Online Open Access publishing platform for Management Research Copyright by the authors - Licensee IPA- Under Creative Commons license 3.0 Research Article ISSN 2229 3795 A study on assessing the awareness on needle stick injury (NSI) with regard to infection control measures among the paramedical and Housekeeping staffs Nirmala Devi N, Sharanya Paranthaman, Bhooma Devi 1- MBA student, Sri Ramachandra University, Chennai, India 2- Lecturer, Sri Ramachandra University. 3- Senior Lecturer, Sri Ramachandra University. sharuaaru@gmail.com ABSTRACT One of the possibilities for Nosocomial infection is commonly through Needle stick injury in many of the hospitals. The purpose of this study was to determine the awareness of needle sticks injury among paramedical and housekeeping staff. Objective of the study is to analyze the awareness level among the various categories of the staff based on designation, department, and unit wise with regard to needle stick injury (NSI) and to suggest measures for controlling infections caused due to needle stick injury. Sample size of 185 was chosen from different departments using stratified simple random technique. This study was done using primary data which was collected by preparing a questionnaire. The analysis was done using percentage analysis as the tool. It was found that 73% of the staff was aware, 24% were unaware and 3% did not answer to the questions regarding NSI. About 25% and 37% of ward boys, male nurse assistants and housekeeping staffs were unaware regarding NSI. Disposal procedures for needles were unknown to 7 staff nurse.48 staff nurse and 19 laboratory staff were unaware regarding the reporting of NSI. Findings of the study shows that the level of awareness among the staff is inadequate, therefore training programs were suggested for the staffs. The awareness among the other staff that may get injured, were covered under this study. The preventive and also suggestions to prevent NSI were explained clearly. Key words: Infections, Needle stick injury, paramedical, housekeeping. 1. Introduction Needle stick injury - Sleeping threat to health care workers Injuries caused due to needles are very common in hospitals. Needles accidentally puncture the skin, leading to blood borne pathogenic diseases. People who are in hazardous environment are those who use hypodermic needle and other needle equipment s. During usage, disassembling, or while disposing of the needles, needle stick injuries can occur. Generally in a hospital one third of nursing and laboratory staff are suffering such injuries every year. Thousands of healthcare workers get needle sticks because they fail to use the safety locks installed on the needles. Waste that is generated in the hospital is called as health care waste. Hospitals use Syringes and those sharps are one of the types of risk waste. The healthcare provider, the patient and also the whole community at large will be affected due to improper management of medical waste. If infection is to be prevented, safe disposal procedures should be followed this was explained by Ilyas M(2000) in the journal called 561
Hospital and Biomedical Waste Management, Community Medicine and Public Health. 5th ed. Time Publishers, Karachi;621-623. Biomedical waste management is very important and also image of the healthcare provider increases with the delivery of good quality service. All the staffs working in the hospital are equally responsible in the proper disposal of waste. The foundation of infection prevention is based on the good housekeeping practices. This practice reduces microorganisms, reduces the risk of accidents, and provides an appealing work and service-delivery space. Many workers do not report to the concerned staff for the post exposure prophylaxis, thereby the estimation cannot be made regarding the percentage of injuries that occur due to needles and other sharps. Many staffs do not know the procedure to report the NSI. Workload pressure of healthcare is one of the reasons for unreported cases of NSI because reporting process is perceived as time-consuming (Connington, 2002; Burke and Madan, 1997). The process of reporting injuries should be made simple and efficient, so that injured persons infection rate can be decreased. To bring an improvement in the number of NSI injury cases reported it is important to understand the health-care workers' behavior in healthcare organizations. Transmission of infectious diseases, mainly blood-borne viruses is possible when any needle stick injury occurs. During recent years, more concern about HIV, Hepatitis B, and C has prompted to perform research in identifying why these injuries occur and also in developing measures to prevent them. Needle stick injuries remain an ongoing problem despite the published guidelines and training programs. In nursing services and laboratory department certain factors influence the occurrence are equipment design, nature of the procedure, and condition of work, staff experience, recapping, and disposal procedures. The awareness among the staff is very important in any hospital and therefore this study fully focused in assessing the awareness of the staff. According to American Nurses Association (ANA) only about 1,000 healthcare workers actually contract an infection that of the numerous needle stick injuries that occurs in hospitals. Nurses get exposed not only to blood borne pathogens but also there are possibilities for about 20 other infections, including tuberculosis, syphilis, and malaria. The National Institute of Occupational Safety and Health (NIOSH) and United States Centers for Disease Control and Prevention (CDC) together issued a report in 2000 stating that sharps should be eliminated from use whenever possible. 