Origi na l A r tic le

Needle Stick Injury among Health Care Workers in

a Government Teaching Hospital, Mandya
Rajagopal Jahnavi1, Assistant Professor, Department of Community Medicine, Mandya Institute of Medical Sciences,
1

Karnataka, India, 2Professor and Head, Department of Community Medicine, Mandya Institute of
M Manjunath1,
Medical Sciences, Karnataka, India, 3Post-graduate Student, Department of Community Medicine,
B J Mahendra2, Mandya Institute of Medical Sciences, Karnataka, India, 4Under-graduate Student, Mandya Institute of
R Ragini3, Medical Sciences, Karnataka, India
H J Swetha3,
M C Harshitha4, Corresponding Author: Dr. Jahnavi Rajagopal, Department of Community Medicine, Mandya Institute
of Medical Sciences, Mandya, Karnataka, India. E-mail: drjahnavi28@gmail.com
P Nishitha4

Abstract
Introduction: Needle stick injuries (NSIs) are wounds caused by sharps such as hypodermic needles, blood collection needles,
intravenous cannulas or needles. The physicians to housekeeping personnel are at an increased risk of accidental needlestick
and sharps injuries, because of the environment in which they work. About 30 diseases like hepatitis B, hepatitis C, HIV can be
transmitted by NSI. The incidence of NSI is considerably higher than current estimates, due to gross under-reporting.
Objectives: (1) To determine the incidence of NSIs among various categories of health care workers (HCWs), (2) To determine
the factors influencing NSIs. (3). To assess awareness regarding NSIs among various categories of HCWs.
Methodology: This cross-sectional study was conducted at Government Teaching Hospital, Mandya for a period of 3 months.
Interview method was used to collect information regarding socio demographic details, occurrence of NSI, factors influencing
NIS and awareness regarding NSI by using a pretested semi-structured questionnaire on HCWs.
Results: Of the 509 HCWs working during the study period, 361 participated in the study. 170 (47.1%) of the HCWs had NSI in
the past 1 year. The common category of HCWs who experienced NSI were the nurses - 53 (31.2%). The mean frequencies of
NSI significantly higher among housekeeping staff. The incidence of NSI per 1000 man hours was more among housekeeping
2.93. The common place of occurrence of NSI was in the wards - 97 (57.1%); followed by operation theatre - 20 (11.7%). The
doctors and interns had better knowledge regarding the diseases spread through NSI.
Conclusions: The housekeeping staff tends to have less knowledge regarding NSI and is more prone to NSI. Ensuring the
safety during handling of biomedical waste could prevent more than half the injuries.

Keywords: District hospital, Health care workers, Needle stick injury

INTRODUCTION are due to percutaneous exposures to blood and body

Needle stick injuries (NSI) are accidental wounds caused
by sharps such as hypodermic needles, blood collection
needles, intravenous cannulas or needles used to connect
parts of intravenous delivery systems. NSI can be sustained
while using a needle or afterward during recapping or
disposal, but most of the time it occur during disposal.1
Accidental NSI and sharps injuries are common among
physicians, surgeons, and nurses to housekeeping
personnel, laboratory technicians and waste handlers,
because of the nature of work.
fluids through contaminated needle sticks and sharps.2
Roughly about thirty diseases like hepatitis B, hepatitis C,
HIV, syphilis, malaria, and herpes are been reported to be
transmitted by NSI, among these hepatitis B, C, and HIV
infections are most dangerous.3 Following NSI, the risk of
transmission from infected patients to HCW are 3-10%
for hepatitis B, 3% for hepatitis C, and 0.3% for HIV.4
There is major loss to the organization, both financial
and in terms of lost man-hours. Anxiety experienced by
themselves and their contacts following NSI is an added
risk factor.5

The morbidity and mortality from infections with blood- The World Health Organization (WHO) estimates that
borne pathogens among health care workers (HCWs) about three million health care providers are exposed to

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 Jahnavi, et al.: Needle Stick Injury among Health Care Workers

