International Journal of Academic Scientific Research
ISSN: 2272-6446 Volume 3, Issue 4 (November-December 2015), PP 27-36
www.ijasrjournal.org
Needle stick Injuries among Healthcare Workers in a
Governmental Hospital, Medina, Saudi Arabia 2012
Nojood Hameed1, Amal Salman1, Marwa Lafi1 , Reham Masoud1, Marwa
Abdallah1, Nadia Ali1, Rawan Obide1 , Shrouq Khalid1
1
College of medicine, Taibah University, University Road, Madinah, Saudi Arabia
Abstract:
Background: Most people who work in a health care facility are at risk of sustaining a needle stick injuries. Despite
published guidelines and training programs, needle stick injuries have been neglected and remain an ongoing problem.
Objectives: To explore the prevalence and circumstances of needle stick injuries among healthcare Workers in a
governmental hospital, Medina, Saudi Arabia 2012
Methods: A cross sectional study was carried out. All health care workers at the general surgery department of Auhod
Hospital were targeted. Inclusion of 49 HCWs only was done. Self administrated data was collected using a specially
designed questionnaire prepared in English form. It included data about socio-demographic characters, exposure to
needle stick injuries, factors and circumstances that enhance injuries. The mean percent score for unfavourable
circumstances during injection was calculated. Chi square test, Fishers’ Exact test and Mann-Whitney U test were used.
Results: 77.6% of HCWs gave injections; with an average of 1.4 ±0.50 injection per day. 81.6% received training on
safe use of needles. 91.8% of HCWs perceived NSIs as dangerous and 95.9% knew the risks. All Saudi HCWs
significantly received assisted disposal of needles.78.3% did not resheath syringe, 95.9% use safe boxes, 55.1%
separated needle from syringes with gloved hands, 87.8% wearing gloves on dealing with patients. The prevalence of
NSIs among HCWs was 28.6 %.
Conclusion: NSIs were prevalent incident. Among HCWs, vaccination coverage for HBV was not complete. Not all
HCWs perceived NSIs as dangerous. Some HCWs performed risky practices on injection and handling syringes. The
score of unfavourable circumstances during injection was relatively high.
Key words: Needle stick injuries, health care workers, sharp injuries, syringes, safety
Abbreviations: Needle stick injuries (NSIs), Health care workers (HCWs), hepatitis B virus (HBV), hepatitis C virus
(HCV).
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International Journal of Academic Scientific Research
ISSN: 2272-6446 Volume 3, Issue 4 (November-December 2015), PP 27-36
I. INTRODUCTION
Workplace safety is a very important aspect of occupational health practice in many countries. Needle
stick injury has been recognized as one of the occupational hazards which results in transmission of blood borne
pathogens [1-3]. Most people who work in a health care facility are at risk of sustaining a needle stick injuries
.They may especially happen to nursing staff, lab workers, Surgeons and housekeepers [4]. Among health care
workers (HCWs), HIV, hepatitis B and C, and cytomegalovirus are recognized occupational health infections of
special importance [5, 6].
In most of the developing countries, very few efforts have been undertaken to raise awareness of the
health-care workers and hospital managers. Concrete knowledge on the transmission of blood-borne diseases in
health-care facilities is very limited. Unsafe practices are very common. Additionally, there is a lack of
regulation and policy to protect health workers from exposure [7]. Most of the time, health care workers never
receive training in infection control and standard precautions although such trainings and practices are low cost
solution to reducing risk of sharp injuries and have a high likelihood of being adopted [8].
Despite published guidelines and training programs, needle stick injuries have been neglected and
remain an ongoing problem because the rate of such injuries depends on the medical discipline which makes it
difficult to know exactly how serious the problem is or how well prevention programs work [9].
Objectives
To explore the prevalence and circumstances of Needle stick Injuries among healthcare Workers in a
governmental hospital, Medina, Saudi Arabia 2012.
