Injection Safety Practices Among Health Care Workers In Selected Primary Health Care Centers In Ejigbo, Osun State
The most important risk factors against injection safety was lack of training on injection injuries, working for more than 40 hours per week, recapping needles for most of the time and not using gloves. To assess injection safety practices among health care workers in selected primary health care centers in ejigbo, osun state, a cross section study design quantitative in nature was used to recruit 60 respondents for the study out whom 60 questionnaires were returned completely filled thus a response rate of 100%. 55% of the respondents stated that hand gloving would prevent Needle injuries, 63% of the respondents strongly agreed that protocols for prevention of Needle accidents should only be followed where there is no post exposure prophylaxis and 75% of the respondents strongly agreed that recapping needles after use is a potentially dangerous practice leading to Needle accidents. The researcher concluded that the respondents were knowledgeable injection safety as they could correctly define Needle accidents and knew the diseases acquired from NSA. Attitudes about prevention and management of Injections were not good despite good knowledge as most of the respondents stated that anyone who got needle injuries should resign from their jobs and that safety precautions should only be practiced when there is no possibility of post exposure prophylaxis and practices about post exposure prophylaxis were good as most of the respondents strongly agreed that personal protective gears were important for prevention of Needle accidents and were not in favour with the practice of recapping used needles.
1.1 Background of the Study
Most of the Needle injuries are due to lack of awareness of the consequences of Needle accidents and attitude among health workers to the proper practice (Maimunah and Ahmad, 2007).
Each day thousands of health workers around the world suffer accidental occupational exposures during the course of their role of caring for patients. These injuries can result in a variety of serious and distressing consequences ranging from extreme anxiety to chronic illness and premature death (Omenn et al., 2009). The misconception exists that health care industry is without hazards, but in fact blood borne exposures encountered can be disastrous (Maupome and Acosta-Gio, 2007).
Health care workers are exposed two million Needle injuries per year that result in infections. While 90% of the occupational exposures occur in the developing world, 10% of the reported infections occur in the United States and Europe (Roy et al., 2012). In Africa, It is estimated that up to 35 new cases of HIV and at least 1000 cases of serious infections are transmitted annually to health care workers. Data from injection safety survey conducted by WHO, shows 4 Needle injuries per worker per year in Africa, Eastern Mediterranean and Asia populations (Chan, 2009).
In a study conducted at Arua hospital in Nigeria, 25.3% of the health care workers suffered Needle Injuries (NSI) and 50% of these NSI cases were from potentially infectious sources (Walusimbi et al., 2012).
Accidents can occur at any time when people use, disassemble or dispose of needles. If not disposed properly, needles can be forgotten in linen or garbage and injure other workers who encounter them unexpectedly (Gerberding, 2010).
WHO. (2015), Stated that 30 to 50% of all Needle accidents occur during clinical procedures. The determinants of Needle accidents includes; over use of injections, lack of supplies, poor disposal of syringes, safer needle devices and disposal containers, lack of access to and failure to use sharp containers immediately after injection, inadequate staffing, recapping of needles after use, lack of engineering controls such as safer needle devices, passing instruments from hand to hand in the operating suite, lack of awareness of hazards and lack of training.
Every day while caring for patients, nurses are at risk of exposure to blood borne pathogens potentially resulting in infections such as HIV, Hepatitis B and Hepatitis C. These exposures, while preventable, are often as being a part of the job Kermode et al., (2010). Needle injuries transmit infectious disease viruses, each of these viruses’ poses a different risk if a health care worker is exposed Gilbert et al., (2011). More than 20 other infections can be transmitted through Needle injuries, including syphilis, malaria (Mbanya et al., 2011).
Needle accidents cause a high burden of death and disability among health care workers. Available statistics underestimate the severity of problem because many cases go unreported as nurses do not report their injuries. This makes it more difficult to know severity of problem and how well prevention is possible. Preventing Needle injuries is the most effective way to protect the health care workers from the infectious diseases caused by accidents (Nsubuga et al., 2012).
To prevent the Needle accidents, there is comprehensive program which includes; employee training, controlled work practice, implementing engineering control, surveillance programs,safe recapping procedures andeffective disposal systems (Supapvanich et al., 2011).
Needle injuries cause a high burden of death and disability among health care workers. The severity of problem becomes worse when cases go unreported as many workers do not report their injury (Oyeyemi et al., 2010). Needle injuries may be reduced by staff education, use of safe equipment. Continuous professional development can influence compliance with safer injection practices by teaching them with modelling appropriate behaviour (Ruderman et al., 2009).
