Hindawi

Journal of Environmental and Public Health

Volume 2017, Article ID 2438713, 6 pages
https://doi.org/10.1155/2017/2438713

Research Article
Occupational Exposure to Needle Stick and Sharp Injuries
and Associated Factors among Health Care Workers in Awi
Zone, Amhara Regional State, Northwest Ethiopia, 2016

Abebe Dilie,1 Desalegn Amare,2 and Tenaw Gualu1

1
Department of Nursing, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
2
Department of Nursing, College of Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia

Correspondence should be addressed to Abebe Dilie; [email protected]

Received 7 February 2017; Revised 4 May 2017; Accepted 16 July 2017; Published 10 August 2017

Academic Editor: Ike S. Okosun

Copyright © 2017 Abebe Dilie et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background. Needle stick and sharp injuries were one of the major risk factors for blood and body fluid borne infections at health
care facilities. Objective. To assess occupational exposure to needle stick and sharp injuries and associated factors among health
care workers in Awi zone, 2016. Methods. institutional based cross-sectional study was conducted among 193 health care workers.
Study participants were selected using systematic random sampling technique. Result. When queried, 18.7% of the respondents’
encountered needle stick and sharp injury in the last 1 year. Participants who practiced needle recapping and had job related stress
were 21.3 and 7.3 times more likely to face needle stick and sharp injury, respectively. However, those who apply universal precautions
and acquire the required skill were 99% and 96% times less likely to face needle stick and sharp injury, respectively, than their
counterparts. Conclusion and Recommendation. The prevalence of needle stick and sharp injury was relatively low as compared to
previous studies. Recapping of needle after use, job related stress, not applying universal precautions, and lack of the required skill
were associated with needle stick and sharp injuries. Therefore, health care providers should apply universal precaution.

1. Introduction body fluids in the past year, of which 29.0% were needle
stick injuries [3]. NSIs can be regarded as preventable, if
Every year, hundreds of thousands of health care workers health care workers adopt a comprehensive program that
are exposed to dangerous and deadly blood borne pathogens addresses institutional, behavioral, and device-related factors
through contaminated needle stick and sharps injuries (NSIs) that contribute to the occurrence of needle stick injuries in
because of performing daily procedures in clinical activi- health care workers [4].
ties. These exposures can carry the risk of infection with A quasi-experimental study concludes that occupational
with Hepatitis B (HBV), Hepatitis C (HCV), and Human exposure to blood borne pathogens can be prevented through
Immunodeficiency Virus (HIV), the virus that causes AIDS improved knowledge and behavior and reduced the number
[1]. of NSI among health care providers [5].
The risk of infection following needle stick exposure is A study indicated that the highest incidence of NSIs was
1.9% to greater than 40% for HBV infections, 2.7% to 10% seen in health care providers and that the associated factors
for HCV infections, and 0.2% to 0.44% for HIV infections. were age, level of education, number of shifts per month, and
It is estimated that NSIs cause approximately 66,000 HBV history of related training. The highest rate of NSIs was related
infections, 16,000 HCV infections, and 200 to 5000 HIV to instrument preparation, injection, and recapping of used
infections among health care workers annually. However, needles [6].
postexposure management was generally poor [2]. NSIs are frequent and important cause of morbidity
A study in in Bahir Dar, Amhara, Ethiopia, showed that and mortality in health care workers who come into con-
65.9% of health care providers were exposed to blood and tact with patient blood and body fluids [7]. Therefore,
2 Journal of Environmental and Public Health