II. SUBJECTS AND METHODS
This cross sectional study was carried out during October through November 2012. All health care
workers at the general surgery department of Auhod Hospital were targeted. The study included 49 HCWs only
with a response rate of only 49%. An informed verbal consent was obtained from all participants after
explanation of the objectives of the study.
Self administrated data was collected using a specially designed questionnaire prepared in English
form. It included data about socio-demographic characters, exposure to needle stick injuries, factors and
circumstances that enhance injuries to design effective prevention programs. A pilot study of 15 non-injured
cases was carried to refine the questionnaire. Reliability of the questionnaire was determined using Cronbach’s
alpha (0.879).
Approval of the ethical committee of the medical college and research Committee of Ohoud hospital
was considered. Confidentiality and privacy of the participants was assured.The mean percent score for
unfavourable circumstances during injection was calculated using the following formula:
Mean percent score = ∑Selected variables x 100 / Maximum possible score
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ISSN: 2272-6446 Volume 3, Issue 4 (November-December 2015), PP 27-36
Statistical Analysis
SPSS package version 17 was used. Frequencies, percentages, proportions, mean and standard
deviation were calculated. Chi square test, Fishers’ Exact test and Mann-Whitney U test were used accordingly.
P-value was considered significant at level less than 0.05 level.
III. RESULTS
There was significant difference between mean age of Saudi (27.7 ±5.28 years) and non Saudi HCWs
(34.7±10.41years) (p=0.010). The majority of HCWs (85.7%) was females (p= 0.628) and 16.3% was
paramedical with insignificant difference between Saudi and non Saudi (p= 0.981). The mean working years
was 8.8 ± 8.15 (p=0.021), working hours per day (9.97±1.84) (p=0.000) and mean number of shifts per week
was 3.3 ±1.54 (p=0.001) (Table 1).
Most of HCWs (95.9%) received HBV vaccine; meanwhile only 69.4% received booster dose in the
past 10 years and 81.6% made periodic check up for HBV, AIDS and HCV. (Table 2)
More than three fourths (77.6%) of HCWs included in the sample gave injections; with an average of
1.4 ±0.50 injection per day (p=0.024). More than four fifths (81.6%) received training on safe use of needles.
Majority (91.8%) of HCWs perceived NSIs as dangerous and 95.9% knew the risks. (Table 3)
All Saudi HCWs included in the sample (100.0%) significantly received assisted disposal of needles
(p=0.029). More than three fourths (78.3%) did not resheath syringe, 95.9% use safe boxes, 55.1% separated
needle from syringes with gloved hands, 87.8% wearing gloves on dealing with patients (p= 0.208, 0.058, 0.130
and 0.046 respectively). (Table 4)
The mean percent score for unfavorable circumstances during injection was significantly lower among
Saudi than non Saudi (58.8 ±8.32, 64.4±6.53, p= 0.013). (Table 5) The prevalence of NSIs among HCWs was
28.6 % with insignificant difference between Saudi and non Saudi (p=0.223). (Figure 1)
The mean percent perception score for hospital safety measures was insignificantly higher among non
Saudi (65.0±13.78) than Saudi (52.9±7.56), (p=0.069). (Table 6)
Nearly one third (30.8%) stated that NSIs were accidents, 53.8% reported it; with 23.1% filled incident
report and 53.8% mentioned that sharp box was beside them while injured. (Table 7)
Table 1: General description of the studied HCWs by nationality
Saudi Non Saudi Total p-value
N=18 (%) N=31 (%) N=49 (%)
Age in years
Mean ± SD 27.7±5.28 34.7±10.41 32.1±9.45 0.010^
Gender
Males 2 (28.6/11.1) 5 (71.4/16.1) 7 (100.0/14.3)
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Females 16 (38.1/88.9) 26 (61.9/83.9) 42 (100.0/85.7) 0.628¥
Specialty
Medical 3(37.5/16.7) 5 (62.5/16.1) 8(100.0/83.7)
Paramedical 15 (36.6/83.3) 26 (63.4/83.9) 41 (100.0/16.3) 0.981¥
Working years
Mean ± SD 5.3±4.89 10.8±9.0 8.8±8.15 0.021^
Working years in KSA
Mean ± SD 9.7±3.39
Working hours per day
Mean ± SD 8.2 ±0.43 9.97±1.84 9.3±1.70 0.000^
Shifts per week
Mean ± SD 4.2±1.62 2.7±1.24 3.3±1.54 0.001^
Marital status
Never married 9 (40.9/50.0) 13 (59.1/41.9) 22 (100.0/44.9)
Ever married 9 (33.3/50.0) 18 (66.7/58.1) 27 (100.0/55.1) 0.757*
For non Saudi, is your family with
you?
