a study to assess the knowledge of staff nurses on …

i

“A STUDY TO ASSESS THE KNOWLEDGE OF STAFF NURSES

ON NEEDLE STICK INJURY IN SELECTED HOSPITALS AT

BANGALORE WITH A VIEW TO DEVELOP INFORMATIONAL

BOOKLET”

BY

MR. JAGADEESHA D S

Dissertation Submitted to the

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

In partial fulfillment of the requirements for the degree of

MASTER OF SCIENCE

In

MEDICAL SURGICAL NURSING

Under the guidance of

ASSO. PROF. MRS. MANJU THOMAS

HOD

DEPARTMENT OF MEDICAL SURGICAL NURSING

SRI LAKSHMI COLLEGE OF NURSING

BANGALORE.

2018

ii

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation/thesis entitled “A Study To

Assess The Knowledge Of Staff Nurses On Needle Stick Injury In Selected Hospitals At

Bangalore With A View To Develop Informational Booklet” is a bonafide and genuine

research work carried out by me under the guidance of Asso. Prof. MRS. MANJU

THOMAS, Head of Department, Department of Medical Surgical Nursing, Sri

Lakshmi College of Nursing, Sunkadakatte, Bangalore.

Date: Signature by candidate

Place: Bangalore

MR. JAGADEESHA D S

v

COPYRIGHT

DECLARATION BY THE CANDIDATE

I hereby declare that the Rajiv Gandhi University of Health Sciences,

Karnataka shall have the rights to preserve, use and disseminate this dissertation /

thesis in print or electronic format for academic / research purpose.

Date: Signature of the Candidate

Place: Bangalore

MR. JAGADEESHA D S

© Rajiv Gandhi University of Health Sciences, Karnataka

x

RESEARCH ABSTRACT

Name : Mr. JAGADEESHA D S

Guide : MRS. MANJU THOMAS

Subject : Dissertation submitted in partial fulfillment of the

requirements of the degree of Master of Science in Nursing to Rajiv Gandhi

University of Health Sciences, Bangalore, Karnataka, 2018.

Statement of the problem : “A Study To Assess The Knowledge Of Staff Nurses On

Needle Stick Injury In Selected Hospitals At Bangalore With A View To Develop

Informational Booklet”.

OBJECTIVES OF THE STUDY

1. To assess the knowledge of staff nurses on needle stick injury.

2. To develop an informational booklet on needle stick injury.

3. To associate knowledge of staff nurses on needle stick injury with selected

demographic variables

HYPOTHESIS

H1 - There will be inadequate knowledge regarding needle stick injury staff nurses.

H2 -There will be significant association between knowledge and selected

demographical variables.

RESEARCH DESIGN:

The research design is Non-experimental

RESEARCH APPROACH:

Descriptive survey approach was adopted for the study.

SETTING OF THE STUDY

The setting of the study is selected hospitals, Bangalore, Karnataka

xi

POPULATION

TARGET POPULATION:

The target population of this study is the staff nurses in Bangalore, Karnataka

ACCESSIBLE POPULATION:

The accessible population of this study is the staff nurses in selected hospitals,

Bangalore, Karnataka.

SAMPLE

Sample for the study will be staff nurses who are fulfilling the inclusion criteria

SAMPLE SIZE

For this study a sample of 100 staff nurses will be considered.

SAMPLING TECHNIQUE

Random sampling technique will be adopted to select the sample

SAMPLING CRITERIA:

INCLUSION CRITERIA FOR SAMPLING

The study includes who staff nurses who are:

Registered staff nurses

willing to participate in the study

present on the day of sampling

EXCLUSION CRITERIA FOR SAMPLING

The study excludes staff nurses who are:

not willing to participate in the study

those who are absent on that day

TOOL

The tool used for the collection of data was self-administered questionnaire. It

consisted of three sections.

xii

Sections -1

Socio demographic variables consists of 08 items such age, sex, religion, residence,

Educational qualification, experience, previous classes and Area of working.

Sections -2

The structured Questionnaire on knowledge related to needle stick injury and it

consists of 30 items

The content validity of the tool was ascertained by submitting it to 7 experts. With

certain modifications and rearrangements as suggested by the subject experts, the

second draft of the tool was finalized.

MAIN STUDY:

The main study data collection was done from 20st of May, 2018 to 21

th of June, 2018.

The total sample of main study consisted of 100 staff nurses. Data was collected using

structured questionnaire to assess the knowledge of staff nurses. Each data collection

session last for about 30-40 minutes and it took 20-30 days to complete the study

DATA COLLECTION METHOD:

A formal written permission was obtained from Medical Superintendent of

Srilakshmi Multi Specialty Hospital and Ashraya hospital, Bangalore. The data was

collected from 20st of May, 2018 to 21

th of June, 2018 from staff nurses who fulfilled

sample inclusion criteria. Before conducting the study oral-consent was taken from

them by explaining the purpose of the study.

DATA ANALYSIS:

The data was analyzed on the basis of objective and hypothesis of the study.

The obtained data was analyzed by descriptive and inferential statistics and

interpreted in terms of objectives and hypothesis of the study. The level of

significance was set at 0.01 and 0.05 level of significance.

xiii

MAJOR FINDINGS OF THE STUDY:

Section I

Distribution of participants according to their demographic variables.

Based on the age: 71% were distributed in the 20-30 years, 17% were distributed in

the 31-40 years and 12% were distributed in the 41 years and above.

Based on the sex: 51% were female and 49 % were male.

Based on the religion: 71% were distributed in Hindu, 19% were distributed in

Muslim and 10% were distributed in the Christian.

Based on the residence 39% were distributed in the urban and 61% were distributed

in rural.

Based on the Educational qualification: 71% were distributed in B.Sc. N, 19% were

distributed in GNM and 10% were distributed in the M.Sc.N.

Based on the experience, 64% were distributed <1 years, 18 % were distributed 1-3

years, 18 % were distributed in >3 years

Based on the whether attended any previous classes regarding needle stick

injury: 60% were distributed in No and 40% were distributed in Yes.

Based on the Area of working 36% were in the Ward, 27 % were from the

Causality, 19 % were from the ICU, 7% were in Dialysis, 11% of them in OPD

Section II (Knowledge score)

Knowledge level of the participants regarding the needle sticks injury

The mean knowledge score obtained by staff nurses was 11.13, mean

percentage was 49.76, and standard deviation 3.12

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Section III

Association of knowledge score of participants with selected demographic

variables.

