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LETTER TO THE EDITOR
Year : 2012  |  Volume : 56  |  Issue : 1  |  Page : 101-103  

Study on prevalence of needle stick injury among health care workers in a tertiary care hospital in New Delhi: A two-year review


1 Department of Microbiology, Maulana Azad Medical College, New Delhi, India
2 Emergency Microbiology Laboratory, LNJP Hospital, New Delhi, India

Date of Web Publication6-Jun-2012

Correspondence Address:
Abha Sharma
Department of Microbiology, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.96987

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How to cite this article:
Sharma A, Gur R, Bhalla P. Study on prevalence of needle stick injury among health care workers in a tertiary care hospital in New Delhi: A two-year review. Indian J Public Health 2012;56:101-3

How to cite this URL:
Sharma A, Gur R, Bhalla P. Study on prevalence of needle stick injury among health care workers in a tertiary care hospital in New Delhi: A two-year review. Indian J Public Health [serial online] 2012 [cited 2019 Aug 20];56:101-3. Available from: http://www.ijph.in/text.asp?2012/56/1/101/96987

Sir,

Health care workers (HCWs) are at a risk of occupational acquisition of human immunodeficiency virus (HIV) infection and other viral infections (HCV and HBV) due to accidental exposure to infected blood and body fluids. [1] The reporting of such injuries is a critical step in initiating early prophylaxis. [2]

The HCWs at Lok Nayak Hospital in New Delhi reported their needle stick injuries immediately after exposure, which required completion of a questionnaire concerning the exposure. The questionnaire includes personal details of HCW, location, time and date of injury, type of injury, job category, immediate precautions taken (allowed to bleed, wash with soap and water, and application of antiseptics), post-exposure prophylaxis (PEP) if started, and prophylactic hepatitis B vaccine if taken. All exposed HCWs and source patients, after taking an informed consent from the patients, were screened for baseline status for HIV 1 and 2 as per NACO guidelines, HCV and HBV infections by rapid screening tests. All positive results were confirmed by ELISA. The HCWs were referred to the ART clinic where the source was HIV positive and the ART in charge would decide on the appropriate management in each case. The HCW was instructed to continue follow up for HIV testing after 3 months and if seronegative, after 6 months.

A total of 376 self-reported cases of needle stick injuries were reported by HCWs. Among them, 55.6% were males and 47.3% were females. Interns had the highest percentage (47%) of needle stick injuries, followed by junior residents (27.08%) and staff nurses (10.1%). The cases of injury reported by the cleaning staff of the hospital was 1.1% suggesting that in addition to sample collection, giving injections to the patients, carrying out surgical procedures, another important area is the waste disposal system where such injuries can be encountered. A greater prevalence of needle stick injuries was observed in the medicine department as compared to the surgery department. Proportion of injury in other departments was as follows: Gynecology and Obstetrics (8.3%), Burns and Plastic Surgery (3.2%), Orthopedics (0.5%), Pediatrics (5.05%) and others such as ENT, Dermatology, Pathology, Microbiology, and Anesthesia (25%). HCWs were most commonly injured in wards (78.2%), followed by casualty (5.9%) and ICU (5.6%). Among them, most (43%) had a mild type of exposure. Maximum HCWs (37.5%) washed the wound followed by bleed and application of an antiseptic. Universal precautions were practiced by 73.6% of the HCWs and 81.9% were immunized with HBV vaccine. The results of one study [3] showed that the level of practice of universal precautions was inversely related to the episodes of needle stick injury, which means that the episodes of injury can be reduced if the level of practice of universal precautions is improved. Most (94.4%) of them had no history of blood transfusion. All exposed HCWs and source patients were screened for HIV 1 and 2, HCV, and HBV infections by rapid screening tests. All positive results were confirmed by ELISA. Among the exposed HCWs, two were positive for HIV-1 antibody, two were positive for anti-HCV whereas only one was positive for HBsAg. Among the source patients, 8 were HIV-1antibody positive, 5 were anti-HCV positive, and 10 were HBsAg positive. Only 20 HCWs reported for follow-up and none of them had developed infection after needle stick injury.

