- Research note
- Open access
- Published:
Assessment of needle stick and sharp injuries among health care workers in central zone of Tigray, northern Ethiopia
BMC Research Notes volume 12, Article number: 654 (2019)
Abstract
Objective
Accidental occupational injuries to health care workers (HCWs) continue to have a significant problem in the healthcare system. Thus, the aim of this study was to assess prevalence of needle sticks and sharp injury and associated factors among health care workers working in Central Zone Tigray northern Ethiopia.
Result
The prevalence of needle stick and sharp injury in the past 12 months preceding the study and entire job were 25.9% and 38.5% respectively. Nearly one-third (31%) of the injuries occurred in emergency unit and 122 (71.3%) of the materials caused injury were used on patients. Practice of needle recap, ever used cigarette in last 12 months, training, work hours > 40 per week, job dissatisfaction and work experience less than 5 years were found factors significantly associated with needle stick and sharp injury for health care workers. The magnitude of Needle stick and sharp injury is high in the study area. Policy makers should formulate strategies to improve the working condition for healthcare workers and increase their adherence to universal precautions.
Introduction
Needle stick and Sharp injuries are a piercing body trauma caused by a sharp medical equipment that was used to screen, diagnose, treat or follow a patient’s disease conditions [1]. Accidental occupational injuries to health care workers (HCWs) continue to have a significant problem in the healthcare system owing to the associated risks [2,3,4,5]. Globally, more than 35 million healthcare workers suffer from occupational needle stick and sharp injury every year [6]. Most (86%) occupationally related infections are due to needle stick injury [7, 8]. An estimated 500,000; 100,000 and 600,000–800,000 needle sticks and other percutaneus injuries were reported annually in Germany, UK, and USA HCWs, respectively [9]. The risk of pathogen transmission from an injury with a sharp object has been estimated to be 6–30% for Hepatitis B virus (HBV) in non-immune individuals, 5–10% for Hepatitis C virus (HCV), and 0.3% for human immunodeficiency virus (HIV) [10].
Sub-Saharan African countries have the highest share of HIV prevalence and more than 90% of occupational exposure [11]. Furthermore, the exposure of HCWs to needle stick and sharp injuries (NSSI) causes infections, illness, disability, and death impacting the quality of the healthcare system [12,13,14]. Studies reported that there is a high prevalence of needle stick injury among health professionals in Ethiopia; Bahrdar 31% [15] and Hawassa 35.8% [16].
The factors associated with NSSI were socio-demographic factors (work experience, educational status, qualification, monthly income, job category), environmental factors (training on infection prevention, long working hours) and other behavioral factors including recapping needles, Use of personal protective equipments (PPE), not complying with standard operating procedures [17,18,19,20,21]. However, previous studies in Ethiopia were limited on referral hospitals and urban settings. Therefore, this study was aimed to assess the prevalence NSSI and its associated factors associated among healthcare workers at health care facilities in central zone, Tigray, northern Ethiopia.
Main text
Methods
Study area, period, design and population
A facility based cross-sectional study was conducted from February 6, to April 15, 2017 in selected health care facilities of central zone of Tigray which is located approximately 1024 km away from Addis Ababa, Ethiopia. It owns three urban and nine rural districts with a total population of 1,352,557: (663,191 males). In this zone there are 3 general hospitals, 1 comprehensive specialized referral hospital, 6 primary hospitals, 54 health centers and around 200 health posts with 1582 health care workers. All health professionals and auxiliary workers at governmental health care facilities of central zone of Tigray were the source population. From the selected health care facilities, all health care professionals who perform medical procedures on a daily basis, auxiliary workers who worked for at least 1 year and above were included in the study.
Sample size and sampling procedure
The sample size was determined using Open-Epi version 2.3.1 software by taking 19.1% prevalence from previous studies on needle stick and other sharp injury [19], considering 5% marginal error, design effect of 2 and with a contingency of 10%, we obtained 456 respondents. In order to have representative respondents from the two urban and three rural districts, multi-stage sampling technique was used; after the proportional allocation to each health care facility, respondents were selected using simple random sampling.
