February 10, 2020
Needlestick injuries among nurses in a regional hospital in South Africa
William H Kruger
Chief Specialist, Department of Community Health, Faculty of Health Sciences, University of the Free State.
S Oluwatosi Jimoh
Affiliation at the time of the study: Advanced University Diploma in Occupational Health student, Department of Current affiliation: Registrar, Department of Family Medicine, University of KwaZulu-Natal.
Head, Department of Biostatistics, Faculty of Health Sciences, University of the Free State.
Needlestick injury in healthcare settings is a global issue, with the preponderance of these injuries among nursing staff being a common occurrence. A cross-sectional study was conducted on 202 nurses in a regional hospital using a 17 item anonymous self- administered questionnaire to describe the epidemiology of self-reported needlestick injury in a one year period 38 nurses (18.8%) indicated that they had had needlestick injuries in the previous 12 months. Most (78.3%) needlestick injuries occurred in wards with syringe needles being the most common causative device, while 28.9% occurred during recapping of needles. The majority of respondents (90.1%) were aware of the hospital policy on needlestick injury. Although needlestick injuries were prevalent at a low rate, only 50% were reported. It remains an important workplace hazard that needs on-going attention such as training, as it could be the cause for diseases, for example HIV and hepatitis B, among nurses.
Needlestick injuries remain a potentially life-threatening occurrence for healthcare workers (HCWs) globally and up to 16 billion healthcare injections administered annually are necessary. These actions result in increased risk for blood-borne infections making needlestick injuries the most common source of occupational exposure to blood and blood-borne infections globally. A healthcare workers risk of contracting HIV after an accidental needlestick injury from a HIV-positive source is 1 in 250, 5% for HBV and 3.5% for HCV. The WHO reported in 2002 that an estimated 2.5% of HIV cases and 40% of hepatitis B and C cases among healthcare workers worldwide could be attributed to the occupational exposure to blood-borne infections.
The preponderance of needlestick injuries occurring in nursing staff is a common feature of studies around the world. Nurses have presented the highest HIV seroconversion rates with figures around two thirds of disease seroconversion following needlestick injury. The majority of needle injury statistics and research globally used the data from officially reported incidents and such an approach may not accurately portray workplace events.
In South Africa, 31 – 38% of nurses and doctors did not report their needlestick injury. Anonymous self-report surveys have become increasingly common for establishing the epidemiology of needlestick injuries in hospital environments.
The purpose of the study was to describe the epidemiology of self-reported needlestick injury in a one-year period. The objectives were to:
There were 202 completed questionnaires out of the targeted 330, giving a response rate of 61.2%. Table 1 shows the shows the demographic profile of participants.
Table 1. Demographic characteristics of nursing personnel (participants) (N = 202)
Professional nurses account for 41.1% of the respondents, followed by enrolled nursing assistants (35.6%). A total of 38 nurses (18.8%) reported 48 needlestick injury events in the 12 months preceding the study, accounting for a rate of approximately 0.24 needlestick injury events / nurse / year, while only 50% of these needlestick injuries were officially reported. Nine of the 38 nurses had more than one needlestick in the previous year. The majority of the needlestick injuries occurred in the wards with 15.2% occurring in the emergency department.
Table 2. Procedure or incident related to needlestick injury (n=45*)
Table 3 shows that 89.6% of the participants had a history of receiving vaccinations against hepatitis B virus. Slightly more than 60% of these 181 participants had received three vaccinations.
With regard to knowledge about and practices and preventative measures by nurses (Table 4), 67.8% of respondents knew about needlestick safety devices and 90.1% of participants stated that they were aware of the hospital’s policy on needlestick injury. Most of the participants (70.3%) never recapped used needles. Concerning diseases transmitted by needlestick injuries, 82.2% knew that hepatitis B could be transmitted by needlestick injuries, while 97.0% and 21.8% indicated that HIV and hepatitis C respectively could be transmitted by needlestick injury. Table 4 shows the results with regard to measures that would be taken following a needlestick injury.
Significantly fewer enrolled nursing assistants (66.7%) knew that hepatitis B could be transmitted by needlestick injuries than professional nurses (97.8%) and enrolled nurses (87.2%).
Overall, the results of this study revealed that needlestick injury occurred at a lower rate when compared to other studies, and consequently the risk of blood-borne infection via needlestick injury might be lower. The high proportion of needlestick injury that was reported in comparison to other studies, was encouraging. The majority of the needlestick injury events occurred in the ward, with syringe needles being the most commonly involved causative device, and most events occurring during the recapping of used needles. The knowledge about needleless safety devices was high and should be used to the advantage of the hospital. Measures taken to prevent hepatitis B virus were inadequate and also knowledge with regard to some of the aspects of diseases caused by needlestick injury. The recommendations from the study are:
Dr Daleen Stuwig, medical writer, Faculty of Health Sciences, University of the Free State, for technical and editorial preparation of the manuscript for publication.