No 23 (74.2)
Yes 8 (25.8)
*Pearson’s Chi-square test, ¥Fishers’ Exact test, ˄ Mann-Whitney U test,
p- value is significant at < 0.05
Table 2: Immune state of the studied HCWs by nationality
Saudi Non Saudi Total p-value
N=18 (%) N=31 (%) N =49(%)
Previous HBV vaccine
No 2 (100.0/11.1) 0 (0.0/0.0) 2 (100.0/4.1)
Yes 16 (34.0/88.9) 31 (66.0/100.0) 47 (100.0/95.9) 0.058¥
If yes received vaccine within the past
10 years
No 2(15.4/12.5) 11 (84.6/35.5) 13(100.0/27.7)
Yes 14 (41.2/87.5) 20 (58.8/64.5) 34 (100.0/72.3) 0.321¥
Periodic check up for HBV, AIDS,
etc…
No 4 (44.4/22.2) 5 (55.6/16.1) 9 (100.0/18.4)
Yes 14 (35.0/77.8) 26 (65.0/83.9) 40 (100.0/81.6) 0.633¥
¥Fishers’ Exact test, p- value is significant at < 0.05
Table 3: Description of some perception’s parameters related to NSIs by nationality
Saudi Non Saudi Total p-value
N (%) N (%) N (%)
Ever administration of injections
No 2(18.2/11.1) 9 (81.8/29.0) 11 (100.0/22.4)
Yes 16 (42.1/88.9) 22 (57.9/71.0) 38 (100.0/77.6) 0.147¥
Average injection number per day
Mean ±SD 1.2 ±0.40 1.5 ±0.51 1.4 ±0.50 0.024^
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Training on safe use of needles
No 3 (33.3/16.7) 6 (66.7/19.4) 9 (100.0/18.4)
Yes 15 (37.5/83.3) 25 (62.5/80.6) 40 (100.0/81.6) 0.815¥
Perception of NSIs
Not dangerous 1 (25.0/5.6) 3 (75.0/9.7) 4 (100.0/8.2)
Dangerous 17 (37.8/94.4) 28 (62.2/90.3) 45 (100.0/91.8) 0.611¥
Risks of NSIs
Did not know 2 (100.0/11.1) 0 (0.0/0.0) 2 (100.0/4.1)
Knew 16 (34.0/88.9) 31 (66.0/100.0) 47 (100.0/95.9) 0.058¥
¥Fishers’ Exact test, ˄ Mann-Whitney U test,
p- value is significant at < 0.05
Table 4: Description of injection practice and syringes’ handling by nationality
Saudi Non Saudi Total p-value
N (%) N (%) N (%)
Assisted disposal of needles
No 0 (0.0/0.0) 7 (100.0/22.6) 7 (100.0/14.3)
Yes 18 (42.9/100.0) 24 (57.1/77.4) 42 (100.0/85.7) 0.029¥
After injection
Resheath syringe 3 (75.0/18.8) 1 (25.0/3.3) 4 (100.0/8.7)
Not resheath syringe 11 (30.6/68.8) 25 (69.4/83.3) 36 (100.0/78.3)
Others 2 (33.3/12.5) 4 (66.7/13.3) 6 (100.0/13.0) 0.208¥
Use of safe boxes
No 2 (100.0/11.1) 0 (0.0/0.0) 2 (100.0/4.1)
Yes 16 (34.0/88.9) 31 (66.0/100.0) 47 (100.0/95.9) 0.058¥
Separation of needle from syringe
With bare hands 5 (55.6/27.8) 4 (44.4/12.9) 9 (100.0/18.4)
With Gloved hands 8 (29.6/44.4) 19 (70.4/61.3) 27 (100.0/55.1)
Using Forceps 0 (0.0/0.0) 4 (100.0/12.9) 4 (100.0/8.2)
Never separate 5 (55.6/27.8) 4 (44.4/12.9) 9 (100.0/18.4) 0.130¥
Wearing gloves on dealing with patient
No
Yes 0 (0.0/0.0) 6 (100.0/19.4) 6 (100.0/12.2)
18 (41.9/100.0) 25 (58.1/80.6) 43 (100.0/87.8) 0.046¥
Injection method resulting in most
NSIs
Intramuscular 5 (38.5/27.8) 8 (61.5/25.8) 13 (100.0/26.5)
