Needle-stick injuries: awareness of vaccinations and preventive measures among intern

doctors in Egypt

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Authors:

Mohamed Ali

- Kasralainy Faculty of Medicine, Cairo University, Cairo, Egypt

- Benha Students’ Innovation and Research Association (BSIRA) Scientific member

and Instructor.

Ahmed Mohamed Elbatrawy

- Faculty of Medicine, Al-Azhar University, Damietta, Egypt

- Email: [email protected]

Sarah Ashraf Hassan

- Faculty of Medicine Benha University, Benha, Egypt

- Email [email protected]

Mohamed Mahmoud

- Faculty of Physical Therapy, South Valley University

Yasmeen Hesham

- Faculty of Medicine El Menia University, El Menia, Egypt

Omar Saqr

- Faculty of Medicine, Al-Azhar University, Cairo, Egypt

Malek Ehab

- Faculty of Medicine Cairo University, Cairo, Egypt

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Table of Contents
Authors.......................................................................................................................................2
Introduction: ..............................................................................................................................4
Aim: ...........................................................................................................................................5
Study
Hypothesis: ......................................................................................................................5
Methodology: ............................................................................................................................5
Study design:..............................................................................................................................5
The inclusion criteria:.................................................................................................................5
The exclusion criteria:................................................................................................................5
Sample size:................................................................................................................................5
Measurement and Instruments:..................................................................................................6

Data collection tools and Methods:............................................................................................6

Sociodemographic Characteristics:............................................................................................7
Awareness about Needle Stick Injury Prevention:....................................................................7
Statements of perception towards Needle stick injury and its prevention: ...............................8
Questions on Practice: ...............................................................................................................8
Statistical Analysis.................................................................................................................... 9
Ethical consideration:.................................................................................................................9
Plan for getting participants' approval and protecting confidentiality:......................................9
Confidentiality and data retention: ...........................................................................................9
References............................................................................................................................... 10

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Introduction:

Every profession comes with its own occupational risks. In the healthcare sector, exposure to

blood-borne infections is a significant concern. Viruses such as Hepatitis B (HBV), Hepatitis

C (HCV), and Human Immunodeficiency Virus (HIV) are particularly worrisome, as they can

lead to serious, life-altering diseases with lasting effects [1].

Healthcare workers (HCWs) face various types of exposure in medical settings, which can

lead to the transmission of blood-borne diseases. Needlestick injuries account for most of

these incidents. Other sharp objects, such as blades and IV cannulas, also pose a risk of

occupational exposure to such infections [2, 3].

According to a World Health Organization (WHO) report from the early 21st century,

needlestick injuries annually result in approximately 1,000 HIV infections, 16,000 HCV

infections, and 66,000 HBV infections among healthcare workers [4].

Needle injuries can occur during various activities, such as removing or recapping needle

caps, handling needles, administering injections, performing procedures or surgeries,

inserting or removing cannulas, accidental collisions, and during clean-up or disposal [5].

Accidental punctures or cuts from contaminated needles can introduce harmful fluids into the

body [6].

Preventing injuries is the most effective way to safeguard healthcare workers, which requires

heightened awareness and a proactive attitude toward injury prevention. Prevention includes

actions taken following exposure, such as post-exposure prophylaxis (PEP). For HIV, PEP

involves the administration of multiple antiretroviral drugs, while for hepatitis B, it includes

vaccination and immunoglobulin. However, in some healthcare settings, despite good

knowledge, post-exposure practices are often insufficient, with many failing to report

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incidents or take appropriate action [7]. Awareness and adherence to preventive measures can

vary significantly among different categories of healthcare workers [8].

Therefore, we conducted a cross-sectional study involving healthcare workers from various

cadres in a tertiary care hospital. The study aimed to assess their awareness about the

practices related to needlestick injuries and their prevention.

Aim:

Assess the level of awareness about the practices associated with needle stick injury and its

prevention.

Study Hypothesis:

There is insufficient awareness about the practices associated with needle stick injury and its

prevention.

Methodology:

Study Design:

A descriptive cross-sectional study will be conducted from March to May 2025 using a self-

administered structured online survey tool through the “Google Forms” platforms among

some university hospitals and Teaching hospitals in Egypt.

The inclusion criteria:

Intern doctors currently enrolled in internship programs at Egyptian university hospitals

in their first or second year of internship and medical students in their final year of medical

university.

The exclusion criteria:

Healthcare workers other than intern doctors and medical students in their final year.

Sample size:

Sample collection was determined by including medical students in their final year and

medical interns. The sample will be collected from the participants by online survey with an

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expected frequency of 50% and a confidence interval of 95%. The minimum sample size was

calculated as 365 samples. This was rounded up, and finally, the sample size was set at 400.

Measurement and Instrument:

A descriptive anonymous, self-administered questionnaire was structured for the study.

Questionnaires will be administered online (e.g., Google Forms), and digitally informed

consent will be obtained before participation. The questionnaire was based on the one used

by Alsabaani et al. [9, 10]. The questionnaire has four parts, Questions about age, sex,

working nature, and years of experience were included in the first part of the questionnaire.