1.2 Statement of the Problem
Globally, as a result of Needle accidents 150,000 health care workers contract Hepatitis C virus, 70,000 Hepatitis B virus and 500 HIV per year. More than 90% of these occur in developing countries (Mittal et al., 2015).
In Africa Needle accidents are common for in a study conducted in Nigeria over 12 months’ period, there was overall prevalence of accidents of 51%. Among doctors the prevalence was 80% and nurses (70%). In a cross sectional study conducted in Mulago national referral hospital Osun State, Nigeria, 57% of the nurses and midwives had at least experienced one Needle injury in the past year. The most important risk factors for injection safety was lack of training on such injuries, working for more than 40 hours per week, recapping needles for most of the time and not using gloves (Tedesse, 2010).
In hospitals inEjigbo, Ogun in particular, injection safety is a significant problem in general practice and exposes health care workers to a serious risk of infections from blood borne transmissible agents.
1.3 Purpose of the Study
To assess injection safety practices among health care workers in selected primary health care centres in Ejigbo, osun state.
1.4 Objectives of the Study
- To assess health workers’ knowledge about injection safety in Ejigbo, Osun state.
- To determine attitudes of health care workers about injection safety in Ejigbo, Osun state.
- To identify health workers’ practice about prevention and management of Needle Accidents in Ejigbo, Osun state.
1.5 Research Questions
- What is the level of knowledge about injection safety in Ejigbo, Osun state.?
- What are the attitudes of health care workers about injection safety in Ejigbo, Osun state?
- What are the practice about prevention and management of Needle Accidents in Ejigbo, Osun state?
1.6 Significance of the Study
Medical services have many risk factors that adversely affect the health of hospital personnel in particular. Therefore, the findings of this study may be beneficial to;
- To become active participants of safety campaigns through health education about adherence to universal precautions.
- The study findings may be incorporated in the nursing curriculum to enhance teaching and learning of student nurses about knowledge, attitude and practices towards injection safety practices.
- The study findings may be used as a reference by other researchers with similar interest in assessing knowledge, attitudes and practices about prevention of needle accidents.
1.7 Definition of Terms
- Knowledge- the information, skills and understanding that you have gained through learning or experience
- Occupational health hazards are those hazards or potential risk for hazards or harm which present or result from an occupation through injury, infection and other sources.
- Occupational health- occupational health as the promotion and maintenance of the highest degree of physical and social wellbeing of workers in all occupations.
- Practice – The act of doing something over and over again
1.8 Organization of the Study
This study is organized into five chapters. Chapter one included the background of the study, research problem, research objectives and questions as well as limitation of the study. Chapter two contains the literature review. Chapter three includes the methodology and study area. Chapter Four contains the results and discussion of key findings of the study. Chapter Five finally looks at the summary, conclusions, and recommendations based on the findings.
Discussion of Findings, Conclusion, Recommendations and Implications
This chapter presents interpretation and discussion of study findings objectively in relation to the study background, statement of the problem and literature review to answer research questions, conclude and make recommendations about knowledge, attitude and practices about prevention and management of Needle accidents among health workers in Osun State making a total of 60 respondents. Out of 60 respondents recruited in the study, 60 questionnaires were returned completely filled thus a response rate of 100%.
5.1.1 Bio demographic data.
Most of the respondents (60%) were in the age range between 26-35 years of age while only 5% were above 45 years of age. As individuals grow up, they tend to behave more responsibly compared to when they were young and are therefore more like to adjust to universal precautions put in place to for injection safety.
Most of the respondents (61.7%) were female while only 38.3% were male. It is not un common to find most of the females practicing nursing profession and laboratory work compared to the males and therefore formed the proportion of the study population. Majority of the respondents (85%) were nurses while only 3.3% were doctors.
Nurses were easily found in the wards and since they are the majority users of the needles in the wards, their knowledge and practice is paramount in the prevention of Needle accidents. This study finding agree with the findings of WHO, (2015), that stated that 30 to 50% of all Needle accidents occur during clinical procedures and that poor disposal of syringes, lack of access to and failure to use sharp containers immediately after injection, inadequate staffing, recapping of needles after use, passing instruments from hand to hand in the operating suite could contribute to injection safety.