Data collection method and quality control
An anonymous, structured, interview questionnaire was developed after reviewing relevant literatures that reviewed key variables as well as earlier studies on NSSI among health care workers [5, 14,15,16, 18, 20]. Data were collected using pre-tested structured self administered questionnaire by trained Nurse Professionals under the supervision of medical doctors.
Data analysis
The pre coded responses were entered in Epi-info version 3.5.3, and then exported to SPSS software version 21 for windows. We have used descriptive statistics to explore the entire variables of the study. Both bi-variable and multi-variable binary logistic regressions were used to identify risk factors for NSSI; variables with p value ≤ 0.2 in bi-variable analysis were transferred to a multi-variable analysis to control the effect of confounding. Finally, the 95% CI with p-value of ≤ 0.05 was considered as statistically significant.
Results
Socio-demographic characteristics
From a total of 456 selected health care workers, 444 participated giving a response rate of 97.4%. The mean age of the respondents was 34 (SD ± 9.6) years. The majority of the respondents 213 (48%) were diploma holders in education. The mean time of thier work experience was 11.72 (SD ± 9.8) years (Additional file 1: Table S1). In addition, majority of the respondents were from the outpatient department and nurses in profession (Additional file 2: Fig. S1, Additional file 3: Fig. S2).
Participants behavior and working environment
Majority of the respondents 427 (96.2%) were concerned about the health risks of NSSI, of whom the risk was perceived as high in 325 (73.2%) respondents. One hundred sixty-seven (37.6%) respondents had recapped the needle at least once in 12 months preceding the study, and 76 (45.5%) respondents had recapped the needle using their two hands. Nearly all respondents (96.8%) knew the diseases transmitted through needle stick and sharp injuries. The reported prevalence of substance use was 10 (2.3%), 82 (18.5%), 600 (13.5%) and 6 (1.4%) for khat, alcohol, cigarette and other substances respectively (Additional file 4: Table S2).
Prevalence and circumstances of needle stick and sharp injury
The overall prevalence of NSSI within the past 2 weeks, 12 months and entire job were 3.8% (95% CI of 2 to 5.6), 25.9% (95% CI of 21.8.0 to 30.2), and 38.5% (95% CI of 34 to 43) respectively. Majority 122 (71.3%) were exposed at the day time (Additional file 5: Table S3). Majority of the injuries were associated with needle stick 115 (67.3%). Nearly one-third (31. %) of the injuries occurred in the emergency unit followed by outpatient (15.2%) and maternity ward (13.5%), Laboratory (9.4%) surgical ward (7%), operation theatre unit (6.4%), medical ward (5.3%), and laundry (5.3%) (Additional file 6: Fig. S3). Majority 122 (71.3%) of the materials that caused the injury were used on patients and 52.4% were from unknown cases (Additional file 5: Table S3). The top reasons for the occurrence of NSSI were sudden movement of the patients during procedure 28.1% followed by disposal and cleaning the work area (18.1%), during giving injection (14.6%), needle recapping 12.3% and drawing blood from a patient 11.7% (Additional file 7: Fig. S4).
Factors associated with NSSI within the past 12 months
In the multi-variable logistic regression analysis, the independent factors to needle sticks and sharp injury were, ever smoked cigarette in the last twelve months, training on occupational health and safety practices, working hours per week, job satisfaction and work experience. Study participants who ever practiced needle recap in the last 12 months were 4.3 times more likely to experience injury by needle sticks and other sharps than those who did not recap needles (AOR = 4.326, 95% CI 2.235, 8.373). Health care and auxiliary workers who ever smoked cigarette in the last 12 months were nearly four times more likely to experience needle sticks and sharp injury than those who did not smoke in the last 12 months (AOR = 4.273, 95% CI 1.645, 11.100). Study participants with work experience of less than 5 years were 4.5 times more likely to experience needle sticks and other sharp injury than those with experience of greater than five years (AOR = 4.482, 95% CI 2.189, 9.178) (Table 1).