assessing the magnitude and factors associated with needle The following terms were described in such a way in this
stick and sharp injury among health care workers is very study.
important.
(i) Needle Sticks and Sharp Injury (NSI). It is any kind of
2. Methods and Materials injury which occurred on the health care worker in relation
to his/her job in the health institution within 1-month period.
An institutional based cross-sectional study was conducted
from April to May, 2016, to assess occupational exposure of (ii) Severe NSI. It is deep stick/cut or profuse bleeding related
NSI among health care providers in Awi zone. to injury.
All health care providers who work both at private and
public health institutions in Awi zone who were willing to (iii) Moderate NSI. It is skin punctured and some bleeding
participate and available during study period were included associated with injury.
in the study. However, health care providers who were in
(iv) Superficial NSI. It is little or no bleeding related to injury.
annual leave and seriously ill during data collection period
within the zone were excluded from the study. (v) Perceived Skill. It is the acquisition of required skill to
The sample size was determined based on single pop- perform procedures as reported by the health care provider.
ulation proportion formula with 5% marginal error and The study was conducted after obtaining ethical clearance
95% confidence interval by considering 42% proportion from Debre Markos University, College of Health Sciences,
prevalence of NSI among health care workers from Arba Research and Ethical Review Committee. After obtaining
Minch, southern Ethiopia [8]. Besides this, by considering official letter from the college, a permission and support
correction formula and 10% nonresponse rate, a total of 213 letter were provided to Awi zone hospitals and health centers
health care workers were included in this study. before data collection. The study participants were informed
Study participants were selected using systematic random about the objective, rationale, and expected outcomes of the
sampling after proportional allocation was done for each study and written consent was provided for guaranteeing
professional category in hospitals and health centers by their choice of participation or refusal. All the information
including all districts with in the zone. was recorded anonymously and confidentiality was assured
The outcome variable of the study was occupational throughout the study.
exposure to needle stick and sharp injury. The independent
variables of the study were sociodemographic factors (sex,
3. Results
age, religion, marital status, level of education, monthly
salary, and work experience), work environment related 3.1. Sociodemographic Characteristics. A total of 213 eligi-
factors (health and safety information access, work shift, ble health workers were included in the study. Of these,
availability of safety box, sharp disposal, application of uni- only 193 health workers voluntarily agreed to participate
versal precautions, needle recap, and working with assistance in this study, and 20 either refused or submitted largely
during procedure), and behavioral related factors (substance incomplete questionnaires. This resulted in a response rate of
use, sleeping disorder, job satisfaction, job related stress, and 90.6%.
perceived skill acquisition). Of all participants, the majority, 172 (89.1%), were ortho-
Data were collected using structured self-administered dox Christian by religion and three-fourths (75%) of the
questionnaire. The questionnaire was adapted by reviewing respondents had ≤5 years’ work experience. Moreover, the
literatures of similar studies on needle stick and sharp injury age of the participants included in this study ranged between
[1, 9]. The data were collected by 4 trained diploma nurses 22 and 48 years with mean age of 28.25 (SD = ±6.149) years
and were supervised by 2 public health professionals having (Table 1).
previous experience in data collection. Continuous follow-
up and supervision were also made by principal investigator 3.2. Needle Stick and Sharp Injury (NSI). Among the respon-
throughout the data collection period. dents, 36 (18.7%) encountered NSI in the last 1 year. Of these,
Data quality was assured by training of data collectors and 28 (77.8%) were due to needles, 2 (5.6%) were due to surgical
supervisors, pretesting the questionnaire on similar setting equipment, and 6 (16.6%) were due to medication ampoule or
(10% of total sample) that was not included in the study, close vial. About 86% of NSI occurred when performing injection
supervision and assistance of data collectors, and checking (Table 2).
filled questionnaires on daily basis for completeness, clarity,
and accuracy of data. 3.3. Work Environment Related Factors for NSI. Among the
The data were entered in to EPI-data version 3.1, and then total respondents, 172 (89.1%) apply universal precautions
the data were cleaned and analyzed by using Statistical Pack- during procedures for protection and 30 (15.5%) of the
age for Social Science (SPSS) version 21 statistical software. respondents had reported that there are needles and sharp
Bivariate and multivariate logistic regression was computed materials outside safety box (Table 3).
to assess statistical association between the outcome variable
and independent variables using odds ratio; significance 3.4. Behavioral Risk Factors of Health Care Workers. Out of
of statistical association was assured or tested using 95% the respondents, 53 (27.6%) believed NSI is nonpreventable
confidence interval (CI) and 𝑝 value (<0.05). and 33 (17.1%) used substance. Moreover, 118 (61.1%) were
Journal of Environmental and Public Health 3