Intravenous 7(36.8/38.9) 12 (63.2/38.7) 19 (100.0/38.8)
Subcutaneous 2 (25.0/11.1) 6 975.0/19.4) 8 (100.0/16.3)
Sutures and other surgical procedures 4 (44.4/22.2) 5 (55.6/16.1) 9 (100.0/18.4) 0.868¥
¥Fishers’ Exact test, p- value is significant at < 0.05
Table 5: Description of injection circumstances by nationality
Saudi Non Saudi Total p-value
N= 18 (%) N=31 (%) N=49 (%)
Light
Dark 4 (80.0/22.2) 1 (20.0/3.2) 5 (100.0/10.2)
Dim 2 (40.0/11.1) 3 (60.0/9.7) 5 (100.0/10.2)
Normal 11 (39.3/61.1) 17 (60.7/54.8) 28 (100.0/57.1)
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Bright 1 (9.1/5.6) 10 (90.9/32.3) 11 (100.0/22.4) 0.052¥
Noise
Silence and Normal voice 10 (33.3/55.6) 20 (66.7/64.5) 30 (100.0/61.2)
Noise and Very annoying voice 8 (42.1/44.4) 11 (57.9/35.5) 19 (100.0/38.8) 0.535*
Hands during injection
Dry 9 (42.9/50.0) 12 (57.1/38.7) 21 (100.0/42.9)
Moist without gloves 2 (25.0/11.1) 6 (75.0/19.4) 8 (100.0/16.3)
Moist inside gloves 4 (33.3/22.2) 8 (66.7/25.8) 12 (100.0/24.5)
With gel, oil or cream 3 (37.5/16.7) 5 (62.5/16.1) 8 (100.0/16.3) 0.832¥
Clarity of vision
Not clear 4 (50.0/22.2) 4 (50.0/12.9) 8 (100.0/16.3)
Clear 14 (34.1/77.8) 27 (65.9/87.1) 41 (100.0/83.7) 0.395¥
Ground condition
Dirty 2 (28.6/11.1) 5 (71.4/16.1) 7 9100.0/14.3)
Clean 16 (38.1/88.9) 26 (61.9/83.9) 42 (100.0/85.7) 0.628¥
Room temperature
Cold 4 (66.7/22.2) 2 (33.3/6.5) 6 (100.0/12.2)
Hot 1 (25.0/5.6) 3 (75.0/9.7) 4 (100.0/8.2)
Suitable 13 (33.3/72.2) 26 (66.7/83.9) 39 (100.0/79.6) 0.254¥
Patient’ cooperation
Not cooperative 4 (36.4/22.2) 7 (63.6/22.6) 11 (100.0/22.4)
Cooperative 14 (36.8/77.8) 24 (63.2/77.4) 38 (100.0/77.6) 0.977¥
Time of injection
Beginning of shift 5 (55.6/27.8) 4 (44.4/12.9) 9 (100.0/18.4)
End of shift 6 942.9/33.3) 8 957.1/25.8) 14 (100.0/28.6)
Did not remember 7 (26.9/38.9) 19 (73.1/61.3) 26 (100.0/53.1) 0.263¥
Error of refraction in HCWs
No 13 (31.7/72.2) 28 (68.3/90.3) 41 (100.0/83.7)
Yes 5 (62.5/27.8) 3 (37.5/9.7) 8 (100.0/16.3) 0.098¥
Mean percent score for unfavourable
circumstances during injection
Mean ± SD 58.8 ±8.32 64.4 ±6.53 62.4 ±7.65 0.013^
*Pearson’s Chi-square test, ¥Fishers’ Exact test, ˄ students’ t test,
p- value is significant at < 0.05
Table 6: Perception of some parameters of hospital safety by injured HCWs
N=13 (%)
Completeness of incident report should
done
New NSIs 1 (7.7)
Used NSIs 10 (76.9)
Both 2 (15.4)
Complete vaccination schedule against
HBV
No 3 (23.1)
Yes 10 (76.9)
Training on NSIs
No 3 (23.1)
Yes 10 (76.9)
Reading a copy of hospital safety policy
on ethical disposal of clinical waste:
No
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Yes 3 (23.1)
10 (76.9)
Mean percent perception score for
