THE EPIDEMIOLOGY OF NEEDLESTICKS AND SHARPS INJURIES AMONG HEALTH CARE WORKERS IN NIGERIA HOSPITALS

THE EPIDEMIOLOGY OF NEEDLESTICKS AND SHARPS INJURIES AMONG HEALTH CARE WORKERS IN NIGERIA HOSPITALS

ABSTRACT

This study focused on the epidemiology of needle Sticks and sharp injuries (NSI) among health care workers (HCW) in Nigerian Hospital. It was a cross sectional descriptive study. Subjects were HCW who are most likely to be exposed to used needles and other sharp instruments.

The instrument of the study was a self-administered questionnaire and analysis was done using SPSS version 15.0 software. Up to 75 4% of HCWs were aware of NSI hazards. There was a relationship between categories of HCWs and awareness of NSI hazards (p<0.05). About 76.1% and 73.9% of HCWs identified HIV and HBV to be associated with NSI respectively.

Majority,  81.7% of HCWs administered injections and 61.8% of these recapped needles. More than half, 56.1% of the respondents incurred NSI injuries with needle recapping accounting for 67. 4% of all the prick injuries. In this study NSI are not related to cadre of HCWs (p>0.05). Use of protective measures were not practiced by majority HCWs. Only, 16.4% used gloves all the time, post exposure HBV immunization was 12.4% and HIV had not been attempted by any of the respondents. In conclusion the study showed clearly that the population of health care workers are at risk of needle stick injures and related hazards, and only very few of them adhere to preventive or protective measures despite high level of awareness of the associated hazards.

Training on preventive measures must be recommended as well as avoidance of needle recapping, reduction in over use of injection in treatment, provision of adequate sharps and none sharps disposal bins and reporting NSI.

CHAPTER ONE

1.1  INTRODUCTION

Health-care providers are at major high-risk for contracting blood-borne infections during the discharge of their duties in health-care facilities now than ever before. Despite the introduction of these preventive procedures in the training of healthcare workers such as nurses, doctors, medical laboratory scientist among others, the possibility of an occupational injury is high due to risk practices among these individuals. Various studies  have revealed that blood-borne infections constitute a sizeable number of serious risk exposures for health-care providers from patients diagnosed with Hepatitis virus (HBV) and Human immunodeficiency virus (HIV) in the course of providing care for these patients.

Health care workers (HCWs) are at a high risk of needle stick injuries and blood-borne pathogens as they perform their clinical activities in a hospital.3  They are exposed to blood borne pathogens, such as human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) viruses, from sharp injuries and contacts with blood and other body fluids.4,5  According to a WHO estimate, in the year 2002, sharp injuries resulted in 16,000 hepatitis C Virus, 66,000 hepatitis B virus and 10,000 HIV infections in health care workers worldwide.6  There is no immunization for HIV and hepatitis C.7  It becomes important to prevent infection by preventing exposure.  Recapping, disassembly, and inappropriate disposal increase the risk of needle stick injury.8,9  The incidence rate of these causative factors is higher in developing countries for the higher rate of injection with previously used syringes.10  Developing countries where the prevalence of HIV-infected patients is very high, record the highest needle stick injuries too.10  Needle stick injuries were also reported as the most common occupational health hazard in a Nigerian teaching hospital.11  The World Health Organization (WHO) estimates that about 2.5% of HIV cases among HCWs and 40% of hepatitis B and C cases among HCWs are the result of these exposures.12  Irrational and  unsafe injection practices are rife in developing countries.13  The practice of recapping needles has been identified as a contributor to incidence of needle stick injuries among HCWs.5, 14 It is believed that only one out of three needle stick injuries are reported in the US, while these injuries virtually go undocumented in many developing countries.15  Unsafe injections and the consequent transmission of blood borne pathogens are suspected to occur routinely in the developing world.16  It was estimated that each person in developing countries receives an average of 1.5 infections per annum.

Occupational safety of HCWs is often neglected in low-income countries in spite of the greater risks associated with occupational exposure to blood, inadequate supply of personal protective equipment (PPE), and limited organizational support for safe practices.33Reports indicate that standard precautions are effective in preventing both occupational exposure incidents and associated infections.25, 63  Compliance with universal precautions has been shown to reduce the risk of exposure to blood and body fluids.64  However, studies have extensively reported suboptimal and non-uniform adherence to standard precautions by HCWs in both developed and developing countries.12, 55, 65, 66  Standard precautions are designed to reduce the risk of transmission of infectious agents from both recognized and unrecognized sources of infection in health care settings.

1.2 STATEMENT OF PROBLEM

The rising prevalence of morbidity and mortality following exposure to blood borne infections is due to the lack of knowledge, wrong attitude towards and non-compliance to standard precautions as well as bad practices such as bending of needles, recapping of needles, detachment of needles, reuse of needles and lack of adequate sharps containers and disposal facilities, shortage of supply of injection equipment and unwarranted and unsafe use of injections, that put both patients and HCWs at risk of occupational exposure.  The improper disposal of used sharps and needles is known to cause needle stick injuries.81 Healthcare workers (HCWs) are at risk of occupational hazards as they perform their clinical activities in the hospital.72  The occupational health of the health care workforce of about 35 million people representing about 12% of the working population has been neglected.72  They are exposed to blood borne infections by pathogens such as HIV, hepatitis B and hepatitis C viruses, from sharps injuries and contacts with deep body fluids.4, 5, 58 In an era of HIV epidemic in sub-Saharan Africa,73 this occupational risk is real and significant.

The Occupational Safety and Health Administration estimates that 5.6 million HCWs worldwide who handle sharp devices, are at risk of occupational exposure to blood borne pathogens.74  These injuries are usually under-reported for so many reasons such as stigmatization, should HIV result from such incidents.15 The sero-prevalence of HIV varies widely from country to country and from one region to another within the same country.75  Sub-Saharan Africa (SSA) has the highest HIV sero-prevalence in the world.75

Occupational safety of HCWs is often neglected in low income countries in spite of the greater risk of infection due to higher disease prevalence, low level awareness of the risks associated with occupational exposure to blood, inadequate supply of personal protective equipment (PPE), and limited organizational support for safe practices.33 Efforts to reduce population levels of infections such as hepatitis and HIV are important goals.

1.3  AIMS  AND OBJECTIVES

The general objective of the study is to determine the  epidemiology of needle Sticks and sharp injuries among health care workers in Nigerian hospitals.

Other Specific Objectives include:

1. To determine the frequency of needle stick injuries among health care workers in Nigerian hospitals.
2. To determine the level of awareness on consequences and type of preventive measures taken on needle stick injuries among health workers.
3. To determine the availability of occupational health services for this category of health workers, immunization, post exposure prophylaxis, protective devices, facilities for universal basic precaution etc.
4. To determine the types of preventive measures in place against needle stick injuries, at the work environment.
5. To determine level of knowledge of health care workers on associated risk factors for needle stick injuries.

1.4 SIGNIFICANCE OF THE STUDY

The following benefits would be derived from carrying out the study:

• To establish the burden of hazards due to needle stick injuries in health care workers in Nigerian hospitals.
• To generate data on needle stick injury.
• To generate data on needle stick injury as evidence based for policy makers on planning for prevention and management.
• The study would also benefit students, researchers and scholars who are interested in developing a further study on the subject matter.

1.5 LIMITATION OF THE STUDY

Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview)

Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

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