Discussion
Healthcare workers are at risk to occupational health hazards mainly due to accidental exposure to injuries such as needle stick and/or other sharp materials [2, 13]. Among health care and auxiliary workers of central Zone of Tigray, the prevalence of NSSI was 25.9% (95% CI of 21.8.0% to 30.2%). This finding is higher than the findings in Bale, Ethiopia 19.1% [18] but in line with the studies done in Bahir-dar 29% and Hawasa 28% [17, 19]. This finding was found to be lower than the findings from Hawasa 35.8%, eastern Ethiopia 31% and Jima 44.12% [14, 22, 23]. The possible difference in the magnitude of the injury could be due to the difference in the capacity of the health care facilities, study participants, and the year of the study. However, whatever the difference in the magnitude of NSSI, studies have implicated that healthcare workers are at higher risk of blood borne pathogens such as HIV, HBV, HCV [2, 24]. This study revealed that needle stick was the major instrument for injury (67.3%) which is in agreement with the previous studies conducted in Bahir-dar (77.3%), and Bale (69.8%).
In this study, six independent factors have been found to be significantly associated with needle sticks and sharp injury.Study participants who ever practiced needle recap in the last 12 months were 4.3 times more likely to experience NSSI than those who did not recap needle (AOR = 4.326, 95% CI 2.235, 8.373). This finding is also similar with the studies conducted in Bale, Hawassa and Addis Ababa, Ethiopia [18, 19, 25]. Health care workers who ever used cigarette in the last 12 months were 4.27 times more likely to experience NSSI than those who did not smoke in the last 12 months (AOR = 4.27, 95% CI 1.64, 11.1). Respondents who were not trained on occupational health safety were 14.5 times more likely to experience NSSI than those who were trained (AOR = 14.46, 95% CI 6.88, 30.37) which is similar with the studies done in Tanzania, Gondar and Addis Ababa [21, 25, 26]. According to a study done in Gondar one of the independent predictor of accidental exposure to HIV was lack of training on infection prevention [21]. Similarly, it was evidenced that injection safety training and infection prevention training reduces the risk of getting sharp injuries by 47.9% and 70% respectively [25].
Respondents who work for greater than 40 h per week were 16 times more likely to experience NSSI than those who were working less than or equal to 40 h per week (AOR = 16, 95% CI 6.252, 41.448). This is similar with the findings from Gondar and Addis Ababa [21, 25]. Study participants who were not satisfied by their job were 4.3 times more likely to experience needle sticks and sharp injury than those satisfied (AOR = 4.264, 95% CI, 1.00, 18.11). This finding is also similar with the study conducted in Gondar and Bahir-Dar [15, 21]. This may be due to stress and emotional upset which could results in poor compliance with health and safety issues for the prevention of occupational exposures [21]. Study participants with a work experience of less than 5 years were 4.5 times more likely to experience NSSI than those with an experience of greater than 5 years (AOR = 4.482, 95% CI 2.189, 9.178). This finding is contradicting with study in Bahr-Dar [17]. The possible difference could be due to the difference in the competency of the junior professionals and availability of supportive capacity building programs.
In conclusion, this study revealed that one-fourth of the respondents had needle stick and sharp injury at least once per year; still the magnitude of NNSI is high in the study area. Practice of needle recap, cigarette smoking, lack of training on occupational health and safety, more working hours per week, job dissatisfaction and less work experience were found to be the major identified risk factors. Therefore, policy makers and health care planners should formulate strategies to improve the working condition for healthcare workers and increase their adherence to universal precautions.
Limitation
The accuracy of the past experince of the rspondents with regard to the ocurence of the NNSI mighthave been affected by recall bias.
Availability of data and materials
The datasets in which conclusion taken is available in the form of Microsoft Excel. It is available on requesting.
Abbreviations
- AKU:
-
Aksum University
- BBF:
-
blood and body fluid
- HBV:
-
Hepatitis B virus
- HCV:
-
Hepatitis C virus
- HIV:
-
human immunodeficiency virus
- IPPS:
-
Infection Prevention and Patient Safety
- NSIs:
-
needle sticks injury
- NSSIs:
-
needle stick and sharp injuries
- WHO:
-
World Health Organization
References
Zhang M, Wang H, Miao J, Du X, Li T, Wu Z. Occupational exposure to blood and body fluids among health care workers in a general hospital, China. Am J Ind Med. 2009;52(2):89–98.