hospital safety measures
Mean ± SD
Total 58.5 ±12.14
Saudi 52.9±7.56
Non Saudi 65.0 ±13.78
P-value 0.069^
^ Mann –Whitney U test, p is significant at ˂0.05 level
Table 7: Description of actually occurred NSIs
N =13 (%)
NSIs occurred due to
Poor disposal 1 (7.7)
Accident 4 (30.8)
Cannot remember 6 (46.2)
Others 2 (15.4)
Reporting
No 6 (53.8)
Yes 7 (53.8)
Filling incident report
No 10 976.9)
Yes 3 (23.1)
Presence of sharp box
No 6 (46.2)
Yes 7 (53.8)
Figure 1: Prevalence of NSIs among HCWs by nationality
DISCUSSION
Because little is known about the prevalence and circumstances of needle stick injuries among health
care workers in governmental hospitals since it has been estimated that most of these injuries go unreported, this
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study contributed to the understanding of the risks of exposure to such injuries among health care workers in
hospital settings. Such information will contribute significantly to an understanding not only the risk for such
injuries but the development of effective intervention strategies. Nearly one third (28.6%) of participant HCWs
had sustained at least one needle stick injury in the last 12 months preceding the study. In the developing
countries, on average 2 million NSIs are projected yearly, this is probably a low estimate, because of the lack of
surveillance systems and underreporting of injuries [10] .
Prevalence of needle stick injuries among Malaysian health care workers in the two teaching hospitals
were reported to be 31.6% and 52.9% respectively [11]. Data from injection safety surveys conducted by the
WHO and others show on average: four NSIs per worker per year in the African, Eastern Mediterranean, and
Asian populations [10]. In Vietnam, 38% of physicians and 66% of nurses reported sustaining a sharp stick
injury in the previous nine months [12] .
In South Africa, 91% of junior doctors reported sustaining a needle stick injury in the previous 12
months, and 55% of these injuries came from source patients who were HIV-positive [13].
The present study provided descriptive epidemiological evidence of how such injuries occur including
under what circumstances incident occurred; with fairly good sore for unfavourable circumstances associated
with injections. The picture that emerges reflects a continuum of risk opportunities throughout the life-cycle of
the device use involving interactions among patients, workers, devices and the environment.
Overall, the epidemiological patterns of reported NSI were consistent with other authors’ reviews [14-
16]. Physicians mostly do not provide injections as nurses do and hence their risk of injury exposure is lower.