The chi-square value shows that there is no significance association between

age, sex, residence area, religion, area of work and level of knowledge with socio

demographic variable.(P > 0.05)

The experience, qualification and previous classes show the significant

association the level of knowledge.

1

IINNTTRROODDUUCCTTIIOONN

2

1. INTRODUCTION

“CARING FOR THOSE WHO CARE”

“A safe injection is one that does not harm the recipient, does not

expose the provider to any avoidable risk, and does not result in any waste that is

dangerous to the community.”1

Each day thousands of health worker 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 consequence ranging from

extreme anxiety to chronic illness and premature death. The health care workforce, 35

million people worldwide, represents 12% of the working population. The

misconception exists that health care industry is without hazards, but in fact blood

borne exposures encountered can be career and life-ending.2

A needle stick injury is a percutaneous piercing wound typically set by a

needle point, but possibly also by other sharp instruments or objects. Commonly

encountered by people handling needles in the medical setting, such injuries are an

occupational hazard in the medical community. These events are of concern because

of the risk to transmit blood-borne diseases through the passage of the hepatitis B

virus (HBV), the hepatitis C virus (HCV), and the Human Immunodeficiency Virus

(HIV), the virus which causes AIDS. Despite their seriousness as a medical event,

needle stick injuries have been neglected: most go unreported needle sticks have

been recognized as occupational hazards.3

Needle stick injuries are a common event in the healthcare environment. When

drawing blood, administering an intramuscular or intravenous drug, or performing

other procedures involving sharps, the needle can slip and injure the healthcare

worker. This sets the stage to transmit viruses from the source person to the recipient.

http://en.wikipedia.org/wiki/Percutaneous

http://en.wikipedia.org/wiki/Occupational_hazard

http://en.wikipedia.org/wiki/Blood-borne_disease

http://en.wikipedia.org/wiki/Hepatitis_B

http://en.wikipedia.org/wiki/Hepatitis_C

http://en.wikipedia.org/wiki/Human_Immunodeficiency_Virus

http://en.wikipedia.org/wiki/Hypodermic_needle

3

These injuries also commonly occur during needle recapping and as a result of failure

to place used needles in approved sharps containers. During surgery, a surgical needle

may inadvertently penetrate the glove and skin of the surgeon or assistant. Generally

needle stick injuries cause only minor bleeding or visible trauma, however, even in the

absence of bleeding the risk of viral infection remains. Scalpel injuries tend to be

larger than a needle stick. In turn, a needle stick injury may also pose a risk for a

patient if the injured health professional carries HBV, HCV or HIV. Needle stick

injuries are not limited to the medical community. Any environment where sharps are

encountered poses a risk. Needle stick injuries may occur not only with freshly

contaminated sharps, but also, after some time, with needles that carry dry blood.

While the infectiousness of HIV and HCV decrease within a couple of hours, HBV

remains stable during desiccation and infectious for more than a week.3

While needle stick injuries have the potential of transferring bacteria, protozoa,

viruses and prions, from a practical point the transmission of the hepatitis B and

hepatitis C viruses and the Human Immunodeficiency Virus (HIV) is important. The

specific risk of a single injury depends on a number of factors when the patients

harbor the virus of concern. Injuries with a hollow-bore needle, deep penetration,

visible blood on the needle, a needle that was located in a deep artery or vein, or with

blood from terminally ill patients are known to increase the risk for HIV infection.3

The incidence of NSI is considerably higher than current estimates, due to gross

under-reporting (often less than 50%)2,3. In USA 6,00,000 to 10,00,000 receive NSI

from conventional needles and sharps every year, while in UK it is 1,00,000

HCWs/year4. In India, authentic data on NSI are scarce. It is known that around 3-6

billion injections are given per year, of which 2/3rd injections are unsafe (62.9%) and

the use of glass syringe is constantly associated with higher degree of

http://en.wikipedia.org/wiki/Sharps_container

http://en.wikipedia.org/wiki/Hepatitis_B

http://en.wikipedia.org/wiki/Hepatitis_C

http://en.wikipedia.org/wiki/Human_Immunodeficiency_Virus

4

unsafety5.Direct and indirect costs6-8. The average percutaneous transmission rates

for hepatitis B (HBV) and C (HCV) are 33.3 (6-33%) and 3.3 per cent (1-10%),

respectively, while the seroconversion risk for HIV is 0.31 per cent9. Although HBV

exposures pose the highest risk for infection, it has an effective vaccine and post

exposure prophylaxis (PEP) for HCWs which can dramatically reduce the risk. This is

not so for HCV and HIV. Therefore, prevention is the only recourse for these.

Preventing NSI is an essential part of any blood borne pathogen prevention

programme in the work place. Every healthcare facility should have an infection

control programme in place through a working hospital infection control committee.

The present study addresses the important issue of NSI and aims at determining the

occurrence of NSI among different categories of HCWs, the various factors

responsible, the circumstances under which these occur and explores the availability

and possibilities of measures to prevent these through improvement in knowledge,

attitude and practice. The study also aims at assessing the awareness levels among

various categories of HCWs, on issues like NSI policy, segregation of sharps at

source and the use and availability of safety devices to prevent NSI.4

Every day while caring for patients, nurses are at risk to exposure to blood

borne pathogens. These exposures, while preventable, are often accepted as being a

part of the job. In the United States, needle stick injuries have begun to decrease from

an estimated one million exposures per year in 1996 to 385,000per year in 2000. This

decline has resulted from the protections afforded by the Occupational Safety and

