicians

42 (15.1%)

236 (84.9%)

83.2%

Total

13.2%

86.8%

100%


Figure (1): Mean age (A), number of exposures to needle sticks (B) and knowledge score (C) of dentists and physicians participating in the study.

1



الملخص العربي
تقييم الاصابات بوخز الإبر والمعرفة المتعلقة بها لدى العاملين بالرعاية الصحية المشاركين فى برنامج تدريبى على طرق التحكم فى العدوى بمستشفى المنيا الجامعى*

إيمان محمد محفوظ1، فاديه عبد الحميد مســـلم1، صفاء محمد عبـــد الرحمن2،
سحـــر أحمد عبـــود2، سيد فكرى عبد الوهاب3
قسم الصحة العامة والطب الوقائى1  ، قسم إدارة التمريض2 ، قسم الميكروبيولوجيا والمناعة3 ، كليات الطب1،3  والتمريض2 – جامعة المنيا -ج.م.ع.

تمثل الإصابات بوخز الإبر لدى العاملين في مجال الرعاية الصحية مخاطر كبيرة عليهم فهى من أهم عوامل الخطورة المؤدية لنقل أمراض الدم. ومن المهم للغاية رصد ومراقبة تعرض العاملين بالرعاية الصحية لهذه الإصابات. وفى هذه الدراسة تم تحديد العبء الناتج عن تلك الإصابات ومدى المعرفة بها وأسبابها لدى العاملين بالرعاية الصحية والمشاركين في البرنامج التدريبي لمكافحة العدوى بمستشفى المنيا الجامعى عن طريق استخدام استمارة استبيان  قبل وبعد الانتهاء من البرنامج التدريبى. ومن محتويات هذه الاستمارة البيانات الاجتماعية والديموغرافية بالإضافة إلى عشرة أسئلة أساسية لتقييم مدى المعرفة بهذه الإصابات واستقصاءات وتحقيقات عن حوادث الإصابات بوخز الإبر ومدى تكرارها وأسبابها. وقد شارك فى هذه الدراسة 278 طبيبا و56 طبيب أسنان وكانت أعمار أطباء الأسنان أقل من الأطباء ، وكان مستوى المعرفة بهذه الإصابات أعلى نوعا ما لدى أطباء الأسنان عنه لدى الأطباء. وقد تبين أن نسبة تعرض أطباء الأسنان للإصابة بوخز الإبر أكثر من تلك الخاصة بالأطباء حيث وجد أن حوالي 61 ٪ و 71.4 ٪ من الأطباء وأطباء الأسنان على التوالى قد تعرضوا لهذه الإصابات مرة واحدة على الأقل خلال ممارساتهم لعملهم. وقد كان المتوسط الإجمالي لعدد الإصابات بوخز الإبر في السنة     4.42(±1.83 ( مرة. وفى هذا الصدد كان متوسط عدد الإصابات بوخز الإبر 4.51 (±1.87 ( ، 4.03 (1.77±) بين المشتركين من الأطباء وأطباء الأسنان ، على التوالي.   هذا وقد كانت الإصابات الناتجة بسبب ثنى أو استرجاع غطاء الإبرة المستخدمة أكثر أسباب الإصابة بوخز الإبر شيوعا (بنسبة 41% و 59% لدى الأطباء وأطباء الأسنان على التوالى). واتضح أن نسبة 72% تقريبا من المشاركين فى الدراسة لديهم معرفة ممتازة بشأن مكافحة العدوى ، ولقد تحسن أيضا مستوى المعرفة بكيفية التصرف فى حالة الإصابة بوخز الإبر بعد تطبيق البرنامج التدريبى لمكافحة العدوى بنسبة 63.3% و 7.8 %  لدى أطباء الأسنان والأطباء، على التوالى . وقد تبين أنه كلما ازداد مستوى معرفة المتدرب بهذه الإصابات كلما قلت قابليته للإصابة بها.  وفى جانب آخر، كانت نسبة التطعيم ضد الالتهاب الكبدى الفيروسى (ب) أكثر ثلاث مرات لدى الأطباء مقارنة بأطباء الأسنان بالرغم من أن معدل التطعيم الاجمالى كان متدنى جداً وبنسبة 15.2% و 4.2% لدى الأطباء وأطباء الأسنان، على التوالى . استنتاجا مما سبق ، تعتبر الإصابة بوخز الإبر مشكلة شائعة بين العاملين فى مجال الرعاية الصحية بمستشفى المنيا الجامعى وكانت التواءات الإبر أو إعادة تغطيتها بعد الاستخدام أكثر الممارسات الغير لائقة انتشارا والتى تزيد احتمالية الإصابة بها . و لذلك لابد من التأكد من تدريب العاملين جيداً على الاستخدام والتخلص الآمن من الأدوات الحادة والذي سيجعل هذه الممارسات أكثر آماناً.

* بتمويل من صندوق مشروع تطوير التعليم العالى بوزارة  التعليم العالى وجامعة المنيا