Certain working conditions increase the risk of needle stick injury. Those were staff reductions where
health care workers assume additional duties or are rushed; difficult patient care situations; and working at night
with reduced lighting [17].
Of the blood borne pathogens, HBV is preventable. Nearly all hospitals in Saudi Arabia have made the
provision of HBV vaccination a requirement of employment at a health care facility.
Majority (95.9%) of staff surveyed reported to receive previous HBV vaccine. Actually only 81.6%
were doing periodic check up for HCV and AIDS. This means that still health care facilities surveyed have
allowed even a small proportion of staff to remain a risk to themselves or to their patient population.
Understanding the scope of the problem requires recognizing the underreported problem. About 53.8%
of the studied health care workers with a history of needle stick injuries did not report the injury to an employee
health service. The underreporting of needle stick injuries is also a serious problem in other researches, thus 40–
80% of all injuries go unreported [19]. Barriers to reporting should be appropriately identified and eliminated in
order to ensure appropriate care and treatment of health workers to prevent infection as a result of exposure.
The current work revealed that the knowledge score for hospital safety measures was relatively low. A
satisfactory adherence of HCWs to infection control guidelines was a protective factor to prevent NSIs.
Noncompliance to a safe work practice is determined by a range of factors including lack of knowledge,
interference with work skills, risk perception, conflict of interest, not wanting to offend patients, lack of
equipment, and time, uncomfortable personal protective equipment, inconvenience, work stress, and perceiving
a weak organizational commitment to safety climate [20] .
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ISSN: 2272-6446 Volume 3, Issue 4 (November-December 2015), PP 27-36
Standard Precautions represents a system of barrier precautions to be used by all personnel for contact
with blood, all body fluids, secretions, excretions, non intact skin, and mucous membranes. It applies to all
patients receiving care in hospitals, regardless of their diagnosis or presumed infection status. These precautions
are the "standard of care." Standard Precautions focuses on reducing the risk of transmission of microorganisms.
This system embodies the concepts of Standard Precautions (Blood and Body Fluid Precautions designed to
reduce the risk of transmission of blood borne pathogens) and Body Substances Isolation (designed to reduce
the risk of transmission of pathogens from moist body substances) [21].
Conclusion
NSIs were prevalent incident. Not all HCWs received HBV vaccination . Not all HCWs perceived
NSIs as dangerous. Some HCWs performed risky practices on injection and handling syringes. The score of
unfavourable circumstances during injection was relatively high.
Recommendation
Emphasis on vaccination for all HCWs with HBV vaccine and importance of periodic check up for
HBV, HCV and AIDS. Improving injection and syringe handling circumstances are mandatory. Obligations and
rules together with legalizations must be planned for continuous training of HCWs about use of sharp boxes,
injection safety and hospital safety policy to decrease prevalence of NSIs.
Study Limitations
Inclusion of small sample size due low response rate was a major limitation that occurred with this
study. Inclusion of HCWs in other departments of hospital may be in favourable. Motivation and assurance of
HCWs will be needed to participate in similar future studies to get the full picture about NSIs.
REFERENCES
[1] Do, A.N., Ciesielski, C.A., Metler, R.P., Hammett, T.A., Li, J., Fleming, P.L., Occupational. acquired human immunodeficiency
virus (HIV) infection: National case surveillance data during 20 years of the HIV epidemic in the United States. Infection
Control Hospital Epidemiology, 2003. 24: p. 86-96.
[2] CDC NIOSH, What every worker should know: How to protect yourself from needle stick injuries. Publication No. 2000-213.
[3] Puro, V., De Carli, G., Petrosillo, N., Ippolito, G., Risk of exposure to blood borne infection for Italian healthcare workers, by
job cat. 2001 Apr;22(4):206-10.
