|Year : 2017 | Volume
| Issue : 2 | Page : 47-51
Magnitude and profile of occupational exposures to blood and body fluids among health-care workers: A study from a tertiary care teaching hospital
Chithra Valsan1, Jane Paul2, Praveenlal Kuttichira3, Resmi Varghese2, Sophiya Joseph2
1 Department of Microbiology, Jubilee Mission Medical College, Thrissur, Kerala, India
2 Hospital Infection Control, Jubilee Mission Medical College, Thrissur, Kerala, India
3 Department of Psychiatry, Jubilee Mission Medical College, Thrissur, Kerala, India
|Date of Web Publication||19-Jan-2018|
Dr. Chithra Valsan
Department of Microbiology, Jubilee Mission Medical College, Thrissur, Kerala
Source of Support: None, Conflict of Interest: None
Background: Health-care workers (HCWs) are always at risk of occupational exposures (OEs) to bloodborne pathogens which mostly occur through needlestick injuries (NSIs). Knowledge about the magnitude and profile of such incidents in a hospital can help to plan effective intervention strategies to reduce such mishaps.
Objectives: This study was carried out to find out the magnitude and trends in OE that had occurred in the past 2 years to the HCWs of our hospital which is an 1800 bedded centre to plan effective strategies for the prevention of such incidents.
Materials and Methods: An observational study was carried out by collecting data on OEs among our HCWs in the past 2 years from the OE register maintained by the Hospital Infection Control Committee. The circumstances at which these incidents occurred also were analysed.
Results: A total of 172 incidents were reported of which 161 (93.6%) were NSIs and 11 (6.4%) splashes. Nurses sustained highest number (38.95%) of NSIs, and maximum incidents occurred in the medical wards (34.9%) and the morning shift (51.3%). Majority (43.6%) occurred during recapping of needles.
Discussion and Conclusion: NSIs occur in all categories of HCWs. A multilevel approach that includes regular awareness programmes that can bring about changes in attitude, strict waste management policies and innovative needles and syringes can reduce such incidents.
Keywords: Health-care workers, needlestick injuries, occupational exposures
|How to cite this article:|
Valsan C, Paul J, Kuttichira P, Varghese R, Joseph S. Magnitude and profile of occupational exposures to blood and body fluids among health-care workers: A study from a tertiary care teaching hospital. J Patient Saf Infect Control 2017;5:47-51
|How to cite this URL:|
Valsan C, Paul J, Kuttichira P, Varghese R, Joseph S. Magnitude and profile of occupational exposures to blood and body fluids among health-care workers: A study from a tertiary care teaching hospital. J Patient Saf Infect Control [serial online] 2017 [cited 2018 Aug 15];5:47-51. Available from: http://www.jpsiconline.com/text.asp?2017/5/2/47/223689
| Introduction|| |
Health-care workers (HCWs) are always at potential risk of occupational exposure (OE) to infectious body fluids. This can lead to the acquisition of blood-borne pathogens such as that of AIDS, Hepatitis B and C, malaria, diphtheria, Herpes and Syphilis which can be life-threatening. Needlestick injuries (NSIs) and cuts are common occupational accidents exposing the HCW to blood and body fluids.
The Centers for Disease Control and Prevention (CDC) estimates that each year 385,000 NSIs and other sharp related injuries are sustained by HCWs, an average of 1000 sharp injuries per day. A study from a tertiary care in India had reported that 80% of HCWs had experienced NSIs at some point in their careers. Such events impose high psychological and financial burden on individuals, families and the society. An alarming finding by some researchers is that 40%–70% of all NSIs are underreported.
The average percutaneous transmission rates for hepatitis B (HBV) and C (HCV) are 33.3% and 3.3%, respectively, while the seroconversion risk for HIV is 0.31%. HBV poses the highest risk for infection, but effective vaccine and postexposure prophylaxis (PEP) are available, unlike HCV and HIV. Hence, prevention is important and the most effective method is improving safe practices among HCWs.