Health Administration’s (OSHA) Blood borne Pathogens Standard. Reasons for the

success in decreasing needle stick and sharps injuries may be attributed to the

elimination of needle recapping and the use of safer needle devices, sharps collection

boxes, gloves and personal protective gear, and universal precautions.7

5

To prevent needle stick injuries an effective exposure control program

should have a responsible person assigned to head the program and a committee that

includes representatives from frontline patient care providers to evaluate the hazards,

injury data and make recommendations for prevention. The committee should assure

appropriate follow up and post exposure prophylaxis as determined by the nature of

the injury and source patient. The most effective means of preventing the transmission

of blood borne pathogens is to prevent exposure to needle stick injuries. The primary

prevention of needle stick injuries is achieved through the elimination of unnecessary

injections and needles. The implementation of education, universal precautions,

elimination of needle recapping and use of sharp containers have reduced needle stick

injuries by 80%.8

While the vast majority of needle sticks injuries occur when the source-person

does not carry the HBV, HCV, and HIV and thus do not carry a risk of infection, these

events nevertheless cause stress and anxiety and signal a breakdown in protocol and

prevention. Preventive steps can be taken at several levels and include reduction or

elimination of use of sharps as much as possible, engineering controls (i.e. needles

with safety devices), administrative controls including training and provision of

adequate resources, and work practice controls; the latter may include using

instruments (not fingers) to grasp needles, load scalpels, and avoiding hand-to-hand

passing of sharp instruments. After a needle stick injury, certain procedures must be

followed to minimize the risk of infection for the recipient. The affected area should

be rinsed and washed thoroughly with soap. 5

Nurses are the largest work force of the health care industry.There are more

than 1 million licensed nurses currently working all over the world2. India produces

over 2,50,000 doctors annually in the modern system of medicine and a similar

6

number of nurses and para-professionals. Accidental needle-stick exposure poses the

greatest hazard to health care workers.6

Every year, hundreds of thousands of health care workers are exposed to

deadly viruses such as hepatitis and the Human Immunodeficiency Virus (HIV) as a

result of needle stick and sharps injuries.These preventable injuries expose workers to

over 20 different blood borne pathogens (CDC, 1998a) and result in an estimated

1,000 infections per year. The most common being hepatitis B, hepatitis C and HIV

(International Health Care Worker Safety Center, 1998). In November 2002, the

World Health Report published data demonstrating that 2.5 % of HIV cases among

health care workers and 40% of hepatitis B and C cases among health care workers

worldwide are the result of occupational exposure (WHO, 2002).7

In developing countries, where the prevalence of HIV-infected patients is

the highest in the world, the number of needle stick injuries is also highest. African

health care workers suffer on average two to four needle stick injuries per year and

over half of the hospitalized patients in South Africa are HIV positive (Prüss-Üstün et

al., 2003). In some regions of Africa and Asia close to half of all hepatitis B and C

infections among health care workers are attributable to contaminated sharps. In some

areas of the Eastern Mediterranean region over two-thirds of hepatitis B and C

infections in health care workers are attributable to contaminated sharps. Over two-

thirds of all hepatitis B in Central and South American are the result of occupational

exposure (Prüss-Üstün et al.).7

Every day while caring for patients, nurses are at risk to exposure to blood

borne pathogens. These exposures, while preventable, are often accepted as being a

part of the job. In the United States, needle stick injuries have begun to decrease from

an estimated one million exposures per year in 1996 to 385,000per year in 2000. This

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/InjuryPrevention.html#CDC98a

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/InjuryPrevention.html#WHO

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/InjuryPrevention.html#Pruss-Ustun



7

decline has resulted from the protections afforded by the Occupational Safety and

Health Administration’s (OSHA) Blood borne Pathogens Standard. Reasons for the

success in decreasing needle stick and sharps injuries may be attributed to the

elimination of needle recapping and the use of safer needle devices, sharps collection

boxes, gloves and personal protective gear, and universal precautions.7

To prevent needle stick injuries an effective exposure control program

should have a responsible person assigned to head the program and a committee that

includes representatives from frontline patient care providers to evaluate the hazards,

injury data and make recommendations for prevention. The committee should assure

appropriate follow up and post exposure prophylaxis as determined by the nature of

the injury and source patient. The most effective means of preventing the transmission

of blood borne pathogens is to prevent exposure to needle stick injuries. The primary

prevention of needle stick injuries is achieved through the elimination of unnecessary

injections and needles. The implementation of education, universal precautions,

elimination of needle recapping and use of sharp containers have reduced needle stick

injuries by 80%.8

To prevent the needle stick accidents, there is comprehensive program which

includes; employee training, controlled work practice, implementing engineering

control, surveillance programs, safe recapping procedures, effective disposal systems.

As nurses are the largest work force of the health care industry and at high risk to

incur needle stick injuries, it is important to have adequate knowledge about hazards,

prevalence and controlling measures of needle stick injury.9

8

NEED FOR THE STUDY

“Reject your sense of injury and the injury itself disappears”

-Marcus Aurelious

Needle stick injuries are a common event in the health care environment.

Needle stick injuries, being accidental self-inoculation, are seldom reported or where

reportable are usually under reported. One study found that needle-stick injuries

represented one third of all work-related accidents and two-thirds of work-related

injuries to nursing staff.10

An investigation estimates the rates of injuries on a global level to affect about

3.5 million individuals. Needle-sticks are virtually undocumented in developing

countries, but probably equal or exceed those in the industrial world. In the absence of

statistics from India, statistics from United States provide some insight into the

occupational risk. American health workers suffer 800,000 to 1 million needle-sticks

annually, not including the vast number that goes unreported. There are more than

100,000 needle-stick injuries in UK hospitals each year.11

A Health Protection Agency (HPA) report regarding healthcare workers,

released in 2012, stated that:[2]

Between 2002 and 2011, 4,381 significant occupational exposures were reported

(increasing from 276 in 2002 to 541 in 2011).

Between 2008 and 2011, there were five HCV hospital-acquired transmissions

from patients to healthcare workers following percutaneous exposure injuries; three

reported from England and two in Scotland.

Even though percutaneous injuries remain the most commonly reported

occupational exposures in the healthcare setting, they have decreased over time as a

percentage of all exposures (from 79% in 2002 to 67% in 2011), whilst

http://patient.info/doctor/needlestick-injury-pro#ref-2

9

mucocutaneous exposures have shown an increase (from 21% in 2002 to 29% in

2011).

The percentage of healthcare workers reporting percutaneous exposures that

involved an HCV-infected source patient declined from 38% in 2002 to 32% in

2011.

Between 2002 and 2011 most occupational exposures occurred in the nursing

profession. In 2011, medical and dental professions reported a similar number of

occupational exposures as nursing professionals. Exposures in the medical and

dental professions increased by 131% (from 100 to 231) between 2002 and 2011.

72 significant occupational exposures reported between 2002 and 2011 involved

ancillary staff. The majority of these exposures were due to non-compliance with

standard infection control precautions for the handling and safe disposal of clinical

waste.

