¹Medical Officer, District Training Centre, Zilla Parishad, Bhandara, Maharashtra, INDIA.

²Assistant Professor, Department of Community Medicine, Vilasrao Deshmukh Government Medical College, Latur, Maharashtra, INDIA.

Email: hinasalam23@gmail.com

Table 1: Characteristics of study subjects

Most of the study subjects 378 (63.21%) were having duration of service ≤10 years. Mean duration of service of study subjects was 10.38 years with standard deviation of 8.12 years and the range being 1-34 years5. Maximum number of study subjects were posted in Surgery allied departments i.e. 255 (42.64%) and Medicine allied departments i.e. 145 (24.25%).  Maximum i.e.182 (30.43%) subjects attended patients per day between 50-75 patients and 135 (22.58%) attended ≤ 25 patients per day. Only 64 (10.70%) subjects attended ≥ 100 patients per day. Out of total 598 study subjects, 279 (46.65%) were exposure to sharps injury and 319 (53.35%) had no history of any exposure to Sharps injury in last one year. Out of 279 study subjects who had a history of sharps injury in last one year, 206 (73.83%) had sharps injury one time and 64 (22.94%) had sharps injury two time during last year. Even 2 study subjects had sharps injury ≥ 4 in frequency in last year.

Table 2: Various type of sharps causing sharps injuries

Hollow bore needle was responsible for maximum number of injuries [150 (53.76%)] followed by suture needle [48 (17.20%)] and intracatheter [39 (13.98%)]. Out of 279 study subjects who sustained sharps injury, only 72 (25.81%) were reported to the appropriate authority. The most common reason stated by 85 (41.06%) study subjects for not reporting the injury was their conviction that the source patient was not infected i.e. 36 (57.17%) doctors, 46 (49.46%) nurses, 3 (37.50%) lab technicians. Others reasons were unaware about reporting [70 (33.82%)], patient was HIV negative [32 (15.46%)], exposure was not significant [13 (6.28%)], no time to report [7 (3.38%)].

Table 3: Reasons stated by study subjects for not reporting sharps injury

Out of 279 study subjects who sustained sharps injury only 72 (25.81%) study subjects reported their injury to appropriate authority i.e. 22 (24.18%) doctors, 39 (29.55%) nurses, 3 (27.27%) lab technicians and 8(17.78%) servants. Out of 279 study subjects, 138 (49.46%) study subjects did testing for HIV on source patient they were 48 (52.75%) doctors, 63 (47.73%) nurses, 6 (54.55%) lab technicians, 21 (46.67) servants. Out of 138 source patients, 16 were HIV positive. Only 66 (23.66%) study subjects did testing for HIV on themselves including 21 (23.08%) doctors, 29 (21.97%) nurses, 6 (54.55%) lab technicians and 10 (22.22%) servants. Very few of them, 26 (9.32%) took PEP drugs for HIV, these were 10 (10.99%) doctors, 12 (9.09%) nurses, one lab technicians and three servants.

Table 4: Practice of PEP for HIV by study subjects after sharps injury

DISCUSSION

In the present study, the prevalence of sharps injury was found out to be 46.65%. This finding was similar to the result of the some of the other studies conducted by Hadadi A et al.⁸ i.e. 43.4%, Zafer A et al.⁹ i.e. 45%, Lachowicz R et al.¹⁰ i.e. 46.7%, Akeem B et al.¹¹ i.e. 41.62%, and Chalya PL et al.¹² i.e.48.6%. Poor compliances to universal precautions are a risk factor for sharp injuries. Some circumstances such as pressure of work and time constraint was a contributing factor.¹³ High prevalence may be attributed to patient overload and different work culture in the Indian scenario.^14,15 In present study, only 72 (25.81%) study subjects reported their injury to appropriate authority i.e. 22 (24.18%) doctors, 39 (29.55%) nurses, 3 (27.27%) lab technicians and 8 (17.78%) servants. Similar findings were reported by the studies conducted by Barakat I et al.¹⁶ Jacob A et al.¹⁷ conducted a study found that only 18% of the respondents who sustained a sharps injury filled in an incident reporting form, which is lower than our study. Markovic Denic L et al.¹⁸ conducted a study and found that 106 (40.2%) had reported an accident to the responsible authority which was higher than our study. Accidents were significantly more often reported by health assistants and hospital hygienists (55.5%). Sarah OA et al.¹⁹ conducted a study and found that 123 (87.0%) of the 142 respondents with needle stick injury reported to the appropriate authority, which is higher as compare to our study. Chalya PL et al.¹² conducted a study only 68 (32.1%) reported the incident to the relevant authority which was nearly similar to our study. In present study, 26 (9.32%) took PEP drugs for HIV, these were 10 (10.99%) doctors, 12 (9.09%) nurses, one lab technicians and three servants. Mathewos B et al.²⁰ reported majority 49 (74.2%) took PEP which was very much higher to our study. Owino O et al.²¹ reported majority 72 % took PEP which was very much higher to our study. Gebreslase T et al.²² reported 31 out of 158 (19.6%) used PEP which was nearly similar to our study. Sarah O A et al.¹⁹ conducted a study found that only 8 out of 142 (6.3%) of respondents had PEP which was lower to our study. Singh R K et al.²³ reported only 7 (14.9%) had taken PEP, which was nearly similar to our study.