As a part of the infection control programme in our hospital, we had been routinely collecting information about the NSIs occurring to our HCWs. Our hospital is an 1800 bedded multi-specialty tertiary care teaching hospital. We felt that the number of incidents reported is quite high. Furthermore, there is lack of published regional data on this topic. Hence, we decided to conduct a study on OEs occurring to HCWs in our hospital. The aims of the study were to assess the magnitude of OE to blood and body fluids that had been reported during a 2-year period and analyse the circumstances under which such incidents had occurred.
| Materials and Methods|| |
The present study is a retrospective observational study based on records. The reported incidents of OE to blood and body fluids that had occurred to HCWs in our hospital during 2-year period from June 2015 to May 2017 were analysed. The study was done after obtaining institutional ethical clearance.
Collection of data
Data were collected from the register for OEs maintained by the Hospital Infection Control Committee. As per hospital policy, all cases of OEs occurring to HCWs have to be reported immediately to the emergency department (ED), following on the spot first aid. The ED doctor assesses the injury and decides on PEP as per the hospital policy which is based on the National AIDS Control Organization (NACO) guidelines for HIV and CDC guidelines  for HBV and HCV. Following counselling baseline serological investigations for HIV, HBV and HCV status of the exposed HCW and the source (if known) are sent. The quantitative estimation of anti-HBS titre of the HCW also is done. All the details are documented in the OE Register.
Data regarding the type of exposure, time of incident and reporting, category of the HCW who got the exposure, source status, results of baseline investigations of the HCW and source, details of PEP and follow-up during the study were collected.
Data were analysed by calculating frequency in percentages. Comparisons between groups were made by the Chi-square test. P <0.05 was considered statistically significant.
| Results|| |
A total of 172 incidents of OEs to HCWs were reported from June 2015 to May 2017 in our hospital. Among them, 161 (93.6%) cases were sharp injuries and 11 (6.4%) were splashes to mucous membranes.
During the first 3 months of the study, there were only seven reported cases. After that, the frequency ranged between 21 and 28 till the last quarter of the 2nd year when the reported incidents were 16.
Among the 172 HCWs exposed, 67 (38.95%) were nurses, 36 (20.95%) were housekeeping staff and waste handlers, 28 (16.28%) were technicians which included 15 laboratory technicians and 13 anesthesia technicians, 24 (13,95%) were students and 17 (9.88%) were doctors.
Out of the total 172 HCWs affected 149 (86.6%) were females which included 58 nurses, 34 housekeeping staff, 26 technicians, 24 students and 7 doctors. The rest 23 (13.37%) were males which included nine nurses, two housekeeping staff, two technicians and ten doctors.
Sixty of the 172 (34.9%) incidents occurred in medical wards, 40 (25.25%) in surgery wards, 25 (14.53%) in operation theatres, 17 (9.8%) in laboratories, 11 (15.27%) each in Intensive Care Units and ED, 7 (4%) in dialysis wards and 1 (0.5%) in labour room. The higher incidence in medical and surgical wards, operation theatres and laboratories was found to be statistically significant (P = 0.001).
Among the 172 OEs occurred, 89 (51.74%) occurred during the morning shift, 54 (31.3%) in the evening shift and 29 (16.86%) in the night shift. Considering individual categories, for nurses highest frequency was found to be in the evening shift [Figure 1].
|Figure 1: Number of exposures and duty shift based on the category of HCWs|
Click here to view
The maximum number (43.6%) of incidents occurred during recapping of needles following medication and cannulation procedures. This was followed by NSIs occurring during handling of waste (23.8%) due to improper segregation of waste resulting in the presence of needles in baskets not intended for it [Table 1].
|Table 1: Identified event for needle stick injury and number of health-care workers involved|
Click here to view
In 93 (54.06%) of the incidents, source was known and all were patients. In 79 (45.9%) of the incidents, source was unknown. Only 17% (16/93) of the known source patients were reactive to the baseline HIV, HBV and HCV tests which included three to HIV, seven to HBV, five to HCV and one to syphilis. PEP to HIV was given to the exposed HCWs following the risk assessment as per the NACO guidelines. Protective levels of anti-HBs antibody were present in all except one with exposures from known Hepatitis B patients. She received Hep B immunoglobulin along with booster dose of vaccine.
In 79 incidents where the source status was unknown PEP prophylaxis against HIV was given in 12 HCWs based on the risk assessment as per the NACO guidelines.