Table 1: Sociodemographic characteristics of health care workers in Table 2: NSI among health care providers in Awi zone, 2016.
Awi zone, 2016.
NSI Frequency (%)
Variable Frequency (%) Did you encounter NSI?
Sex Yes 36 (18.7)
Male 106 (54.9) No 157 (81.3)
Female 87 (45.1) Which device caused the injury?
Age Needles 28 (77.8)
20–29 years 149 (77.2) Surgical equipment∗ 2 (5.6)
30–39 years 29 (15) Medication ampoule/vial 6 (16.6)
≥40 years 15 (7.8) Task performed during injury
Religion Suturing 2 (5.5)
Orthodox 172 (89.1) Injection 31 (86)
Muslim 13 (6.7) Drawing sample 2 (5.5)
Protestant 8 (4.2) Recap of needle 1 (3)
Marital status Type of injury
Single 103 (53.4) Severe† 8 (22.2)
Married 90 (46.6) Moderate✠ 9 (25)
Educational level Superficial‰ 19 (52.8)
Diploma 95 (49.2) Was source patient identifiable?
Degree 83 (43) Yes 15 (41.6)
Masters 13 (6.7) No 21 (58.4)
Specialty 2 (1) Did you receive care after injury?
Monthly income (in Ethiopian Birr) Yes 23 (63.8)
<3000 116 (60.1) No 13 (36.2)
3001–4999 22 (11.4) ∗
Lancet, suturing needle, scalpel, and towel clip. † Deep stick/cut or profuse
≥5000 55 (28.5) bleeding. ✠ Skin punctured, some bleeding. ‰ Little or no bleeding.
Service year
0–5 years 145 (75.1)
access to health and safety were not significantly associated
6–10 years 33 (17.1)
with NSI in multivariate analysis.
≥11 years 15 (7.8)
Application of universal precaution and perceived skill
Profession
acquisition were negatively associated with NSI. Health care
Nursing 76 (39.4)
providers who use universal precautions were 99% times less
Public health 32 (16.6) likely to face NSI [AOR = 0.01 (0.002, 0.1)] as compared to
Midwifery 49 (25.4) those who did not use universal precaution. Moreover, health
Laboratory 24 (12.4) workers who had acquired the required skill were 96% times
Physician 12 (6.2) less likely to encounter NSI [AOR = 0.04 (0.003, 0.57)] than
those who did not have the required skill.
Similarly, male health workers were 10 times more likely
satisfied with their job and 97 (50.3%) had sleep disturbance to encounter NSI [AOR = 10 (1.5, 16)] than females. Health
(Table 4). workers who had job related stress were 7.3 times more likely
to face NSI [AOR = 7.3 (1.6, 33.2)] than those who did not
3.5. Factors Associated with Needle Stick and Sharp Injuries. have job related stress. Moreover, health workers who recap
In bivariate logistic regression analysis, sex of the respondent, needles were 21.3 times more likely to encounter NSI [AOR =
profession, information access to health and safety, applica- 21.3 (4.4, 23)] than those who did not recap needle.
tion of universal precaution, recapping of needle, perceived
skill acquisition, and job related stress were statistically 4. Discussion
associated with NSI with 𝑝 value less than 0.05 at 95%
confidence interval (Table 5). The study showed that 18.7% of the respondents had needle
After bivariate analysis, only those variables which were stick and sharp injury at least once in the previous 1 year.
significantly related (𝑝 value < 0.05) were entered for further This finding is lower than a study done in Ondo state,
multivariate analysis. By adjusting potential confounders in Nigeria, where 55.8% of health care providers encounter
multivariate logistic regression analysis, only sex, application needle stick and sharp injury [10]. This might be due to the
of universal precaution, recapping of needle, perceived skill presence of trainings and safety guidelines that advocate for
acquisition, and job related stress were significantly associ- proper patient and self-care as well as study time differences.
ated with NSI. But participant’s profession and information However, it is relatively similar with a study done in Bale
4 Journal of Environmental and Public Health