The total number of HCV seroconversions in healthcare workers reported between

1997 and 2011 is 20; 17 cases reported in England and 3 in Scotland.

The last case of an HIV seroconversion in an occupationally exposed healthcare

worker was reported in 1999.

Prevention of sharps injuries; NHS Employers

Eye of the Needle 2012; Health Protection Agency (archived content)

The average estimated seroconversion risks from reports are:[1]

0.3% for percutaneous exposure to HIV-infected blood.

0.1% for mucocutaneous exposure to HIV-infected blood.

0.5-1.8% for percutaneous exposure to HCV-infected blood with detectable RNA

30% for percutaneous exposure of a non-immune individual to an HBeAg positive

source.

http://www.nhsemployers.org/your-workforce/retain-and-improve/staff-experience/health-work-and-wellbeing/protecting-staff-and-preventing-ill-health/partnership-working-across-your-organisation/health--safety/prevention-of-sharps-injuries

http://webarchive.nationalarchives.gov.uk/20140714084352/http:/www.hpa.org.uk/Publications/InfectiousDiseases/BloodBorneInfections/EyeOfTheNeedle/1212EyeoftheNeedle2012Report/

http://patient.info/doctor/needlestick-injury-pro#ref-1

10

The Ontario Hospital Association/Ontario Medical Association (2012) estimate that

after an injury in workplace situations from a needle contaminated with hepatitis B

virus, there is a 6 to 30% chance that an exposed person will be infected. In a similar

situation with HIV, there is about a 0.3% chance of infection, and there is about a 2%

chance of infection for hepatitis C.

Note also that because the hepatitis B virus may survive on environmental

surfaces for more than a week, indirect exposure can occur via contaminated

inanimate objects. Injuries have transmitted many other diseases involving viruses,

bacteria, fungi, and other microorganisms to health care workers, laboratory

researchers, and veterinarian staff.12

Needle stick injuries are among the most important occupational injuries for the

nurses. Ebrahami H and Khosrari A (2007) conducted a study to determine the

incidence of needle stick injuries in population of nurses in Shabroud Imam Hossein

hospital Iran. The case incidence of needle stick injury was 63.6%. The causal devices

in 105 cases (92.1%) were hollow borne needles and the main cause of percutaneous

injuries with hollow borne needle were recapping (32.4%); and manipulating needles

in pats (18.1%). The majority (51.8%) of injuries occurred after use and before

disposal of the objects.13

Training the staff and developing good sharps management plans can ensure

safety from sharps. A standing order procedure should be formulated regarding sharp

injuries in all health institutions. Since needle stick injuries were highest in waste

handlers and nurses (33%), it underscores the need to provide compulsory, education

to health care workers, with respect to needle stick injuries. Health care workers

should made aware of hazards and preventive measures against needle stick injuries.14

12

2. OBJECTIVES

This chapter deals with the statement of the problem, objectives of the study,

operational definition, assumptions, hypothesis, and delimitation of the study and

conceptual frame work, which provides a frame of reference.

STATEMENT OF THE PROBLEM:-

“A Study To Assess The Knowledge Of Staff Nurses On Needle Stick Injury In

Selected Hospitals At Bangalore With A View To Develop Informational Booklet”.

OBJECTIVES OF THE STUDY





HYPOTHESIS

H1 -There will be inadequate knowledge regarding needle stick injury staff nurses.

H2 - There will be significant association between knowledge and selected


VARIABLE UNDER STUDY

DEPENDENT VARIABLE

Knowledge of staff nurses regarding effects of needle stick injury

EXTRANEOUS VARIABLE

Socio demographic variables: age, sex, religion, residence, Educational

qualification, experience, previous classes and Area of working.

13

OPERATIONAL DEFINITIONS

Assess: In this study it refers to the organized systematic and continuous

process of collecting information regarding effect of needle stick injury among

staff nurses

Staff nurses: It refers to the nurses registered from any state nursing council

and practicing in selected hospitals, Bangalore.

Informational booklet: Self learning information furnished in simple and

illustrated way prepared in English regarding the needle stick injury to

improve the knowledge of staff nurses.

Needle stick injury: A needle stick injury is a percutaneous piercing wound

typically set by a needle point, but possibly also by other sharp instruments or

objects.

ASSUMPTIONS

The present study assumes that Staff nurses will have minimal knowledge on needle

stick injuries

DELIMITATIONS

This study is limited to staff nurses working in selected hospitals, Bangalore,

Karnataka

http://en.wikipedia.org/wiki/Percutaneous

18

REVIEW OF LITERATURE

19

3. REVIEW OF LITERATURE

A review of literature enables one to get an insight into the various

aspects of the problem under study. It covers promising methodological tools, throws

light on ways to improve the efficiency of data collection and suggests how to

increase effectiveness of data analysis and interpretation. Review of literature is

therefore an essential step in the development of the research project.

The sources to obtain information on the topic were books, journals, abstracts,

Medline, unpublished dissertations and internet. For the purpose of logical sequence,

the chapter is divided into sections.

The literature reviewed has been presented under the following categories:

Studies related to Needle Stick Injuries.

Studies related to knowledge on Needle Stick Injuries among Staff Nurses.

Studies related to effects of Needle Stick Injuries.

Studies related to Needle Stick Injuries.

Fredrich M, Nsuduga and Maritta S. Jalkkola (2005)Conducted a study on needle

stick injuries among nurses in sub-saharan Africa. The study revealed that 57% of the

nurses and midwifes had experienced at least on needle stick injury in the last year.