All the HCWs who sustained NSIs remained nonreactive to HIV, HBV and HCV in the follow-up sessions at 3 and 6 months.
| Discussion|| |
The present study is a retrospective analysis of the reported cased of OEs to blood and body fluids that had occurred to HCWs in the past 2 years in our hospital. During the study, a total of 172 cases of OEs were reported of which 161 (93.6%) were NSIs, and 11 (6.4%) were splashes to mucous membrane. Following the development of NSI protocol 2 years back several awareness classes were conducted to different sections of the HCWs on various aspects of this topic including the importance of prompt reporting of such incidents to the concerned authorities. As shown in the results of our study, the number of reported incidents in the first 3 months of the study period was only seven which later increased to an average of 23.5 in the following quarters. HCWs are always at risk of OE to infectious body fluids. The increase in the number of reported incidents after the first 3 months reflect the improved awareness among the HCWs about the need for prompt reporting of such incidents that had developed following the repeated teaching sessions by the infection control team. Perhaps the reporting rate improved earlier than the actual safe practice. This could be due to one's own awareness or prompts from others.
A total number of 172 reported OEs from 2980 HCWs of the hospital gives an overall rate of 2.8%/year. In earlier studies by Pournaras et al. and Sharma et al. the occurrence rate of NSIs had been reported as 2.4% and 3.4%, respectively. Our observation is in agreement to those figures. All these could be underreported figures only, as according to researchers 40%–70% of all NSIs are unreported., Unreported NSIs are a serious problem as it will prevent injured HCWs from receiving PEP against HIV, which is shown to be 80% effective against HIV infection. If the incident is not reported, the affected HCW will not have the right for compensation from the hospital, in case, he becomes infected following NSI with bloodborne pathogens.
In the present study, the maximum number (38.95%) of incidents occurred to nurses followed by housekeeping staff and biomedical waste handlers (20.95%), technicians (16.28%), students (13.95%) and then doctors (9.88%). Another study by Muralidhar et al. also reported similar figures. Parsa-Pili et al. also reported highest rate (76.2%) of NSIs among nurses. The higher risk of NSIs for nurses may be due to their constant interaction with patients during their working hours. Other factors such as patient overload and different work culture may also be important in the Indian scenario. In contrast to this finding Rele et al. had reported highest incidence of OE in resident doctors. This contradiction may be due to different pattern of duties among different categories of HCWs in different countries.
Majority (86.6%) of the involved HCWs were females in our study. This finding in our study may due to the fact that in our hospital majority of the nursing staff are females only. Similar observation had been made in some previous studies also.,
We found that in our hospital maximum numbers of OEs occur in medical and surgery wards followed by operation theatres than in other areas. This difference was statistically significant (P< 0.05). This finding is in agreement with previous studies where most of the injuries had occurred in the inpatient wards and during the intravenous (IV) sampling.,,
Another finding from our study was that overall maximum number of incidents occurred during the morning shift compared to other hours of the day. Jahangiri et al. had reported that majority (57.8%) of NSIs occurred in the morning shift and the same finding had been reported in many earlier studies also., Morning hours are hectic for HCWs in most of the hospitals when maximum patient care related activities occur compared to evening and night shift. Morning rounds, discharge of patients following that, admission of new patients, collecting samples for new investigations, etc., happen more during the morning hours. Patient care activities happening in a hurry can have a negative impact on HCW's level of performance, thereby increasing the risk of NSIs.,
On analysing the various events that led to the OE, majority (43.60%) of cases occurred during recapping of needles. Similar to this finding Jahangiri et al. also had reported that recapping of needles was the most common activity (41.4%) leading to NSIs. The same problem had been reported and condemned by many earlier authors also., The habit is so deep-rooted among the HCWs that it may require repeated educational sessions and long time to eradicate such practices from them. We feel that some technological solution can prevent this practice. Measures like designing caps which are automatically destroyed on uncapping the first time could prevent any attempt to recap. We have already discussed this problem in an interactive joined platform where representatives from engineering colleges and medical colleges shared and discussed their problems and sought solutions. Another measure is by reducing the unnecessary use of needles and finding other alternatives for IV delivery. The majority (~70%) of the U. S. hospitals have eliminated unnecessary use of needles through the implementation of IV delivery systems that do not require (and in some instances do not permit) needle access.,
| Conclusion|| |
All categories of HCWs especially nurses are prone for NSIs. Practices such as recapping of needles and proper waste segregation require regular educational sessions covering all categories of HCWs. Preventive strategies should also include bringing a positive change in the attitude of individual HCW by creating the feeling that infection control is everyone's responsibility.