2. Review of literature Cruse et al, (1980) reported that infections that are acquired in hospitals which are called as nosocomial infections have been of increasing concern to health care providers, consumers, insurers and governments. Aiken, et al, (1997) suggested that during the recapping of needle injuries are occurring in more numbers. Stone et al, 2004 performed the study on analyzing the working conditions, short staffing, and the influence on increases in accidental. Gershon and Flanagan (2000) said that 500,000 NSI are occurring per year in US, among which 1 in 100 are acquiring HIV. Alam (2002) conducted study and stated that awareness levels among workers regarding the fact that HIV and Hepatitis gets transmitted through NSI and percentage of awareness was between 21% and 30%. About 70% are getting admitted due to previous history of needle sticks. Deisenhammer, Radon, and Nowak, (2001) identified by performing study regarding that education levels and work environment has the influence on how different levels of education and work environment influenced needle stick exposures in a medical student population. Bartosz Bilski (2005) pursued study at Department of Preventive Medicine Medical University, Poland and found that the needle stick injury in his study group per year was 28.0%. In dialysis units, emergency medical care, surgical wards, 562
and operating rooms were areas where NSI are more common among nurses. Majority of cases that causes injuries were self-inflicted. Improper handling of syringes and needles after injections are the causes for injuries. Smith, and Leggat, (2005) sample population for the study was nursing students, findings implicit that uncapping needles and leaving it open resulted in the large no of injuries. Cervini andbell, (2005) identified that the procedure for reporting the needle stick injury was not known because, students lack knowledge regarding the effects of NSI. Mungure et al, (2007) research was to identify the level of awareness and experience of needle stick injuries among the dental students and concluded that the awareness levels was high regarding the risk of cross-infection from NSI. The awareness regarding the means of prevention and protocol was low. Rajiv saini (2011) conducted study among students to assess the knowledge and awareness regarding NSI by cross-sectional observation method. Findings of the study show that 91.55% adequate level of awareness, and 08.45% incorrect level of awareness was found about management of needle stick injury. 3. Research objective 1. To observe the procedures of the staffs in handling the needles and their disposal activities. 2. To analyze the awareness level among the various categories of the staff based on designation, department, and unit wise with regard to needle stick injury. 3. To explain and give awareness regarding the post exposure prophylaxis to the staff, regarding Needle stick injury through hospital management trainers. 4. To suggest measures for controlling infections caused due to needle stick injury 5. Education to the staff as per the protocol of staff, based on the findings of the study. 4. Research methodology 4.1 Steps in methodology 1. Hospital is selected as the area of research to perform the study and the target population is those who are prone to acquire NSI. 2. Based on the demographic data obtained from the hospital, the categorization of staff is done. 3. In this descriptive research questionnaire is used as the tool for data collection; and 185 samples were selected by using probability sampling technique in which stratified simple random technique is used. 4. Percentage analysis, bar charts and pie chart are used as the statistical tools for analyzing the awareness levels regarding NSI. 5. Finally the results and findings are obtained. 4.2 Analysis and interpretation Table 1: Demographic data (Source: Secondary data) S.no Demographic data Number Percentage 1. Contribution Total strength 1805 10.25% 563
Contributed 185 2. Designation Total categories Contributed designation 3. Department Total categories Departments participated 15 11 13 12 73.3% 92.3% Figure 1: Awareness regarding needle stick injury of all the staff (Source: Primary data) Figure 2: Participation of the staff based on designation illustrated in the bar chart (Source: Primary data) 564
Table 2: Awareness percentages of the staff based on designations regarding nsi (Source: Primary data) Staffs Aware Unaware Not answered Nursing officers 86% 13% 1% Nurse Aid 77.5% 19.5% 3% Ward Boys, Male nurse Assistant 69% 25% 6% Laboratory staff 81% 19% 0% Housekeeping staff 51% 37% 12.6% Staff Nurse 75% 24% 1% ANM 93% 7% 0% Total staff awareness 73% 24% 3% Table 3: Disposal of needle (Source: Primary data) No of staff aware regarding needle disposal procedure Nursing officer Nurse Aid Ward boys Laboratory Ayah Staff nurse ANM Aware 11 17 27 26 13 76 3 Unaware 1 1 1 0 1 7 0 Not Answered 0 0 0 0 1 0 0 Figure 3: Awareness regarding disposal of needle Table 4: Post exposure prophylaxis (Source: Primary data) Nursing Nurse Ward Staff Laboratory Ayah off Aid boys nurse ANM Aware 12 18 25 25 11 79 3 Not aware 0 0 3 1 3 1 0 Not Answered 0 0 0 0 1 3 0 565