Only 18% had not experience any such injury in their entire career. The rate of needle

stick injury was 4.2 individually per year. The study concluded that strongest

predictor for needle stick injury was lack of training.15

Elmiyeh B, Whitaker S, James MJ, Chahal CAA, Galea A, Alshafi K (2004)

conducted a study regarding needle stick injuries in the National Health Service. A

confidential questionnaire was posted to 300 health professional in clinical work (175

nurses and 125 doctors) at the Lister hospital, Stevenage, U.K. 57% of the

20

respondents had sustained one or more needle stick injuries in their careers and

doctors were less likely to report injuries than nurses.16

Syed F. Shah, Abdulbari, Berner, Suad Al Kaabi, Abdul Latif Al Khal, Soji

Samson (2001)Conducted a study to characterize the epidemiology of needle stick

injuries of health care workers working at Hamad medical corporation Doha. A

survey was carried out among health care workers. 1022 workers responded to the

questionnaire on needle stick injuries with a response rate of 80.2%. Out of this, 214

studied subjects (20.9%) were victims of needle stick injuries. The highest incidence

of episodes of needle stick injuries occurred in the area of specialty such as 25

workers in medicine (13.1%), 20 in laboratory (9.3%) and 19 in emergency (5.9%),

followed by 17 in pediatric (7.9%).17

Rober t C (2001) conducted a study to find out factors responsible for needle stick

injuries to nurses. The study showed that 5-25% of the 346 nurses had needle stick

injury. 22 (63%) reported injury involving needle stick containing blood and nurses

who were working with poor work climate and lower staffing levels had more risk

factors for needle stick injuries.18

M. Varma, G. Mehta (2000) Conducted a study on needle sticks in medical

students in India. A questionnaire survey of 100 third year medical students in India

and they were asked about observation of safety precautions during invasive

procedures. Injuries occurred at some time in 65 students. The most common injury

was associated with drawing blood with a needle and syringe occurring at about 1.5

injuries per student per month.19

A retrospective study was conducted to assess the risk of needle stick injury

among nurses caring for patients with diabetes in 381 different hospitals throughout

the United States. The study was based on responses to an internet-based survey.

21

Result revealed that of 400 nurses who responded, 313 (78.3%) reported experiencing

at least one needle stick injury. The study found that nearly 80% of nurses experience

needle stick injuries caring for patients with diabetes.20

A survey was conducted on epidemiology of needle stick injuries among health

care workers working in Buraidah Central Hospital in Buraidah, Saudi Arabia. The

data was collected by a retrospective survey of all self-reported documents related to

needle stick injuries. Result revealed that of the total 73 injuries reported, nurses were

involved in 66% of instances, physicians in 19%, technicians in 10% and non-clinical

support staff in 5.5%.The study emphasized the importance of awareness, training and

education of health care workers for reporting and prevention of needle stick

injuries.21

A study was conducted on risk of needle stick injuries among healthcare workers

of L.T.M. Medical College and General Hospital, Sion over a period of one year. The

data collected was based on self-reported incidence of needle stick injuries and other

exposures to patient’s blood and body fluids. Result revealed that a total of 38 cases

were reported and no sero-conversion in any of the reported accidental injury cases.

This data emphasized that needle stick injuries present the single greatest risk to

medical personnel and the importance of increased awareness and training is in

universal safety precautions for prevention of nosocomial infections.22

A study was conducted on the prevalence of needle stick injuries among medical,

dental, nursing and midwifery students at Shiraz University of Medical Sciences, Iran.

A self- administered questionnaire was used to collect data. The results revealed that

out of 688 students responded, 71.1% of the students had needle stick injuries and

82% of the injuries were not reported. The study concluded that needle stick injuries

and non-reporting of needle stick injuries were highly prevalent in these students.23

22

Husoyam conducted a study on needle stick injury and reportingroutines in

Norwegian shows that health care workers transmission of blood-borne agents

through percutaneous exposure. Reporting of sharps injuries is essential for

instigation of adequate post-exposure prophylaxis and follow-up. We aimed at

providing an account of number of sharps injuries reported by type of health care

worker and the reporting systems used for injuries that have an inherent risk of

transmitting blood-borne agents. On average, 210 sharps injuries are reported

annually at Hauk eland University Hospital. In addition analyses of hepatitis and HIV

linked to 159 sharps injuries that had not been reported otherwise, were requested

annually. 51 % of sharps injuries were reported by nurses, 10 % by laboratory

workers, 6 % by doctors and 33 % by others.24

Rajis conducted a study on Guideline 'Needle stick injuries' risk assessment and

post-exposure management in practice in Bithoven. The objective of the national

guideline 'Needle stick injuries' is to make the assessment of needle stick injuries

more structured and uniform. The injury is classified as high risk or low risk

according to the volume of blood transmitted. For high-risk injuries measures to

prevent hepatitis B, hepatitis C and HIV infection have to be considered, whereas for

low-risk injuries only measures to prevent hepatitis B. The need for post-exposure

prophylaxis is determined by the victim's immunity to hepatitis B and the presence of

hepatitis B virus, hepatitis C virus or HIV in the source person. Post-exposure

prophylaxis against hepatitis B consists primarily of hepatitis B vaccination; hepatitis

B immunoglobulin is added in the case of a high-risk injury with a hepatitis B positive

source or a source belonging to a risk group for hepatitis B. In high-risk injuries the

victim is tested for hepatitis C and HIV transmission (except in case of a seronegative

23

source). Antiretroviral post exposure prophylaxis is advised for high-risk injuries with

a HIV seropositive source or a source belonging .25

Von Over Beck J Wess conducted a study on ” Needle stick accidents procedures

following potentially infectious exposure in medical personnel in Bern

(Germany)shows that exposure of blood carries with a definite risk for the health care

worker of infection by various blood borne pathogens, especially the hepatitis B,

hepatitis C, and human immunodeficiency virus. The risk of transmission from

exposure to HIV is lower than that associated with exposure to HBV and HCV.

Should HIV infection occur, however, the outcome is likely to be fatal. Although

general infection control precautions, safer use of needles, gloves, and other

procedures may substantially reduce the incidence of occupational exposures; they

cannot eliminate the risk completely. The post-exposure management is discussed.

Neither the efficacy nor the safety of AZT (zidovudine) for use as a chemo

prophylactic agent following occupational exposures to HIV has been established.

Nevertheless in selected cases it can be proposed to health care workers.26

A study conducted at selected hospitals in New Zealand. The aim of the study was

to determine frequency of needle stick injury. The response rate of health care

workers was 82%. An incidence rate of 22 needle stick injuries in 100 health care

workers per month period was found. For practice nurses it was 17 in 100 per months

period. Precautionary measures were not being followed by most individuals. Needle

stick injury is a substantial problem in practice nurse to a serious risk of infection

from blood borne transmissible agents.27

A study was carried out in three hospitals of Karachi. Total of 222 health care

providers in which 52 were nurses participated in the study. Approximately 60% of

health care providers had experienced needle stick injury at least once during their

24

service. The most frequency source of injury occurred while recapping the syringe.