Financial support and sponsorship
This study was supported by Jubilee Mission Medical College and RI, Thrissur, Kerala, India.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lee JM, Botteman MF, Xanthakos N, Nicklasson L. Needlestick injuries in the United States. Epidemiologic, economic, and quality of life issues. AAOHN J 2005;53:117-33.
Singru SA, Banerjee A. Occupational exposure to blood and body fluids among health care workers in a teaching hospital in Mumbai, India. Indian J Community Med 2008;33:26-30.
] [Full text]
Centers for Disease Control and Prevention. Sharps Injury Prevention Workbook. Overview: Risks and Prevention of Sharp Injuries in Healthcare Personnel; 2008. p. 4.
Muralidhar S, Singh PK, Jain RK, Malhotra M, Bala M. Needle stick injuries among health care workers in a tertiary care hospital of India. Indian J Med Res 2010;131:405-10.
] [Full text]
Parsa-Pili J, Izadi N, Golbabaei F. Factors associated with needle stick and sharp injuries among health care workers. Int J Occup Hyg 2014;5:191-7.
Muralidhar V, Muralidhar S, editors. Safety and risk management. In: Hospital Acquired Infections-Power Strategies for Clinical Practice. New Delhi: Viva Books Pvt. Ltd.; 2006. p. 110.
U.S. Public Health Service. Updated U.S. Public health service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep 2001;50:1-52.
Pournaras S, Tsakris A, Mandraveli K, Faitatzidou A, Douboyas J, Tourkantonis A, et al.
Reported needlestick and sharp injuries among health care workers in a Greek general hospital. Occup Med (Lond) 1999;49:423-6.
Sharma R, Rasania S, Verma A, Singh S. Study of prevalence and response to needle stick injuries among health care workers in a tertiary care hospital in Delhi, India. Indian J Community Med 2010;35:74-7.
] [Full text]
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.
] [Full text]
Serafińska S, Smoliński P, Gładysz A. Critical evaluation of reporting on postexposure skin damage incidents and its consequences for Polish health workers. Med Pr 2006;57:439-50.
Askarian M, Malekmakan L. The prevalence of needle stick injuries in medical, dental, nursing and midwifery students at the university teaching hospitals of Shiraz, Iran. Indian J Med Sci 2006;60:227-32.
] [Full text]
Amini M, Behzadnia MJ, Saboori F, Bahadori M, Ravangard R. Needle-stick injuries among healthcare workers in a teaching hospital. Trauma Mon 2015;20:e18829.
Jahangiri M, Rostamabadi A, Hoboubi N, Tadayon N, Soleimani A. Needle stick injuries and their related safety measures among nurses in a university hospital, Shiraz, Iran. Saf Health Work 2016;7:72-7.
Hashemi SH, Mamani M, Torabian S. Hepatitis B vaccination coverage and sharp injuries among healthcare workers in Hamadan, Iran. Avicenna J Clin Microbiol Infect 2014;1:1-5.
Ilhan MN, Durukan E, Aras E, Türkçüoǧlu S, Aygün R. Long working hours increase the risk of sharp and needlestick injury in nurses: The need for new policy implication. J Adv Nurs 2006;56:563-8.
Honda M, Chompikul J, Rattanapan C, Wood G, Klungboonkrong S. Sharps injuries among nurses in a Thai regional hospital: Prevalence and risk factors. Int J Occup Environ Med 2011;2:215-23.
Hadaway L. Needlestick injuries, short peripheral catheters, and health care worker risks. J Infus Nurs 2012;35:164-78.
Gourni P, Polikandrioti M, Vasilopoulos G, Mpaltzi E, Gourni M. Occupational exposure to blood and body fluids of nurses at emergency department. Health Sri J 2012;6:60-8.
Pugliese G, Bartley J, McCormick R. Selecting sharps injury prevention products. In: Cooper E, editors. Medical Device Manufacturing and Technology. London: World Markets Research Centre; 2000. p. 57-64.