These data emphasize the risk of needle stick injuries in HCWs. The reporting date of needle stick injury is varied by job categories. In a study from United States, nurses accounted for 68%, interns for 35%, and resident doctors for 31% of BBF exposures. [4] Another study conducted in Mumbai, India, observed that the incidence of occupational exposure due to infected blood and body fluids were highest among resident doctors (76%), followed by nurses (11%), and interns (5%). [5] Since interns in our hospital have more patient contact because sample collection is mainly done by them, there are more frequent uses of needles by them than physicians or nurses, and it is not surprising that interns should report a higher incidence of needle stick injury during sample collection. These findings suggests the need for improved continuing education programs which verify competency of HCWs, especially interns about standard precautions and risk of needle stick injuries. A surveillance of HCWs exposed to BBF exposures in Canada [6] reported 17% exposures from medicine wards and 7% from surgical wards. Although it is anticipated that injuries should be more from surgery departments rather than medicine departments, because of increased exposure to sharp devices, instruments, and needles during operating procedures. The higher percentage of injuries from the medicine department in our hospital may be due to more samples being collected for investigations performed in medical patients than surgical patients for diagnosing medical illness. The reason for more needle stick injuries in Casualty and ICU may be that the HCWs have to take fast actions to provide rapid health care services to the patients in crisis due to which chances of accidents increase. In 2007, injuries were the highest in August and in 2008, in May. The most likely reason for the incidence change in different months may be due to the fact that the patient load in our hospital is more in summers and less in winters. The first aid is a crucial factor to decrease the risk of infection from needle stick injuries. Washing the wound immediately and thoroughly with soap and water is the most important management.

To reduce the risks and effects of needle stick injuries among HCWs, adequate education of HCWs about the risk and prevention of needle stick injuries and post-exposure management is required. Especially, the medical school administrators should include teaching programs for risk reduction in the MBBS teaching curriculum during the preclinical years and reinforce during each clinical posting so that in internship the risk of needle stick injuries are reduced among interns. The specific recommendations in our hospital include mandatory hepatitis B vaccination for all medical students including interns and other HCWs. During sample collection, use of AD syringes and vacutainers are encouraged as safer practices. The Hospital Infection Control Committee of LNJP Hospital conducts regular meetings to review all needle stick injuries reported by the HCWs to ensure follow up. In our hospital, all needle stick injury cases are reported first to the casualty medical officer, who then refers the cases to the emergency microbiology laboratory of the hospital, which provides 24 h service for further follow-up. It is ensured that unsafe work practices such as recapping needles are avoided, used needles are disposed of promptly in an appropriate sharp instrument disposal container. Finally, efforts are being made to improve the surveillance systems for needle stick injuries and collected data are analyzed to develop and assess methods to decrease the risk to HCW exposure.

 
   References Top

1.Doig C. Education of medical students and house staff to prevent hazardous occupational exposure. CMAJ 2000;162:344-5.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Makary MA, Al-Attar A, Holzmueller CG, Sexton JB, Syin D. Needle stick injuires among surgeons in training. N Engl J Med 2007;356:2693-9.  Back to cited text no. 2
    
3.Noorsayani MY, Hassim IN. Study on incidence of needle stick injury and factors associated with this problem among medical students. J Occup Health 2003;45:172-8.  Back to cited text no. 3
    
4.Alvarado-Ramy F, Belttrami EM, Short LJ, Srivastava PU, Henry K, Mendelson M, et al. A Comprehensive approach to percutaneous injury prevention during phlebotomy: Results of a multicenter study, 1993-1995. Infect Control Hosp Epidemiol 2003;24:97-104.  Back to cited text no. 4
    
5.Rele M, Mathur M, Turbadkar D. Risk of needle stick injuries in health care workers-A report. Indian J Med Microbiol 2002;20:206-7.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Nguyen M, Paton S, Villeneuve PJ. Update. Surveillance of healthcare workers exposed to blood/body fluids and bloodborne pathogens: 1 April, 2000 to 31 March, 2001. Can Commun Dis Rep 2001;27:201-9, 212.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  



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