None of the health care provider had adequate knowledge regarding immediate

measures following in needle stick injury.28

Studies related to knowledge on Needle Stick Injuries among Staff Nurses.

A study was conducted to assess the knowledge, attitude and practices regarding

needle stick injuries among 70 nurses and paramedical staff from different

departments of 100-bedded armed force’s hospital, Sharourah. Data collection was

carried out using a standardized questionnaire. The results revealed that 21% and 30%

of the healthcare workers, respectively, were unaware of the fact that AIDS and

Hepatitis C can be transmitted by needle stick injury. A total of 74% had a history of

needle stick injury and only 4% reported the injuries. The survey concluded that

knowledge of healthcare workers about the risks associated with needle stick injuries

and use of preventive measures is inadequate.29

A study was conducted to assess the knowledge, attitude and practices on needle

stick injuries among 70 nurses and paramedical staffs from different departments of

Kathmandu Medical College and Teaching Hospital. A 15-item questionnaire was

administered for analysis. Result revealed that 4% and 61% of healthcare workers,

respectively, were unaware of the fact that hepatitis B and hepatitis C can be

transmitted by needle stick injuries. 74% had a history of needle stick injuries and

only 21% reported the injuries. Only 23% were in the habit of using gloves for

phlebotomy procedures all the time.79% were of the impression that needle should be

recapped after use. Only 66% were aware of universal precaution guidelines. The

study concluded that knowledge of health care workers about the risk associated with

needle stick injuries and use of preventive measures is inadequate.30

25

A study was conducted to assess the knowledge, attitude and practices of

healthcare workers regarding needle stick injuries among 29 doctors and 51 registered

nurses at Aga Khan University hospital. A structured pretested questionnaire was

administered. Results revealed that about 45% reported having a needle stick injury in

the past. The most common reason identified was stress or being overburdened

followed by careless attitude. Two-third of the participants was familiar with the

prevention protocols. The study concluded that despite knowing the risk frequency of

needle stick injury, higher and mandatory reporting, proper follow-up and constant

reinforcement are recommended to reduce the rate of nosocomial transmission to

healthcare workers.31

A cross sectional study conducted in southern England to know the knowledge

and attitude of health care workers including staff nurses regarding glove techniques

and precautions followed in needle stick injury at a teaching hospital. The result

showed knowledge could be improved in relation to standard precautions to be taken

to avoid needle stick injury. Respondents had negative attitude towards use of gloves.

Interventions could be aimed at staff education and training.32

A study conducted at a hospital in Britain to know the attitude of health care

workers including nurses. The study revealed some general and psychological factors

contributing to low reporting attitude of personals regarding needle stick injury.

Continued training of staff, a sympathetic attitude and clarification of some general

issues might improve reporting of needle stick injury.33

Study conducted to know knowledge and nurses attitude regarding

gloving practice and risk factors of needle stick injury at a metropolitan hospital,

Taiwan. 210 nurses included in study, in which all nurses use, gloves because fear of

contracting HIV. The knowledge of nurses was deficit regarding risk factors of needle

26

stick injury. Continuous education program may alleviate these nurses attitude and

concerns regarding risk factors of needle stick injury.34

Knowledge concerning needle stick injury Most of the students had knowledge

about the diseases transmitted by contaminated sharp objects. In a study by Norsayani

MY et al, most of the student acquired knowledge of blood borne disease mainly from

the lectures 98.3%, books 90.8% through informally 81.6%. Almost all of the

participants (n = 250, 93%) identified blood as the most infectious body fluid that can

transmit infections through occupational exposure. 35 In the study by Deisenhammer

S et al, general, students’ knowledge about the transmission risks of HIV, hepatitis B

and C through a needle stick injury with a contaminated needle

Most of the students had knowledge about the diseases transmitted by

contaminated sharp objects. In a study by Norsayani MY et al, most of the student

acquired knowledge of blood borne disease mainly from the lectures 98.3%, books

90.8% through informally 81.6%. Almost all of the participants (n = 250, 93%)

identified blood as the most infectious body fluid that can transmit infections through

occupational exposure. 35 In the study by Deisenhammer S et al, general, students’

knowledge about the transmission risks of HIV, hepatitis B and C through a needle

stick injury with a contaminated needle was poor. A study by Saleem T et al, more

than 85% students from each class were aware of the possibility of acquisition of

Hepatitis B, Hepatitis C and HIV from needle stick injuries. Only 16.4% 3rd year

students, 29.5% 4th year students and 36.2% final year students knew the full details

of needle stick injury prevention protocols. Curriculum was cited as an important

source of information regarding needle stick injuries. 19The percentage of students

who acquired knowledge of universal precaution was 70.3%10 and in a study by

Kulkarni et al ,the knowledge of the study participants was high regarding standard

27

precautions, as 70.5% (n = 189) of the participants were able to identify all of the

components35

.

A similar study on health science students in northern china reported that the

students displayed a general lack of knowledge of occupational exposure standards.22

the transmission risk of HIV was rated correctly by only 9% of a first year as compare

to 45% of the fifth year students. Similar results were found for hepatitis B and C.

Overall, the students tended to overestimate the transmission risks. Author

International Journal of Collaborative Research on Internal Medicine & Public

Health.35

Studies related to effects of Needle Stick Injuries.

A quasi- experimental study was conducted to assess the impact of structured

training on prevention of occupational exposure to blood-borne pathogens on

knowledge, behaviour and incidence of medical sharp injuries among 106 student

nurses in Changsha, People’s Republic of China. The 106 students taken for the study

were divided into two classes, one class served as experimental group while the other

served as a control group. Students in the experimental group participated in

structured training interventions. Results revealed that the group that received the

structured training scored significantly higher than the standard education group on

both knowledge and behavior.36

A study was conducted to assess the effectiveness of a training program on

reducing needle stick injuries/sharp object injuries among soon graduate vocational

nursing school students in Southern Taiwan. The study method consisted of a lecture

to the students after the internship training and a self-study brochure for them to

study. This study used the pre-test questionnaires completed by the students and the

post-test questionnaires completed by 107 graduates after work experience as licensed