Majority of the respondents (73.3%) had experience of 1-3 years while only 11.7% had experience of more than 5 years. The more years of professional experience, the better the knowledge and practice hence more likely to adhere to universal precaution for prevention of Needle accidents although some may tend to neglect the precautionary measures.
Most of the respondents (66.7%) attained diploma while only 15% attained certificate level of education. The higher the academic achievement, the better the knowledge which can be translated to better attitudes and practices deemed relevant for prevention of Needle accidents. The study findings agree with the findings of Morom et al., (2009), who stated that injection safety may be increased by staff education, use of safe equipment and that continuous professional development can influence compliance with safer practices by teaching them with modelling appropriate behaviour.
5.1.2 Health workers knowledge on injection safety.
All the respondents (100%) had ever heard about Needle accidents. Most of the respondents (67%) stated that Needle injuries are un intended needle pricks while only 16% stated that injuries by needles and sharps. Knowledge about Needle accidents influences attitudes behavior change about its prevention and management as health care workers who are better equipped with sufficient knowledge about prevention and management of Needle accidents are more likely to translate it into better practice. This study findings concur with the findings of Dragovich et al., (2007), who conducted a cross sectional study in southern England to know the knowledge of health care workers regarding glove techniques and precautions followed in Needle injury at a teaching hospital and found out that knowledge was low in relation to standard precautions to be taken to avoid Needle injury despite a high level of awareness (70%).
All the respondents (100%) stated that they knew some diseases transmitted from Needle injuries. More than half of the respondents (53%) mentioned HIV, Hepatitis C and B as the diseases transmitted by Needle accidents while only 17% Syphilis, malaria, typhoid fever and cholera. Many blood born infections are transmitted through Needle accidents, the most virulent ones being HIV, hepatitis B and C. This study findings are in stuck contrast with the findings of Roy and Robillard, (2012), who conducted a study in Nigeria and found out that most of the health care workers had knowledge about the diseases transmitted by contaminated sharp objects and that most of the HCWs acquired knowledge of blood borne disease mainly from the lectures 98.3%, books 90.8% and informally 81.6%.
More than half of the respondents (55%) stated that hand gloving would prevent Needle injuries while only 6.7% mentioned disposing needles in safety boxes. Gloving does not prevent Needle injuries and therefore has to be backed up with other precautionary measures such as safe disposal of sharps in a safety box. This study findings are in line with the findings of Gilbert et al., (2007), who conducted a study in Ethiopia and found that almost all of the participants (n = 250, 93%) identified blood as the most infectious body fluid that can transmit infections through Injections and therefore considered gloving as a precautionary measure for NSA.
5.1.3 Attitudes about injection safety
Most of the respondents (66.7%) strongly agreed that health care workers who get infections from Needle accidents should resign from their jobs while only 5% disagreed. After getting a Needle accident, it is wise to take precautionary measures to prevent Needle accidents instead of considering resigning from the job. This study findings concur with the findings of Ogulesi et al., (2008), who conducted a study in Pakistan and found out that 47% of HCWs Strongly disagreed with the statement that “ If health care workers got infected with HIV infection due to injection injuries, they should resign from their profession”
Most of the respondents (63%) strongly agreed that protocols for prevention of Needle accidents should only be followed where there is no post exposure prophylaxis while only 2% strongly disagreed. Protocols for prevention of Needle accidents should be followed all the time since the time of occurrence of accident cannot be predicted. This study finding agree with the findings of Mekenzie et al., (2010), who conducted a study in Indonesia and found out that the lack of Post Exposure Prophylaxis was a motivating factor for observing safety precaution for f injection safety in more than 60% of health workers interviewed thus they had positive attitudes towards standard operating procedures.
More than half of the respondents (57%) strongly disagreed that needles stick accidents cannot always be prevented while only 5% strongly agreed. Needle accidents can be prevented as long as one adheres to universal precautions. This study finding are in concert with the findings of Gill et al., (2011), who found out from a study in Tanzania that most health workers (65%) expressed fear of stigma from Injections and were skeptical about protection from Needle Injuries as they considered it inevitable due to understaffing (45%) and poor working conditions (55%) such as lack of safety boxes.