Prüss-Üstün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med. 2005;48(6):482–90.
Cheng H-C, Su C-Y, Yen A-M, Huang C-F. Factors affecting occupational exposure to needlestick and sharps injuries among dentists in Taiwan: a nationwide survey. PLoS ONE. 2012;7(4):34911.
O’Connor M. Needlestick injury advice in the UK and Ireland. J Hosp Infect. 2009;71(2):185–6.
Memish ZA, Assiri AM, Eldalatony MM, Hathout HM, Alzoman H, Undaya M. Risk analysis of needle stick and sharp object injuries among health care workers in a tertiary care hospital (Saudi Arabia). J Epidemiol Global Health. 2013;3(3):123–9.
Deisenhammer S, Radon K, Nowak D, Reichert J. Needlestick injuries during medical training. J Hosp Infect. 2006;63(3):263–7.
Rezaeian M, Asadpour M, Khademrezaeian H. Epidemiology of occupational exposure to needlestick and body fluids among doctors and medical students in Rafsanjan University of Medical Sciences. J Occup Health Epidemiol. 2012;1(1):44–9.
Shah R, Mehta H, Fancy M, Nayak S, Donga BN. Knowledge and awareness regarding needle stick injuries among health care workers in tertiary care hospital in Ahmedabad, Gujarat. Nat J Com Med. 2010;1:93–6.
Rampal L, Zakaria R, Sook LW, Zain AM. Needle stick and sharps injuries and factors associated among health care workers in a Malaysian hospital. Eur J Soc Sci. 2010;13(3):354–62.
Sjöström HT, Skyman E, Hellström L, Kula M, Grinevika V. Cross-infection prevention, basic hygiene practices and education within nursing and health care in Latvia: a Swedish-Latvian practice development project. Nurse Educ Today. 2003;23(6):404–11.
Mashoto KO, Mubyazi GM, Makundi E, Mohamed H, Malebo HM. Estimated risk of HIV acquisition and practice for preventing occupational exposure: a study of healthcare workers at Tumbi and Dodoma Hospitals, Tanzania. BMC Health Serv Res. 2013;13(1):1.
Bekele A, Kotisso B, Shiferaw S. Work-related operating theatre accidents among surgical residents in Addis Ababa, Ethiopia. 2008.
Tadesse M, Tadesse T. Epidemiology of needlestick injuries among health-care workers in Awassa City, Southern Ethiopia. Tropical doctor. 2010;40(2):111–3.
Kebede G, Molla M, Sharma HR. Needle stick and sharps injuries among health care workers in Gondar city, Ethiopia. Saf Sci. 2012;50(4):1093–7.
Walle L, Abebe E, Tsegaye M, Franco H, Birhanu D, Azage M. Factors associated with needle stick and sharp injuries among healthcare workers in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: facility based cross-sectional survey. Int J Infect Control. 2013;9:4.
Mengesha HB, Yirsaw BD. Occupational Risk Factors Associated with Needle-Stick Injury among Healthcare Workers in Hawassa City, Southern Ethiopia. Occupational Medicine & Health Affairs. 2014;2014.
Yenesew MA, Fekadu GA. Occupational exposure to blood and body fluids among health care professionals in Bahir Dar town, Northwest Ethiopia. Saf Health Work. 2014;5(1):17–22.
Kaweti G, Abegaz T. Prevalence of percutaneous injuries and associated factors among health care workers in Hawassa referral and adare District hospitals, Hawassa, Ethiopia, January 2014. BMC Public Health. 2016;16(1):1.
Bekele T, Gebremariam A, Kaso M, Ahmed K. Factors associated with occupational needle stick and sharps injuries among Hospital Healthcare workers in Bale Zone, Southeast Ethiopia. PLoS ONE. 2015;10(10):e0140382.