28

nurses. The results revealed that, the incidence of needle stick injuries / sharp injuries

decreased significantly from 50.5% pre-test to 25.2% post-test, and the report rate

increased from 37.0% to 55.6%, respectively. In conclusion, this intervention

significantly reduced the incidence of needle stick injuries/sharp injuries and

increased the report rate of such events.37

A study was conducted to assess the knowledge and existing practices of staff

nurses regarding needle stick injuries and to evaluate the guidelines developed for the

prevention and management of needle stick injuries in a selected government hospital

of Delhi. The study revealed that 70% of the staff nurses had sustained needle stick

injuries. There was lack of awareness among staff nurses regarding prevention and

management of needle stick injuries. Among the nurses who sustained needle stick

injuries, the majority (71%) did not report it. The developed guidelines regarding,

prevention and management of needle stick injuries was found to be effective in

enhancing the knowledge and improving the practice of staff nurses. The study

concluded that it is useful to the British nurses to be able to compare their experience

of needle stick injuries with that of nurses in Delhi. 38

A study was conducted to assess the impact of introduction of sharp containers

and education programmes on the pattern of needle stick injuries in a tertiary care

centre in India. Introduction of large sharp containers, accompanied by an intensive

education programme was used as the study method. Details of documented injuries

were analysed using the epi-info software for a selected period of time. Result

revealed that a total of 347 injuries occurred mainly due to improper disposal of

needles, recapping and carelessness during use. After the education programme the

percentage of injuries attributed to disposal fell from 69.2% to 38.5%.A further

29

decrease was noted after the additional introduction of small sharp containers. The

study concluded that relatively simple intervention decreased the number of injuries.39

31

FIG:-2 SCHEMATIC PRESENTATION OF RESEARCH STUDY/DESIGN.

Population = staff nurses

Sample= 100 staff nurses

Target population = staff nurses

Accessible population = Staff nurses working in selected hospital, Bangalore

Sampling technique = Random sampling technique

Tool = 1. Structured questionnaire to assess the knowledge

Data analysis

Findings

Development of information booklet

Distribution of

sample

characteristics in

frequency and

percentage of the

staff nurses

Chi-square test to

associate the socio

demographic

variable with

knowledge

32

4. RESEARCH METHODOLOGY

Research methodology designed to develop or refine procedure for obtaining

organizing and analyzing data. Research methods are the steps, procedure and the

strategies for gathering and analyzing the data in a research investigation.

This chapter deals with the methodological approach adopted to evaluate the

knowledge of staff nurses on needle stick injury

Research methodology organized all the components of the study deals with

the type of research approach used, the setting of the study, the population, sampling

technique, sample selection, the inclusion and exclusion criteria, the development of

the tool, collection of data, pilot study, procedure of data collection and plan for data

analysis.

RESEARCH APPROACH:

Research approach is the basic procedure for the research enquiry. The research

approach helps the researchers to determine what data to collect and how to analyze

it. It also suggests possible conclusions to be drawn from the data. A descriptive

survey approach was considered as the most appropriate and adopted for assess the

knowledge on needle stick injury among staff nurses working in Srilakshmi Multi

Specialty Hospital and Ashraya hospital, Bangalore.

RESEARCH DESIGN:

The research design refers to the researcher’s overall plan for obtaining

answers to the research question or for testing the hypothesis. Research design helps

the researcher in selection of subjects, identification of variables, their manipulation

and control. The research design adopted for this study was Non experimental

descriptive design.

33

SETTING OF THE STUDY

The study was conducted in selected hospital (Srilakshmi Multi Specialty

Hospital and Ashraya hospital, Bangalore, Karnataka). The settings were chosen

based in terms of availability of samples and feasibility for conducting study

VARIABLES UNDER STUDY

Variable is “an attribute of a person or object that to varies, that is taken on

different values”

Dependent Variable

Knowledge of staff nurses regarding effects of needle stick injury

Extraneous Variable

Age, sex, religion, residence, Educational qualification, experience, previous

classes and Area of working.

POPULATION

The population refers to the aggregate or totality of all the objects, subject or

members that conform to a set of specification

The target population of this study is the staff nurses in Bangalore, Karnataka

The accessible population of this study is the staff nurses in selected hospitals,

Bangalore, Karnataka.

SAMPLE

Sample consists of the subset of the population selected to participate in research

study. Sampling refers to the process of selecting the portion of population, which

represents the entire population.

Sample for the study will be staff nurses who are fulfilling the inclusion criteria

SAMPLING TECHNIQUE:

Random sampling technique will be adopted to select the sample

34

SAMPLING CRITERIA:

INCLUSION CRITERIA FOR SAMPLING

The study includes who staff nurses who are:

Registered staff nurses

willing to participate in the study

present on the day of sampling

EXCLUSION CRITERIA FOR SAMPLING

The study excludes staff nurses who are:

not willing to participate in the study

those who are absent on that day

DATA COLLECTION TOOL

Selection and Development of the Tool

The data collection technique is through self-administered structured

questionnaire. It was prepared to assess knowledge of staff nurses regarding needle

stick injury. Based on the research problem and objective of the study the following

steps were under taken to select and develop the data collection tool.

DESCRIPTION OF THE TOOL

Data collection is the gathering of information needed to research problem.

The tool was constructed after an extensive review of literature, discussion with the

experts and investigator’s personal experience.

The tool consists of 2 sections:

Sections -1



35

Sections -2

The structured Questionnaire on knowledge related to needle stick injury and

it consists of 30 items

Development of Criteria Rating Scale

Criteria rating scale for validation of tool was developed,

Part-I – comprised of demographical data

Part-II – self-administered questionnaire on needle stick injury which had

very relevant, relevant, needs modification, not relevant and remarks of experts.

CONTENT VALIDATION OF THE TOOL:-

Content validity refers to the degree to which an instrument measures what it

is intended to measure.

The prepared instrument along with the objectives, blue print and criteria

check list was submitted to 7 experts comprising of experts in the field of Medical

Surgical Nursing (4), Statistician (1) and Medical personals (2) for establishing the

content validity. The tool was modified as per suggestions of the experts and the final

tool was constructed.

Pre testing the Tool:

Pretesting of self-administered questionnaire was done to check the clarity of the

items, their feasibility and practicability. Pretest was done in Srilakshmi Multi

Specialty Hospital, Bangalore. It was administered to 10 staff nurses. The sample

chosen were similar in characteristics to those of the population under study.

It was found it took 40 minutes to complete the tool and it was found that the items

were simple to comprehend.

36

The first of the tool consisted of 35 items on knowledge. Based on the suggestions

given by experts, modifications, and rearrangements of few items were done, and few

items were not found appropriate by item analysis, so they were deleted.