Most of the respondents (70%) strongly agreed that reporting Needle accidents may not be helpful while only 10% disagreed. Reporting Needle accidents helps management to improve on measures put in placement for injection safety as well also helping the victim to be initiated on Post Exposure Prophylaxis and can also claim for compensation whenever possible for occupational hazards. This study findings are in line with the findings of Thairu and Pelto, (2008), who conducted a study in Nigeria and found out that majority of the HCWs (68.3%) perceived themselves to be at a very high risk of acquiring HIV infection during their medical career and were not willing to go for psychological counseling and that the common reasons for perceived risk of acquiring HIV infection were due to needle pricks/cuts during surgical procedures (32.4%), frequent exposure to the blood/ secretions of patients (28.5%) and insufficient availability of gloves (17.6%). The study findings also agree with the findings of by Supapvanich et al., (2011), who conducted a study in Kenya and found out that 23.2% of the respondents were of the opinion that HCWs in future might lose interest in the medical profession due to the increasing risk of HIV infection and few (3.1%) were even considering to leave the medical profession for fear of injuries.
5.1.4 Health workers’ practices on injection safety
Most of the respondents (60%) strongly agreed that personal protective gears were good and safe to use while only 8.3% strongly disagreed. Personal protective gears help to minimize risk of coming in contact infected material as well as injuries from sharp objects. The study findings concur with the findings of Leadford et al., (2013), who conducted a study in Zambia and found out that 70% of the nurses were not adhering to the Standard Operating Procedures (SOPs) despite charts on the wards on walls to guide HCWs on SOPs such as hand washing and gloving. The study findings also agree with the findings of Osrin, (2012), who conducted a study in Kenya and found out that a greater percentage of doctors (90%) compared to nurses (54%), midwives (51%) and ward orderlies (32%) used safety precautions such as gloves, face masks and aprons.
Most of the respondents (60%) agreed that post exposure prophylaxis is a very good measure if well applied while only 3% disagreed. Though post exposure prophylaxis is good for prevention of occurrence of infection after potential exposure to infectious material, emphasis should be laid primarily on prevention of occurrence of exposures to Needle accidents than the prophylaxis. This study findings are in tandem with the findings of Marsh et al., (2012), who conducted a study about the management of occupational exposure to the human immunodeficiency virus among health workers in Nigeria and found out that there were poor practices towards the prevention and management of Needle accidents and that nurses and midwives did not avoid risky practices such as recapping used needles as well as hand to hand passage of sharp tools and equipment.
Most of the respondents (75%) strongly agreed that recapping needles after use is a potentially dangerous practice leading to Needle accidents while only 3.3% disagreed. Recapping needles increases chances of getting a Needle accident hence is better to avoid it. The study findings are in line with the findings of Chan, (2009), who documented in a study in a teaching hospital in Nigeria that the majority of health care workers had poor practices towards the prevention and management of Needle accidents as they recapped used needles.
Most of the respondents (61%) strongly agreed that separation of medical waste is a good practice towards prevention of Needle accidents while only 5% disagreed.
Segregating medical waste minimizes the risks of accidents to waste handlers from sharps such as Needles. The study findings are related to the findings of Naumanen, (2011), who conducted a study about Finnish occupational health nurses’ work and expertise and found out that the majority of health workers interviewed had good practices towards the prevention and management of Needle accidents as they strictly followed the recommended safety measures for prevention of occupational health hazards.
- The respondents were knowledgeable about prevention and management of Needle accidents as they could correctly define injection safety and knew the diseases acquired from Needle accidents.
- Attitudes about prevention and management of Needle accidents were not good despite good knowledge as most of the respondents stated that anyone who got a Needle accident should resign from their jobs and that safety precautions should only be practiced when there is no possibility of post exposure prophylaxis.
- Practices about post exposure prophylaxis were good as most of the respondents strongly agreed that personal protective gears were important for prevention of Needle accidents and were not in favour with the practice of recapping used needles.
- Continuous medical education of hospital staff about prevention and management of Needle accidents will improve on existing knowledge about medical waste management as well as provide new updates about universal precautions for injection safety.
- Ministry of health to increase availability of protective materials such as gloves and other incentives to motivate hospital staff to perform their duties with less stress.
- Improve monitoring of junior staff by their superiors to make sure that they are complying with the agreed protocols.
- More research be done about knowledge, attitude and practices of health workers about prevention and management of Needle accidents so as to obtain more comprehensive results and make more generalizing conclusions.
5.4 Implications to the Nursing Practice
The study findings will help nurses to learn to adhere to safety precautions for prevention of Needle accidents and advocate for incentives for prevention of Needle accidents such as safety boxes.
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