CONCLUSION

In present study, overall prevalence of sharps injury among health care workers in tertiary care hospital is found to be 46.65%. Most of sharps injuries were unreported (74.19%). Timely reporting after exposure of the HCW is indeed the need of hour to avail the facility of PEP. There is a need for sensitizing the HCWs regarding the importance of PEP after occupational exposure to HIV.

REFERENCES

1. Shevkani M, Kavina B, Kumar P et al. An overview of post exposure prophylaxis for HIV in health care personals: Gujarat scenario. Indian J Gender Transm Dis 2011; 32: 9-13.
2. Goniewicz M, Wloszczak A. Injuries caused by sharp instruments among health care worker, international and polish perspectives. Annals of Agricultural and Environmental Medicine 2012; 19 (3):523-527.
3. Makary MA, Al-Attar A, Holzmueller CG et al. Needle stick injuries among surgeons in training. N Engl J Med 2007; 356: 2693-9.
4. Au E, Gossage JA, Bailey SR. The reporting of needle stick injuries sustained in theatre by surgeons: are we under reporting? J Hosp Infect 2008; 70: 66- 70.
5. Kermode M, Muani V. Injection practices in the formal and informal healthcare sectors in rural north India. Indian J Med Res 2006; 124: 513-20.
6. Ganczak M, Barss P, Kuwaiti A. Use of the Haddon Matrix as a tool for assessing risk factors for sharps injury in emergency department in the United Arab Emirates, Infection control and hosp. Epidemiology 2007: 28(6):89-93.
7. Hesse A, Adu-aryee N, Entsua-mensah K et al. Knowledge, attitude and practice universal basic precautions by medical personnel in a teaching hospital. Ghana medical journal 2006; 40:261-65.
8. Hadadi A, Afhami S, Karbakhsh M et al. Occupational exposure to body fluids among healthcare workers: a report from Iran. Singapore Med J. 2008; 49(6): 492–6.
9. Zafar A, Aslam N, Nasir N et al. Knowledge, attitudes and practices of health care workers regarding needle stick injuries at a tertiary care hospital in Pakistan. J Pak Med Assoc. 2008; 58(2):57–60.
10. Lachowicz R, Matthews P. The pattern of sharps injury to health care workers at Witbank Hospital. South African Fam Pract. 2009; 51(2):148–51.
11. Akeem B, Abimbola A, Idowu A. Needle Stick Injury Pattern Among Health Workers in Primary Health Care Facilities in Ilorin, Nigeria. Acad Res. 2011; 1 (3):419–27.
12. Chalya PL, Seni J, Mushi MF et al. Needle-stick injuries and splash exposures among health-care workers at a tertiary care hospital in north-western Tanzania. Tanzan J Health Res. 2015; 17(2):1–15.
13. Rais N, Jamil HM. Prevalence of needle stick injuries among health care providers. Int J Endorsing Heal Sci Res. 2013; 1(2):73–9.
14. Muralidhar S, Singh PK, Jain RK et al. Needle stick injuries among health care workers in a tertiary care hospital of India. Indian J Med Res. 2010; 131(3):405–10.
15. Pathak R , Kahlon A, Ahluwalia AS et al. Needle Stick Injury and inadequate Post Exposure Practices among Health Care Workers of a Tertiary Care Centre in Rural India. International Journal of Collaborative Research on Internal Medicine and Public Health.2012; 4(5): 638-48.
16. Barakat I A, Saoud B, Elsour I et al. Knowledge, Attitudes and Practices of Health Care Workers in Benghazi, Libya towards Post Exposure Prophylaxis for HIV. Ibnosina J Med BS 2013; 5(6):318-323.
17. Jacob A, Newson-Smith M, Murphy E et al. Sharps injuries among health care workers in the United Arab Emirates. Occup Med (Chic Ill). 2010; 60(5):395– 7.
18. Markovic-Denic L, Maksimovic N, Marusic V et al. Occupational Exposure to Blood and Body Fluids among Health-Care Workers in Serbia. Med Princ Pract 2015; 24(1):36–41.
19. Sarah OA, Akinsegun AA, Charles JE et al. Knowledge, Attitude and Practices of HIV Post Exposure Prophylaxis among Health Workers in Lagos University Teaching Hospital. Occup Med Health Aff 2014; 2: 149-52.
20. Mathewos B, Birhan W, Kinfe S et al. Assessment of knowledge, attitude and practice towards post exposure prophylaxis for HIV among health care workers in Gondar, North West Ethiopia. BMC Public Health. BMC Public Health; 2013; 13(1):1-4.
21. Owino O S. Shrivanichakron S, Thepthien B. Awareness of occupational post exposure prophyalaxis against HIV infection among health workers in Nyanza province, Kenya. J Pub Health Dev. 2013; 11(2):19-30.
22. Gebreslase T. HIV Post-Exposure Prophylaxis Use and Associated Factors among Health Professionals of Governmental Health Institutions in Mekelle Town, Tigray Ethiopia, Cross-Sectional Study. J AIDS Clin Res. 2014; 05(6):1-4.
23. Singh R, Kumar M, Rawat C et al. Awareness and practice of post-exposure prophylaxis (PEP) of HIV among health-care workers in tertiary care hospital of Haldwani, Nainital, Uttarakhand, India. Int J Med Sci Public Heal. 2015; 4 (7):1-4.