Figure 4: Awareness of the staff regarding post exposure prophylaxis Table 5: Communications after needle sticks injury (Source: primary data) Nursing officer Nurse Aid Ward boys Laboratory Ayah Staff nurse ANM Aware 10 11 20 19 4 63 3 Not Aware 2 6 8 7 10 18 0 Not Answered 0 1 0 0 1 2 0 Figure 5: Awarenss regarding communication after needle sticks injury 566
Table 6: Awareness of the staff regarding form to be filled after NSI (Source: Primary data) Nursing officer Nurse Aid Ward boys Laborator y Aya h Staff nurse Aware 7 6 5 7 3 35 3 Not Aware 5 11 11 19 9 48 0 Not answered ANM 0 1 12 0 3 0 0 5. Result and discussion By analysis using the statistical tools, it was found that the 73% of the staff were aware and 24% were unaware and 1% did not answer the questions and it is shown in figure 1. Regarding the participation of staff based on the designation is shown in the Bar chart figure no 2. Awareness of the staff regarding NSI was assessed in this study. Analysis performed designation wise is well explained in the table no: 3 where each staffs awareness percentages were specified. From the table it shows that awareness percentage is very low for third level categories such as housekeeping, male nurse assistants and ward boys 37% and 25% respectively. 7 staff nurse were unaware regarding the disposal procedures of needles. With respect to the post exposure prophylaxis ward boys and housekeeping staffs were unaware which is illustrated in table 4. The bar chart (figure no: 5) shows the result of the staffs response towards the communications that to be done after NSI. The overall findings of the study show that the awareness of the housekeeping and ward boys is inadequate. 5.1 Limitation of study 1. The study was limited to the period of one month 2. The study was related to assessing the knowledge and awareness level about the NSI in high risk areas such as ICU, NICU etc. 5.2 Conclusion 1. The researcher took up to study the awareness levels among the staff in order to prevent the NSI. From the research it was found that 73% of the staffs are aware regarding NSI and 24% were unaware and 3% of staff did not answer as shown in figure no: 1. 2. The suggestions for the study are to make use of retractable devices and follow the disposal procedures accurately. The appraisal for the reporting of the Needle prick cases would beneficiate the hospital to identify the no of NSI that occur. 3. Awareness and training for the staff will improve the knowledge of the working groups so that precautionary measures can be taken and post exposure prophylaxis can be performed correctly. 4. The study would beneficiate the Hospital and its staff in preventing the Needle stick injury if the standards are followed and recommendations to attain the aim of the hospital i.e. Zero Needle stick injury. 567
5.3 Future work As this study includes only the awareness part further studies can be done on this objectives with respect to injuries rate that occurs in the hospital and also the number of unreported cases of the staffs who work with the needles. Further research can be proceeded because this problem usually seen in the hospitals always. 6. References 1. Cruse, P. and Ford, R., (1980), The epidemiology of wound infection: a 10-year prospective study of 62, 939 wounds, Surgery Clinical North America, 60, pp 27.40. 2. Aiken, L., Klocinski, J., and Sloane, D. (1997)p Hospital nurses occupational exposure to blood: prospective, retrospective, and institutional reports. American Journal of Public Health, 87(2), pp 103-107. 3. Burke, S., Madan, I. (1997), Contamination incidents among doctors and midwives: 4. Gershon, M. R., and Flanagan. A. P. (2000), Health care workers experience with post exposure management of blood borne pathogen exposures: A pilot study. The Department of Environmental Health Sciences, pp 421-428. 5. Ilyas M (2000) Hospital and Biomedical Waste Management. Community Medicine and Public Health. 5th ed. Time Publishers, Karachi, pp 621-623. 6. Deisenhammer, S., Radon, K., and Nowak, D. (2001), Needle stick injuries during medical training. Journal of Hospital Infection, 63, pp 263-267. 7. Connington, A. (2002), Has the Point been Made? A needle-stick injury awareness survey. SafeGard Medical. Available at www.needlestickforum.net 8. Bartosz bilski (2005), International Journal of Occupational Medicine and Environmental Health, 18(3),pp 251-254 9. Smith, D. R., and Leggat, P. A. (2005), Issues and innovations in nursing practice: Needles tick and sharps injuries among nursing students. Journal of Advanced Nursing, 51(5), pp 449-455. 10. Cervini, P., and Bell, C. (2005), Brief report: Needle stick injury and inadequate postexposure practice in medical students. Journal of General Internal Medicine, 20(5), pp 419-421. 11. Drexler, H., Schmid, K., and Schwager, C. (2007), Needle stick injuries and other occupations exposures to body fluids amongst employees and medical students of a German university: Incidence and follow-up. Journal of Hospital Infection, 67, pp 124-130. 12. Mungure EK, Gakonyo JM, Mamdani Z, (2007), Awareness and experience of needle stick injuries among dental students at the University of Nairobi, Dental Hospital. 568
13. Kothari, C. R., Research methodology, New Delhi, New Age International Pvt. Ltd., 1985 569