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:
- Determine the demographics of nurses, frequency, circumstances, reporting as well as most common devices causing needlestick injuries among nursing personnel.
- Assess the knowledge regarding diseases caused by needlestick injuries, measure to be taken following needlestick injuries and awareness about needleless safety devices, during a one-year period.
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.
- The most common device involved in needlestick injuries was a syringe needle, which accounted for 73.9% events.
- Recapping a needle was the most common activity responsible for needlestick injury, accounting for 28.9% of needlestick injury events, and managing a restless patient accounted for 22.2%.
- Putting up an intravenous (IV) line or administering injections and disposal of the used items were responsible for 17.8% events, while
- 6.7% was caused by other activities which included drawing blood from a patient and monitoring a patient’s blood glucose (Table 2).
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%).
Table 3. History of hepatitis B virus vaccination amongst participants
Table 4. Knowledge, practices and preventive measures taken by nurses regarding needlestick injuries
Conclusion and recommendations
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:
- An ongoing education programme on safe working practices including safe handling and disposal of sharp objects should be designed with periodic evaluation of such programme.
- An administrative policy prohibiting the recapping of needles must be instituted.
- Nurses should be involved in the evaluation and selection of an appropriate needleless safety device, training and ongoing training in its appropriate use, as well as ongoing evaluation of the usability and acceptability of such a device.
- Staff members should be involved in the planning of systems to improve the reporting of needlestick injuries so that appropriate protective measure can be taken.
- Measures should be put in place to ensure that the recommended course of hepatitis B vaccination is followed; this should include exploring how checking of antibody to hepatitis surface antigen could be made possible, and providing this at a subsidised rate should be considered, given the importance of the knowledge of one’s immunity to the success of this immunisation.
- It might be beneficial in future to follow a group of nurses over a 12-month period in order to get a higher response rate and a less biased outcome.
Dr Daleen Stuwig, medical writer, Faculty of Health Sciences, University of the Free State, for technical and editorial preparation of the manuscript for publication.
- Needlestick injuries among healthcare workers in South Africa should not be ignored as unacceptable practices, such as re-capping of syringe needles which caused the majority of injuries in this study.
- A health promotion programme on the safe use and risks regarding needles should be presented to healthcare workers on a continuous basis as knowledge relating to the appropriate measures following a needlestick injury was poor.
- Hospitals should ensure that formal reporting produces for needlestick injuries are in place and made known to all employees. Actions are required to encourage reporting as many nurses did not report their needlestick injuries.
- The hepatitis B vaccination programme for healthcare workers should be in line with evidence-based medicine and healthcare workers should be encouraged to complete the vaccination course.