Table 3: Health care providers working environment condition in Table 4: Behavioral characteristics of health care workers in Awi
Awi zone, 2016. zone, 2016.

Working environment risk factors Frequency (%) Behavioral risk factor Frequency (%)
Working institution Sleep disturbance
Hospital 83 (43) Yes 97 (50.3)
Health center 110 (57) No 96 (49.7)
Shift work Perceived skill acquisition
Yes 65 (33.7)
Yes 66 (34.2)
No 128 (66.3)
No 127 (65.8)
Doing with assistance
Information access to safety
Yes 19 (9.8)
Yes 185 (95.9)
No 174 (90.2)
No 8 (4.1) Substance use
Use of universal precaution Yes 33 (17.1)
Yes 172 (89.1) No 160 (82.9)
No 21 (10.9) Job satisfaction
Did you recap needles? Yes 118 (61.1)
Yes 49 (25.4) No 75 (38.9)
No 144 (74.6) Job related stress
Availability of safety box Yes 24 (12.4)
Yes 189 (97.9) No 169 (87.6)
No 4 (2.1) Belief on the risky nature of NSI
Presence of needles and sharp materials High risk 100 (51.8)
outside safety box Moderate risk 88 (45.6)
Yes 30 (15.5) Low risk 5 (2.6)
No 163 (84.5) Belief on preventability of NSI
Condition of safety box Preventable 140 (72.5)
Overfilled 164 (85) Nonpreventable 53 (27.6)
Torn out 13 (6.7)
Empty 12 (6.2)
recapping of needle [AOR = 4.2 (1.5, 12.0)] [8]. This might be
Others 4 (2.1) due to increased risk of injury when recapping needle after
Sharp waste final disposal use.
Burn and burry 35 (18.1) In this study, male health workers were 10 times more
Incinerator 150 (77.7) likely to face needle stick and sharp injury (AOR = 10 (1.5,
Open dumping 8 (4.2) 6.6)) than females. This is relatively similar with a study done
at Ondo state Nigeria, where male workers are likely to sustain
more NSIs than female workers (OR = [1.987 (1.061–3.721)])
[10]. This may be due to the fact that females are better in
zone, Ethiopia, where 19.1% had needle stick and sharp safety precautions compared to males.
injury [11]. This might be due to having relatively similar Moreover, health workers who had perceived skill acqui-
sociodemographic characteristics. sition were 96% times less likely to encounter needle and
The most important factor that affects needle stick and sharp injury [AOR = 0.04 (0.003, 0.57)] than those who
sharp injury was application of universal precautions during did not have the required skill. Another study which was in
procedure. Health care providers who use universal precau- United States also showed that lack of skill accounts for 12%
tion were 99% times less likely to face needle stick and sharp occurrence of needle stick injury [12]. This might be due to
injuries [AOR = 0.01 (0.002, 0.1)] as compared to those who the fact that not knowing when and how to apply the required
did not use universal precaution. This might be due to the fact skill can also expose professionals at risk of NSI.
that applying universal precautions can act as a barrier from In addition, health workers who had job related stress
exposure to blood and body fluid. were 7.3 times more likely to face needle stick and sharp injury
Another factor that affects needle stick and sharp injury (AOR = 7.3 (1.6, 33.2)) than those who did not have job related
in this study was recapping of needle after use. Health workers stress. However, this contradicts a study done at Felege Hiwot
who recap needles were 21.3 times more likely to face needle Referral Hospital, where those who were satisfied on their job
stick and sharp injury [AOR = 21.3 (4.4, 23)] than those who were about 3 times more likely to sustain needle stick and
did not recap needle. A similar study done in Arba Minch sharp injury than those who were not satisfied on their job
also showed having significant association between NSI and [AOR = 2.78 (1.01, 7.63)] [13].
Journal of Environmental and Public Health 5

Table 5: Bivariate and multivariate logistic regression analysis of factors associated with NSI in Awi zone, 2016.