[4] Park K: Hospital Waste Management. Park’s Textbook of Preventive and Social Medicine. 18th ed. India: Banarsidas Bhanot;
2007:596
[5] Kane A, Lloyd J, Zaffran M, Simonsen L, Kane M. Transmission of hepatitis B, hepatitis C and human immunodeficiency viruses
through unsafe injections in the developing world: model-based regional estimates. Bull World Health Organ. 1999;77(10):801-
7.
[6] Prüss-Üstün A, Rapiti E, Hutin Y. Sharps injuries: global burden of disease from sharps injuries to health-care workers. World
Health Organization, Geneva. (WHO Environmental Burden of Disease Series No. 3) 2003.
[7] Talaat M. Kandeel A. El-Shoubary W. Bodenschatz C. Khairy I. Oun S. Mahoney FJ. Occupational exposure to needlestick
injuries and hepatitis B vaccination coverage among health care workers in Egypt. American Journal of Infection Control 203;
31(8):469-74.
[8] Ismail NA, Aboul Ftouh AM, El Shoubary WH. Safe injection practice among health care workers, Gharbiya, Egypt. J Egypt
Public Health Assoc. 2005;80(5-6):563-83.
[9] Luthi JC, Dubois-Arber F, Iten A, Maziero A, Colombo C, Jost J, Francioli P. The occurrence of percutaneous injuries to health-
care workers: a cross sectional survey in seven Swiss hospitals. Journal Suisse de Médecine 1998; 128(14):536–43.
[10] Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of blood borne
pathogens: a review. Bull World Health Organ. 1999;77(10):789-800.
www.ijasrjournal.org 35 | Page
International Journal of Academic Scientific Research
ISSN: 2272-6446 Volume 3, Issue 4 (November-December 2015), PP 27-36
[11] Ng YW, Hassim IN. Needlestick injury among medical personnel in Accident and Emergency Department of two teaching
hospitals. Med J Malaysia. 2007 Mar;62(1):9-12.
[12] Ministry of Health, Department of Therapy, Vietnam. Report on the implementation of the APW of a pilot survey on unsafe
injection practice in Vietnam, Hanoi 2003,p. 30.
[13] Mingoli A, Sapienza P, Sgarzini G, Modini C. Surgeons’ risk awareness and behavioral methods of protection against blood
borne pathogen transmission during surgery. Ann Surg 1999;230:737-8.
[14] Trim JC, Elliott TS. A review of sharps injuries and preventative strategies.J. Hosp. Infect. 2003; 53 (4):237-42.
[15] 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 (3):117-33.
[16] Lewis FR, Short LJ, Howard RJ, Jacobs AJ, Roche NE. Epidemiology of injuries by needles and other sharp instruments.
Minimizing sharp injuries in gynecologic and obstetric operations. Surg. Clin. North Am. 1995;75 (6):1105-21.
[17] WHO. Sharp injuries, Health care worker safety. Protection of the human environment. Environmental burden of disease. Series
No.11 Geneva, 2005, Annex 2.
[18] Center for Disease Control and Prevention. Immunization of health-care workers: recommendations of the Advisory Committee
on Immunization Practices (ACIP) and the Hospital Infections Control Practices Advisory Committee (HICPAC). Morbid.
Mortal. Weekly Rep. 1997;46(RR-18):23.
[19] Abu-Gad HA, Al-Turki KA. Some epidemiological aspects of needle stick injuries among the hospital health care workers:
Eastern province, Saudi Arabia. European Journal of Epidemiology 2001; 17: 401-7.
[20] Centers for Disease Control and Prevention. National Institute for Occupational Safety and Health (NIOSH) NIOSH Alert:
Preventing Needle stick Injuries in Health Care Settings, 1999. Publication No. 2000-108.
[21] Center for Disease Control. Perspective in disease prevention and health promotion update. Standard precautions for prevention
of transmission of HIV, HBV and other blood-borne pathogens in health care settings. MMWR1988;37:24.
www.ijasrjournal.org 36 | Page