The second part contained 10 questions focusing on awareness regarding protocols for sharp

waste disposal and recapping of needles. The third section included seven questions about

attitudes towards needle stick injuries, such as reporting injuries and precautions while

handling sharps. Questions related to blood-borne pathogens, their risk of transmission, and

vaccination details were also part of the questionnaire.

Data Collection Tools and Methods:

A descriptive anonymous, self-administered questionnaire was structured for the study.

Questionnaires will be administered online (e.g., Google Forms), and digital informed

consent will be obtained before participation. The questionnaire was based on the one used

by Alsabaani et al. [9, 10]. The questionnaire has four parts, Questions about age, sex,

working nature, and years of experience were included in the first part of the questionnaire.

The second part contained 10 questions focusing on awareness regarding protocols for sharp

waste disposal and recapping of needles. The third section included seven questions about

attitudes towards needle stick injuries, such as reporting injuries and precautions while

handling sharps. Questions related to blood-borne pathogens, their risk of transmission, and

vaccination details were also part of the questionnaire.

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Sociodemographic Characteristics:

The online questionnaire collected data concerning sociodemographic characteristics,

including age (Open-ended), Gender: [Male / Female], [Profession: student/intern],

Nationality [Egyptian or not], Institution of Internship: (Open-ended)

Awareness about needle stick injury prevention:

The second section of the questionnaire included a total of 10 questions/items to assess

awareness about needle stick injury prevention.

- Disposal in a sharps container after performing procedures is recommended to decrease the

risk of needle stick & Sharp injury. (Yes/ No)

- Recap of the needle after performing nursing procedures is recommended to decrease the

risk of needle stick injury. (Yes/ No)

- Doses of vaccines required for full protection from Hepatitis B. (1/2/3/4/5)

- Hepatitis C disease can be prevented by vaccine. (Yes/ No/ don’t know)

- Choose any three Blood-borne pathogens that hospital workers are most commonly exposed

to when they experience needle stick injury. [Dengue -Hepatitis B -Malaria -Filariasis -

Hepatitis C -Syphilis -HIV -Leptospirosis -Don’t know]

- In needle stick injury, which disease carries the greatest risk of transmission.

[Dengue, Hepatitis B, Malaria, Filariasis, Hepatitis C, Syphilis, HIV, Leptospirosis, don’t

know.]

- Are you aware of the procedure and guidelines to follow if you sustain a needle stick injury

in your workplace? (Yes/No)

- If you have a needle stick injury your immediate action will be to wash with [Water only,

Soap Betadine, Spirit, Peroxide, Others]

- There is currently no approved post-exposure prophylaxis for which of the following? [HIV,

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Hepatitis C, Hepatitis B, don’t know]

- PEP for HIV must be started within ______ hours after a needle stick injury

[12 24 48 72 don’t know]

Statements of perception towards Needle Stick injury and its prevention:

- I am worried about having a needle stick injury. (Yes/No)

- Patient care is more important than my own safety. (Yes/No)

- I would report all sharp injuries at work immediately. (Yes/No)

- I think needle stick injury is preventable. (Yes/No)

- If the quantity of sharp waste is very small or if the potential of infection is less, it can be

mixed with domestic waste. (Yes/No)

- I am not sure about taking post-exposure prophylaxis as it involves multiple drugs or

injections and side effects (Yes/ No)

- I ensure others around me take extra precautions while handling sharp/ needles (Yes/No)

Questions on practice

- Do you have the habit of recap needles before disposal? (YES/NO/ not applicable)

If yes, do you recap needles with 2 hands before disposal? (YES/NO)

- Do you bend needles before disposal? (YES/NO)

- Do you use a needle cutter/burner, shredder, etc. to dispose of a needle?

(YES/NO/Occasionally/Not applicable)

- Do you collect all the needles used during the procedure and dispose of them together at the

end of the session? (Yes / No/ Occasionally)

- Do you put sharp items into their assigned disposal container? (Always/NO/Occasionally)

- Have you attended any training program on the safe usage of needles/ sharps in the last year

last year? (YES/NO)

- Have you been vaccinated against Hepatitis B within the last 5 years? (YES/NO)

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* a. If no, have you checked your Hepatitis B titre within the last 5 years? (YES/NO)

* b. If yes, was it adequate? (YES/NO/ don’t know)

Statistical Analysis:

The pre-coded data will be enrolled in the statistical package of the social science software

program, version 21 (SPSS) to be statistically analyzed. Data will be summarized using

mean, median, SD, and IQR for quantitative variables and number and percent for qualitative

variables. P value less than 0.05 was regarded as statistically significant.

Ethical consideration:

Digital informed consent will be obtained before participation. We will obtain ethical

approval from the ethical committees of the universities where the study will be conducted in

before data collection. The participants’ identities will remain anonymous, and no personal

data will be collected, and individual data will not be published.

Plan for getting participants' approval and protecting confidentiality:

We will explain the aim of the study in the introduction of the survey and get consent by

asking a question “Do you agree to fill out the survey?” in the survey.

Confidentiality and data retention:

All data will be maintained confidentially and accessed only by the data analyst. All

responses will be coded and mainly used for statistical analyses, so all responses will be kept

confidential.

Risk and benefit for the participants:

There are no risks or direct benefits to the participants in this study. Information collected in

this study will benefit intern doctors and the general population.

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