Needle stick and sharp injury (NSI)

Variable Response Yes No COR (95% CI)∗ AOR (95% CI)∗∗ 𝑝 value
Male 27 (75%) 79 (50.3%) 2.9 (1.3, 6.7) 10 (1.5, 16) 0.014
Sex
Female 9 (25%) 78 (49.7%) 1 1
Nursing 11 (30.6%) 65 (41.4%) 5.9 (1.6, 21.6) 0.75 (0.09, 5.8) 0.79
Public health 6 (16.7%) 26 (16.6%) 4.3 (1.1, 18.2) 0.43 (0.06, 2.9) 0.39
Profession Midwifery 9 (25%) 40 (25.5%) 4.4 (1.2, 17.1) 0.24 (0.01, 3.6) 0.30
Laboratory 4 (11.1%) 20 (12.7%) 5 (1.0, 23.7) 0.17 (0.01, 1.5) 0.12
Physician 6 (16.7%) 6 (3.8%) 1 1
Yes 32 (88.9%) 153 (97.5%) 0.20 (0.5, 0.8) 0.25 (0.01, 5.4) 0.37
Information access
No 4 (11.1%) 4 (2.5%) 1 1
Yes 18 (50%) 154 (98.1%) 0.01 (0.005, 0.073) 0.01 (0.002, 0.1) 0.001
Use universal precaution
No 18 (50%) 3 (1.9%) 1 1
Yes 22 (61.1%) 27 (17.2%) 7.5 (3.4, 16.6) 21.3 (4.4, 23) 0.001
Recap of needle
No 14 (38.9%) 130 (82.8%) 1 1
Yes 6 (16.7%) 59 (37.6%) 0.33 (0.1, 0.8) 0.04 (0.003, 0.57) 0.017
Perceived skill
No 30 (83.3%) 98 (62.4%) 1 1
Yes 11 (30.6%) 13 (8.3%) 4.8 (1.9, 12) 7.3 (1.6, 33.2) 0.010
Job related stress
No 25 (69.4%) 144 (91.7%) 1 1
∗
COR: crude odds ratio; ∗∗ AOR: adjusted odds ratio; CI: confidence interval.

