Needle Sticks Injuries (NSIs) and Hepatitis B Vaccination status among Health Care Workers (HCWs) at Asia’s Largest Trauma Care Centre in Bengaluru
Sachina B T1, Asima Banu2, S. Balaji Pai2, Shahid S3, Chidambara V N3
1Nursing Officer, Infection Control Nurse, Trauma and Emergency Care Centre,
Bangalore Medical College and Research Institute.
2Professor, Dept. of Microbiology, Trauma and Emergency Care Centre,
Bangalore Medical College and Research Institute.
2Professor and HOD, Dept. of Neuro Surgery, Trauma and Emergency Care Centre,
Bangalore Medical College and Research Institute.
3Nursing Officer, Infection Control Nurse, Trauma and Emergency Care Centre,
Bangalore Medical College and Research Institute.
*Corresponding Author E-mail: sachinbanur@gmail.com
ABSTRACT:
Background: Needle stick injuries (NSIs) are the most common workplace-related health hazards responsible for the transmission of blood-borne pathogens among the HCWs where safety measures have not already been established. Injuries mostly occur during needle recapping, operative procedures, blood sample collection, intravenous line administration and poor waste disposal practices. Following NSIs, more than 20 blood-borne pathogens can be transmitted through body fluids. However, the most common diseases that can be potentially transmitted through body fluids are HIV, HBV, and HCV. Moreover, among the three important pathogens transmitted through NSIs, only HBV has an effective vaccine. The HBV vaccination coverage among HCWs has also been generally less, putting them at greater risk for HBV infections. This study aims to analyze the swing of voluntary reporting of NSIs among HCWs and also the HBV vaccination status among those HCWs reporting NSIs in our tertiary health-care center. Materials and Methods: A retrospective study was conducted between January 2018 and March 2020 at Asia’s Largest Trauma Care Centre in Bangalore. A standard proforma was filled by all HCWs reporting NSIs and a record of the same was maintained. Testing for HIV, hepatitis B virus surface antigen (HBsAg) and HCV was provided to the HCWs and also to the sources. HIV testing, HBsAg testing, and HCV testing were done by using rapid standard kits. All the tests were performed and interpreted according to the manufacturer's instructions. The testing for HIV 1 and 2 was done according to the National AIDS Control Organization Guidelines. The HCWs were tracked up to 6 weeks, 3 months, and 6 months for HIV and at 3 months and 6 months for HBV and HCV, consecutively after guidance, counseling and appropriate interventions. Results: A total of 34 incidents of NSIs were reported between January 2018 and March 2020 in that 11 were reported in 2018, 17 and 06 in 2019 and 2020 respectively. Majority of the HCWs 50 % had complete course of HBV vaccination, 41.17% had incomplete (1 or 2 doses) and 8.82% had not taken any course of HBV vaccination. Conclusion: The study disclosed that the collective prevalence of NSI among HCWs was high. The inadequate training of HCWs among the health care facilities might make HCWs more susceptible to injury. Therefore, the current study recommends the following measures to reduce NSIs - adequate training, simulation training to mimic everyday situations of junior staff, compulsory HBV vaccination for all the HCWs, System in place for reporting, adequate first aid facility and provision of safe working environment.
KEYWORDS: Needle sticks Injuries, Hepatitis B Vaccination status, Health Care Workers Largest Trauma Care Centre.
INTRODUCTION:
Health care facilities (HCFs) can provide diagnostic, preventive, curative, and prognostic services for the community. However, while they are providing services, health care workers (HCWs) are exposed to blood and body fluids through occupational sharps, splashes and needle stick injuries.1-2 The National Institute for Occupational Safety and Health, Centers for disease control and prevention (CDC), defines needle stick injuries (NSIs) as “those injuries caused by needles such as hypodermic needles, blood collection needles, intravenous (IV) stylets, and needles used to connect parts of IV delivery system”.3 Particularly, there is a potential exposure among doctors, nurses, laboratory professionals, and biomedical waste management staff to blood-borne pathogens worldwide.4–6
Needle stick injuries (NSIs) are the most common workplace-related health hazards responsible for the transmission of blood-borne pathogens7-8 among the HCWs where safety measures have not already been established.2 Injuries mostly happen during needle recapping, operative procedures, blood sample collection, intravenous line administration and poor waste disposal practices.9 Following NSIs, more than 20 blood-borne pathogens can be transmitted through body fluids.10-11 However, the most common diseases that can be potentially transmitted through body fluids are HIV, HBV, and HCV10.
Though currently the exact incidence of NSIs is believed to be underreported12, the World Health Organization (WHO) reported as 3 million HCWs were exposed to blood-borne viruses each year globally. From this, 2 million, 900,000, and 300,000 were contributed to HBV, HCV, and HIV, respectively and the majority (9 0%) happened in the developing countries.13-14 The high incidence of NSIs associated with blood-borne infections among developing countries is mainly attributed due to the high disease prevalence and lack of proper personal protective devices.15-16
The risk of acquiring HBV, HCV, and HIV infections from the sharp exposure when the source patient is positive can range from 2 to 40%, 3 to 10%, and 0.2 to 0.5%, respectively.17-18 In addition, HBV can survive up to a week under optimal conditions and has been detected from the discarded needles.19 The morbidity and mortality associated with occupational hazards are impacting the health and productivity of the health workers20 through high cost, health consequences, emotional distress, and missing working days.21-22
Furthermore, among the three important pathogens transmitted through NSIs, only HBV has an effective vaccine. Unfortunately, the voluntary reporting rates of NSIs globally has been low, more so in developing countries where NSIs are more common than the developed world.23-26 The HBV vaccination coverage among HCWs has also been generally low, putting them at greater risk for HBV infections.27-29
This study intends to analyze the trends of voluntary reporting of NSIs among HCWs and also the HBV vaccination status among those HCWs reporting NSIs in our tertiary health-care center over 15 consecutive months.