Aynalem Tesfay F, Dejenie Habtewold T. Assessment of prevalence and determinants of occupational exposure to HIV infection among healthcare workers in selected health institutions in debre Berhan town, North shoa zone, Amhara region, Ethiopia, 2014. AIDS Res Treat. 2014. p. 2014.
Beyera GK, Beyen TK. Epidemiology of exposure to HIV/AIDS risky conditions in healthcare settings: the case of health facilities in Gondar City, North West Ethiopia. BMC Public Health. 2014;14(1):1–8.
Reda AA, Fisseha S, Mengistie B, Vandeweerd J-M. Standard precautions: occupational exposure and behavior of health care workers in Ethiopia. PLoS ONE. 2010;5(12):e14420.
Beker J, Bamlie T. Needle Stick and Sharp Injuries and Associated Factors among Nurses Working In Jimma University Specialized Hospital, South West Ethiopia. J Nurs Care. 2015;4:1–8.
Egwuda L, Igbudu TJ. Needle-stick/Sharps injuries among health care workers in a Tertiary hospital, Makurdi, Nigeria.
Feleke BE. Prevalence and determinant factors for sharp injuries among Addis Ababa Hospitals Health Professionals. Sci J Public Health. 2013;1(5):189–93.
Chalya PL, Seni J, Mushi MF, Mirambo MM, Jaka H, Rambau PF, et al. Needle-stick injuries and splash exposures among health-care workers at a tertiary care hospital in north-western Tanzania. Tanzania J Health Res. 2015;17:2.
Acknowledgements
We would like to give sincere thanks to Aksum University for financial support in conducting the research. Our heartfelt thank also goes to Aksum health insurance, Tigray central zone Administration, concerned health facilities and all study participants for their cooperation during this study.
Funding
Aksum University has financially supported the process of data collection. The funder has no role in the design and outcome of the study.
Author information
Authors and Affiliations
Contributions
EW wrote the proposal, participated in data collection, analyzed the data, and drafted the paper. DT, BB, ZW, HG and MT approved the proposal, participated in data analysis and revised subsequent drafts of the paper. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Ethical clearance was obtained from Aksum University College of health sciences, Ethical review committee. Permission to conduct the study was obtained from all selected district health offices and each selected health facility. Written consent was obtained after the potential participants were informed of the study’s objectives and reading the information sheet. Only participants who gave consent to participate were included in the study. All participants were also informed that they could withhold or withdraw from participation at any time, without any negative consequences. Confidentiality and privacy of the study were maintained during data collection, analysis, and reporting.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Additional file 1: Table S1.
Socio-demographic characteristics of health care and auxiliary workers at central zone of Tigray, northern Ethiopia, 2017 (n = 444).
Additional file 2: Figure S1.
A bar graph which shows job category of health care and auxiliary workers in central Zone Tigray, northern Ethiopia, 2017.
Additional file 3: Figure S2.
A bar graph which shows Current working department of health care and auxiliary workers in central Zone Tigray, northern Ethiopia, 2017.
Additional file 4: Table S2.
Participants behavior and working environment of health care and auxiliary workers at central zone of Tigray, northern astern Ethiopia, 2017.
Additional file 5: Table S3.
Needle and Sharp handling method of health care and auxiliary workers at central zone of Tigray, northern Ethiopia, 2017.
Additional file 6: Figure S3.
A bar graph shows place where needle sticks and sharp injury occurred among health care workers in central Zone Tigray, northern Ethiopia, 2017.
Additional file 7: Figure S4.
A bar graph which shows the reason for the occurrence of needle sticks and sharp injury among health care and auxiliary workers in central Zone Tigray, northern Ethiopia, 2017.
Rights and permissions
Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
About this article
Cite this article
Weldesamuel, E., Gebreyesus, H., Beyene, B. et al. Assessment of needle stick and sharp injuries among health care workers in central zone of Tigray, northern Ethiopia. BMC Res Notes 12, 654 (2019). https://doi.org/10.1186/s13104-019-4683-4
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s13104-019-4683-4