blood and body fluid due to needle stick or sharps injuries experienced NSI were the nurses - 53 (31.2%) followed by
annually. the housekeeping staff - 48 (28.2%). The mean frequency
of NSIs was highest among the housekeeping staff - 12.27,
There are nearly 57 documented cases of HIV followed by nurses - 3.32 (Table 2).
seroconversion in 2001 among healthcare personnel
following blood and body fluid exposures. More than 80% In the present study when the mean frequencies of NSI
of NSI are preventable with the use of safe needle.6 were compared amongst the various categories of HCW,
there was a significantly higher mean frequency of NSI
The incidence of NSI is considerably higher than current among housekeeping staff (Table 3).
estimates, due to gross under-reporting (often <50%). So
the present study was done to determine the incidence
Table 1: Socio demographic characteristics of
of NSI among HCWs in a government teaching hospital HCWs
and their awareness levels regarding NSI among various
Socio demographic characteristics Number (%)
categories of HCWs. The study was undertaken with the
Age
following objectives:
20-29 121 (33.5)
1. To determine the incidence of NSIs among various 30-39 149 (41.3)
categories of HCWs 40-49 064 (17.7)
2. To determine the factors influencing NSIs >50 027 (07.5)
Sex
3. To assess awareness regarding NSIs among various Male 125 (34.6)
categories of HCWs. Female 236 (65.4)
Occupation
Doctors 86 (23.8)
METHODOLOGY Interns 69 (19.1)
Nurses 116 (32.1)
Laboratory technicians 16 (04.5)
This cross-sectional study was conducted at Government House keeping 74 (20.5)
Teaching Hospital, Mandya Institute of Medical Work experience in health care
Sciences (MIMS), Mandya for a period of 3 months 12 months 21 (5.9)
from 1st February, 2014 to 31st April, 2014 after getting 13-60 months 132 (36.4)
61-120 months 97 (27.1)
approval from Institution Scientific Committee. Interview 121 months 111 (30.6)
method was used to collect information regarding HCWs: Health care workers
socio demographic details, occurrence of NSI, factors
influencing NIS and awareness regarding NSI by using a
pretested semi-structured questionnaire on HCWs, who Table 2: Number and frequency of exposure
consented to participate in the study. Data were analyzed among various HCW
using Open-Epi version 2.3.1 (Copyright 2003, 2008 HCW Number (%) Frequency (mean frequency)
Andrew G Dean and Kevin M. Sullivan, Atlanta, GA, Doctors 27 (15.8) 060 (02.22)
Interns 38 (22.4) 074 (01.95)
USA). Nurses 53 (31.2) 176 (03.32)
Laboratory technician 04 (02.4) 012 (03.00)
Housekeeping staff 48 (28.2) 589 (12.27)
RESULTS Total 170 (100) 911
HCW: Health care workers
Of the 509 HCWs working during the study period,
361 participated in the study, 90 did not give consent to
participate and were unavailable even after 2 consecutive Table 3: Comparison between mean frequencies of
visits and 58 were not at risk of exposure to need stick NSI with various categories of HCW
injury. HCW T value P value
Nurses versus doctors 2.016 0.023
The mean age of the HCWs was 33 2.8 years. The age Interns versus doctors 0.558 0.289
Housekeeping staff versus doctors 4.830 <0.001
range was between 21 and 59 years. 236 (65.4%) of the Doctors versus lab technicians 0.711 0.241
HCWs were females, and 116 (32.1%) were working as Nurses versus interns 2.955 0.002
nurses followed by 74 (20.5%) as housekeeping (Table 1). Housekeeping staff versus nurses 6.009 <0.001
Nurses versus lab technician 0.262 0.396
Housekeeping staff versus lab technicians 1.729 0.045
170 (47.1%) of the HCWs had NSI in the past 1 year. Housekeeping versus interns 5.882 <0.001
The total number of episodes of NSI experienced by the Interns versus lab technicians 1.102 0.138
HCW was 911. The common category of HCWs who NSI: Needle stick injuries, HCW: Health care workers

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 Jahnavi, et al.: Needle Stick Injury among Health Care Workers

In the present study, the incidence of NSI per 1000 man

Table 4: Circumstances of occurrence of
hours was more among housekeeping - 2.93; followed by
NSIs (n=170)
nurses - 0.55; and least was seen among doctors - 0.30.
Circumstances of occurrences Number* (%)
The common place of occur rence of NSI was While recapping the needle 50 (29.4)
Handling biomedical waste 47 (27.6)
in the wards - 97 (57.1%); followed by operation While conducting procedures 42 (24.7)
theatre - 20 (11.7%); and injection room - 9 (11.2%). The While drawing drug from ampule 27 (15.8)
most common circumstances during which the NSIs While drug/vaccine administration 26 (15.2)
While drawing blood 08 (04.7)
occurred was while recapping the needle and while handling
Taking the needle from co-worker 06 (03.5)
the biomedical waste (Table 4). 131 (77.1%) of the NSIs *Multiple responses, Limitation: Respondents gave information of the most
occurred during the morning hours, followed by 24 (14.1%) common circumstances of occurrence of NSIs and information on every episode
in the afternoon hours and 15 (08.8%) at night. could not be collected. NSIs: Needle stick injuries