MATERIALS AND METHODS:
This is a retrospective study conducted between January 2018 and March 2020 at Asia’s Largest Trauma Care Centre in Bangalore. A standard proforma was filled by all HCWs reporting NSIs and a record of the same was maintained.
Testing for HIV, hepatitis B virus surface antigen (HBsAg) and HCV was provided to the HCWs and also to the source. HIV testing, HBsAg testing, and HCV testing were done by using rapid standard kits. All the tests were performed and interpreted according to the manufacturer's instructions. The testing for HIV 1 and 2 was done according to the National AIDS Control Organization Guidelines. The HCWs were tracked up to 6 weeks, 3 months, and 6 months for HIV and at 3 months and 6 months for HBV and HCV, consecutively after guidance, counseling and appropriate interventions. The data were entered into an Excel sheet and analyzed.
The hospital infection control committee (HICC) of the institute has also conducted awareness programs for prevention of hospital-acquired infections including sessions on prevention and management of NSIs during the study period. The program was conducted every month and comprised two sessions. The number of participants was restricted to a maximum of 30 only, and those participants missing any sessions were advised to attend the same in the subsequent months. The HICC also administered complete course of HBV vaccination for all the HCWs.
RESULTS:
A total of 34 incidents of NSIs were reported between January 2018 and March 2020 in that 11 were reported in 2018, 17 and 06 in 2019 and 2020 respectively. Among them 10 were Registered Nurses, 14 were Trainee Doctors and 10 were Class IV Officials (Figure 1). Among the source, 26 were of unknown source, 2 of retro positive, 5 of retro negative and 1 was HBs Ag positive (Figure 2).
Among 34 HCWs all the registered nurses (10) had taken complete course of HBV vaccine, whereas 14 trainee doctors had incomplete (1 or 2 doses) vaccination and 7 of Class IV officials have taken the complete course of HBV vaccine where as 3 Class IV officials had not received any vaccine (Newly Recruited) (Table 1). Area wise distribution of cases was 14 were reported in emergency ward, 10 in casualty, 7 in ICU, 1 in OT and 2 in biomedical storage area (Figure 3).
HCWs whose source was positive for HIV was managed as per the protocols of ART by NACO, whose source was positive for HBV and HCV were managed based on the institutional protocol based on national guidelines.
Figure 1: Total Incidence of NSI among various health care workers
Figure 2: Source of NSI
Figure 3: Area of NSI
Table 1: HBV Vaccination status among HCWs (n=34)
|
HBV Vaccination status |
Percentage of population |
|
Completed |
17(50.00) |
|
Incomplete (1 or 2 doses) |
14 (41.17) |
|
Not Vaccinated |
3 (8.82) |
|
HBV=Hepatitis B virus |
|
DISCUSSION:
The health and safety of the workers involved in health care has long been easily overlooked until it got slowly reckoned and various guidelines related to occupational safety were formulated by different organizations. [11] In spite of the implementation of these guidelines, there is still underreporting of NSIs by HCWs globally. Our study finds overall increasing trends of reporting of NSIs among HCWs of the institute over a period of 03 years.
There was no significant difference in incidents related to the gender of the HCWs. Among the various categories of HCWs, the trainee doctors reported maximum number of NSIs (14) whereas registered nurses and class IV officials reported equal number of NSIs (10).
Maximum number (14) NSI were reported in emergency ward, 10 in casualty, 7 in ICU, 1 in OT and 2 in biomedical storage area.
Majority of the HCWs 50 % had complete course of HBV vaccination, 41.17% had incomplete (1 or 2 doses) and 8.82% had not taken any course of HBV vaccination.
A gradual increase in the rates of reporting of NSIs is observed in this study. This change in the attitude of the HCWs may be attributed to the frequent conduct of awareness programs by the HICC of the institute as a part of NABH, Kayakalpa (a clean hospital initiative) and NQAS (National Quality Assurance Standards) programme. The institute also provides hepatitis B vaccination to all its HCWs at zero cost. The WHO, apart from recommending organizations to make policies and periodic education of staffs on safe injection practices such as avoiding recapping of syringes and applying universal precautions to prevent NSIs, also suggests providing alternates to injection and modifying the mechanics of sharp operation. [30] Implementing all these may also significantly add to the economic burden of the organization. Nevertheless, a systematic review about the economic evaluation of NSIs has shown that, though NSIs contribute to the economic burden of the organization, the measures aimed at preventing the same could prove to be beneficial in the long run.31
CONCLUSION:
The result of this study revealed that the pooled prevalence of NSI among HCWs was high. The inadequate training of HCWs among the health care facilities might make HCWs more susceptible to injury. Therefore, the current study recommends the following measures to reduce NSIs
1. Adequate training
2. Simulation training to mimic everyday situations of junior staff
3. Compulsory HBV vaccination for all the HCWs
4. System in place for reporting
5. Adequate first aid facility
6. Provision of safe working environment.
CONFLICTS OF INTEREST:
There are no conflicts of interest.
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Received on 01.08.2022 Modified on 08.09.2022
Accepted on 14.10.2022 ©A&V Publications All right reserved
Int. J. of Advances in Nur. Management. 2022; 10(4):401-404.
DOI: 10.52711/2454-2652.2022.00088