5. Strengths and Limitations of the Study Acknowledgments

5.1. Strength of the Study. The major strength of this study The authors would like to thank Debre Markos University for
lies in the fact that it has attempted to assess occupational financial support; the authors would also like to extend their
exposure to NSI and associated factors for the first time in gratitude to all the study participants and data collectors.
the study area. Besides this, both private and public health
institutions within the zone were included to make the study References
representative.
[1] AN. Association, “American Nurses Association’s Needlestick
5.2. Limitation of the Study. The study might be subjected Prevention Guide, 2002 [acesso 16 ago 2011]”.
to response set bias from the respondent. Since it was [2] X. Lin, W. Qing-yan, K. Hong, and T. Si-yuan, “The epidemiol-
cross-sectional study design, it was difficult to draw causal ogy of needle stick and sharp Injuries in central sterile supply
department of hospitals in Hunan Province,” International
relationships.
Journal of Infection Control, vol. 10, no. 1, 2014.
We exclude seriously ill participants as they may suffer
[3] M. A. Yenesew and G. A. Fekadu, “Occupational exposure to
from needle stick and sharp acquired blood borne pathogens. blood and body fluids among health care professionals in Bahir
Dar Town, Northwest Ethiopia,” Safety and Health at Work, vol.
6. Conclusion and Recommendation 5, no. 1, pp. 17–22, 2014.
[4] A. R. and D. V., “A cross sectional study to evaluate needle stick
The prevalence of needle stick and sharp injury was relatively injuries among health care workers in Malabar medical college,
low as compared to previous studies. Calicut, Kerala, India,” International Journal Of Community
The most important factors that cause needle stick and Medicine And Public Health, vol. 3, no. 12, pp. 3340–3344, 2016.
sharp injury were recapping of needle after use, job related [5] H. Wang, K. Fennie, G. He, J. Burgess, and A. B. Williams, “A
stress, not using universal precautions during procedure, training programme for prevention of occupational exposure
and lack of the required skill. Safe handling and disposal to bloodborne pathogens: Impact on knowledge, behaviour
of needle stick and sharp materials enable preventing blood and incidence of needle stick injuries among student nurses
in Changsha, People’s Republic of China,” Journal of Advanced
borne infections. Therefore, health care providers should get
Nursing, vol. 41, no. 2, pp. 187–194, 2003.
training to fill the skill gap, apply universal precaution during
[6] H. Motaarefi, H. Mahmoudi, E. Mohammadi, and A.
procedure, and never recap needles after use.
Hasanpour-Dehkordi, “Factors associated with needlestick
injuries in health care occupations: A systematic review,”
Conflicts of Interest Journal of Clinical and Diagnostic Research, vol. 10, no. 8, pp.
IE01–IE04, 2016.
The authors declare that there are no conflicts of interest [7] S. Momani, M. Hdaib, and YW. Najjar, “Sustained reduction
regarding the publication of this paper. in needlestick and Sharp injuries among nursing students:
6 Journal of Environmental and Public Health

an initiative educational program. Educ Res,” in Najjar YW.

Sustained reduction in needlestick and Sharp injuries among
nursing students: an initiative educational program. Educ Res, p.
654, 9, 654-8, 2013.
[8] W. G. Kelebore, M. Mamo, L. Yilma, K. Shewalem, S. Shakayto,
and M. Kelile, “Assessment of Factors Affecting Needle Stick
and Sharp Injuries Among Health Professionals and Cleaners
in Arba Minch General Hospital, Gamo Gofa Zone, Southern
Ethiopia, 2015 G. C,” Science Journal of Public Health, vol. 4, no.
6, p. 463, 2016.
[9] PS. Rajput, MK. Doibale, VK. Sonkar, IF. Inamdar, A. Nair,
and AD. Shingare, “Prevalence of needle stick injuries and
associated risk factors among nurses in a tertiary care hospital,”
International Journal of Preventive and Public Health Sciences,
vol. 1, p. 17.
[10] O. Oluwatosin, M. Oladapo, and M. Asuzu, “Needlestick
injuries among health care workers in Ondo State, Nigeria,”
International Journal of Medicine and Public Health, vol. 6, no.
1, p. 31, 2016.
[11] T. Bekele, A. Gebremariam, M. Kaso, and K. Ahmed, “Factors
associated with occupational needle stick and sharps injuries
among hospital healthcare workers in bale zone, Southeast
Ethiopia,” PLoS ONE, vol. 10, no. 10, Article ID 140382, 2015.
[12] M. A. Makary, A. Al-Attar, C. G. Holzmueller et al., “Needlestick
injuries among surgeons in training,” New England Journal of
Medicine, vol. 356, no. 26, pp. 2693–2699, 2007.
[13] L. Walle, E. Abebe, M. Tsegaye, H. Franco, D. Birhanu, and M.
Azage, “Factors associated with needle stick and sharp injuries
among healthcare workers in Felege Hiwot Referral Hospital,
Bahir Dar, Northwest Ethiopia: facility based cross-sectional
survey,” International Journal of Infection Control, vol. 9, no. 4,
2013.
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