Gloves were used by only 61 (35.8%) HCWs when NSI Table 5: Knowledge regarding NSIs
occurred. The reporting of NSIs was done by only
Knowledge HCW Knowledge Chi-square P value
47 (27.6%) of the HCWs. 37 (21.8%) HCWs got their factor (%)
viral serology done for Hepatitis B and HIV sustaining Diseases Doctors 86 (100) 13.974 0.007
an NSI. Among 361 HCWs, 238 (65.9%) were vaccinated which Nurses 113 (97.4)
against hepatitis B. spread Interns 69 (100)
through Housekeeping 68 (91.8)
NSI staff
The doctors and interns had better knowledge regarding the Laboratory 16 (100)
diseases spread through NSI when compared with nurses technicians
and housekeeping staff and the difference in knowledge Recapping Doctors 37 (43.1) 55.209 <0.001
of needle Nurses 62 (53.4)
among these categories was statistically significant. When should not Interns 11 (16.0)
compared with the other categories of HCW, the nurses be done Housekeeping 11 (14.8)
were more likely to be aware that needle should not be staff
Lab technicians 05 (31.2)
recapped after use and they knew that NSI has to reported Register for Doctors 19 (22.1) 17.555 0.002
and recorded in a NSI register (Table 5). reporting Nurses 43 (37.1)
NSI Interns 21 (30.4)
Housekeeping 08 (10.8)
DISCUSSION staff
Lab technicians 05 (31.2)
The present study has addressed certain aspect of NSI NSI: Needle stick injuries, HCW: Health care workers

in a government teaching hospital. In order to avoid the

effects of recall bias, NSI was assessed in the past 1 year.
It was found that 47% of the HCWs had experienced
NSI. Whereas, the studies from New Delhi, India have
shown relatively higher proportion of NSI among HCWs
of tertiary care hospital i.e., 79.5% and 80.1% respectively
when compared to the present study findings.1,7 The
studies from Nigeria involving primary HCWs (57.1%)
and a study from Pakistan involving HCWs of two tertiary
care hospitals comprising both public and private health
sector (64%) have shown marginally lower percentage
of NSIs.8,9
Certain practical aspects like recapping of needle after use
was the common cause of NSI, and the practice seems
to continue and the knowledge about proper disposal
of needles is less even among doctors.10-12 In the present
study, high percentage of nurses have experienced NSI;
the findings are similar to others studies but when the
frequency was assessed, it was found housekeeping
were more frequently exposed when compared to other
profession of HCWs with each of the housekeeping
staff experiencing about 12 NSIs per year.13,14 Similarly,
a considerable percentage of NSIs occurred during
handling of biomedical waste. The knowledge about
the diseases transmitted through NSIs was less among
the housekeeping staff when compared with the
other categories of HCW which emphasizes that the
housekeeping staffs has to be educated on the same and
appropriate handling of biomedical waste. More than half
the NSIs could be avoided if recapping of the needles
was not done and the biomedical waste handling was
taken care of 74% were using gloves at the time of NSI
that was high compared with the usage of gloves in the
present study.1
Though glove usage cannot prevent NSI it considerably
reduces the risk of acquiring a blood-borne infection
due to an injury. The WHO recommends the use of
non-sterile examination gloves during procedures during
which contact with blood is probable, while handling

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 Jahnavi, et al.: Needle Stick Injury among Health Care Workers
waste and sterile gloves for other surgical/radiological
procedures.15
The knowledge regarding recapping of needle and the NSI
register was low among all categories of HCW barring
staff nurses. A low percentage of HCW underwent
serological testing following NSI, which is of concern.
Similar to other studies, despite the availability of the
vaccine and access to it, only 65.9% were immunized
against hepatitis B.16,17
CONCLUSIONS
The NSI exposure among HCWs in the past 1 year was
47%. Among the HCWs, the nurses and housekeeping
staff tend to have less knowledge regarding NSI and are
more prone to NSI. Recapping the needle, handling the
biomedical waste are the circumstances and wards are the
place where NSI commonly occur.
RECOMMENDATIONS
Adopting appropriate disposal of needles and ensuring
safety during handling of biomedical waste could prevent
more than half the injuries. Instructions regarding safe
injection techniques/procedures should be placed in
places like injection room, immunization center, wards,
etc., Simple steps like education regarding reporting of
NSI and hepatitis B vaccination to all health care providers
need to be emphasized on.
ACKNOWLEDGMENT
We sincerely acknowledge study subjects and scholars
whose articles are cited and included in our references.
We also thank the Director, Staff of the Department of
Community Medicine, MIMS, Mandya for their support.
How to cite this article: Jahnavi R, Manjunath M, Mahendra BJ, Ragini R, Swetha HJ, Harshitha MC, Nishitha P. Needle Stick Injury
among Health Care Workers in a Government Teaching Hospital, Mandya. Int J Sci Stud 2014;2(7):103-106.
Source of Support: Nil, Conflict of Interest: None declared.
International Journal of Scientific Study | October 2014 | Vol 2 | Issue 7
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