Thus the second draft of the prepared tool consisted of 30 items on knowledge

RELIABILITY OF THE TOOL

Reliability of the research instrument was defined as the extent to which the

instrument yields the same results in repeated measures. It was then concerned with

the consistency, accuracy, precision, stability, equivalence and homogeneity.

The tool after validation was subjected to test for its reliability. The self-

instructed questionnaire was tested for reliability by administering it to 10 staff nurses

of Srilakshmi Multi Specialty Hospital, Bangalore. The reliability was established by

split half method. The internal consistency was assessed by using split half technique

with raw score method and deviation method and Spearman’s Brown Prophecy

formula.

Spearman’s Brown Prophecy formula for reliability

r1

= 2r / 1+r

r = the correlation, coefficient, computed on the split haves

r1

= the estimated reliability of the entire test.

For computing the coefficient of correlation, the formulae used were:

Raw score method:

∑

Deviation method: ∑

√∑

37

The reliability obtained for tool was r = 0.88 which was considered to reliable

and adequate.

PREPARING INFORMATION BOOKLET

Preparing of first draft of information booklet was done according to review of

literature. Modification was done after the expert validation. The final draft of

information booklet was prepared containing adequate information on needle stick

injury.

PILOT STUDY

“Pilot study is a small scale version or a trial run, done in preparation for a major

study”.

The pilot study is a small preliminary investigation of the same general

character as in major study.

It is conducted in selected hospital (Srilakshmi Multi Specialty Hospital)

Bangalore and the pilot study data was collected from 4-04-2018 to 10-04-2018. 10

staff nurses are selected by Random sampling technique after obtaining permission

from the concerned authority. Verbal consent was obtained from staff nurses and

assured regarding confidentiality of the information.

Knowledge about needle stick injury was assessed by using self-administered

questionnaire on selected aspects. The time taken for the completion of the tool was in

between 30-40 min.

The pilot study result shows that the study is necessary on the selected sample

in the selected setting

Problems faced during pilot study:

- It consumed more time to collect the data from the staff nurses in ICU.

38

- Some questions that had been framed were found to be slightly difficult to be

understand by the participants and they were modified so that they were easy for

them to understand.

Procedure for data collection:

“Data collection is the gathering of information needed to address a research

problem.”

The main study data collection was done from 20st of May 2018 to 21

th of

June 2018. The total sample of main study consisted of 100 staff nurses. Data was

collected from the sample by administering structured questionnaire after obtaining

consent from the participants. Each session of data collection last for about 30-40

minutes and it took 25-30 days to complete the study.

Plan for data analysis:

The data collected from the participants was planned to be analyzed on the

basis of the objectives of the study using descriptive and inferential statistics.

Organize the data in master data sheet.

Demographic variables are to be analyzed in terms of frequency and percentage.

Knowledge score on needle stick injury is to be presented in the form of mean,

median and standard deviation.

X2 (Chi-Square) is used to determine the association between the knowledge and

selected demographic variables among staff nurses regarding on needle stick

injury.

40

5. RESULTS

Analysis is a process of organizing and synthesizing the data in such a

way that the research questions may be answered and hypothesis tested. Analysis of

data is processed by which quantitative information is reduced, summarized,

organized, interpreted and communicated in a meaningful way

This chapter deals with the analysis and interpretation of the data collected

from 100 staff nurses of Srilakshmi Multi Specialty Hospital and Ashraya hospital to

find out the knowledge. The result was computed descriptive and inferential statistics

based on the objective of the study. The results were computed using descriptive and

inferential statistics based on following objectives of the study

Objectives of the Study:





Research Hypothesis:

H1 -There will be inadequate knowledge regarding needle stick injury staff nurses.



ORGANIZATION AND PRESENTATION OF DATA

The data collected was organized and presented under the following sections

a) Section –A :Description of sample characteristics

b) Section –B: Findings related to knowledge scores of participants.

c) Section –C: Association between knowledge scores and selected demographic

variables.

41

Section A

Table- 1 – Distribution of Staff Nurses according to demographic variables by

frequency and percentage N=100

Socio demographic variables Frequency Percentage

1.Age in years

a. 20-30yrs 71 71%

b. 31-40 yrs 17 17%

c. 41 yrs and above 12 12%

2.Sex

a. Male 49 49%

b. Female 51 51%

3. Educational qualification

a. B.Sc.N 71 71%

b. GNM 19 19%

c. M.Sc. N 10 10%

4. Religion:

a) Christian 71 71%

b) Hindu 19 19%

c) Muslim 10 10%

5. Residence belongs to

a) Urban 39 39%

b) Rural 61 61%

6. Experience

a) < 1 years 64 64%

b) 1-3 years 18 18%

c) >3 years 18 18%

42

7. Whether attended any previous classes regarding needle stick injury

a) Yes 40 40%

b) No 60 60%

8. Area of working

a. Wards 36 36%

b. Causality 27 27%

c. ICU 19 19%

d. Dialysis 7 7%

e. OPD 11 11%

Table- -1 shows that the number and percentage of the distribution of the

subjects.







in rural.







Based on the Area of working 36% were in the Ward, 27% were from the Causality,

19 % were from the ICU, 7% were in Dialysis, 11% of them in OPD

43

Figure (3) Bar Diagram showing the distribution of the age among Staff

Nurses



Figure (4) Pie Diagram showing the distribution of sex among the Staff Nurses.

Based on the sex, 51% were female and 49 % were male.

0

10

20

30

40

50

60

70

80

20-30yrs 31-40 yrs 41 yrs and above

Male 49%

Female 51%

DISTRIBUTION OF SEX

44

Figure (5) Bar Diagram showing the distribution of the religion

Based on the religion: 71% were distributed in Christian, 19% were distributed in

Hindu and 10% were distributed in the Muslim.

Figure (6) Bar Diagram showing the distribution of residence


in rural.

0 10 20 30 40 50 60 70 80

Christian

Hindu

Muslim

Urban Rural

39

61

DISTRIBUTION OF RESIDENCE

45

Figure (7) Doughnut Diagram showing the Educational Qualification



Figure (8) Pie Diagram showing the distribution of experience among Staff

Nurses.

Based on the experience, 64% were distributed < 1 years, 18 % were distributed 1-3


Qualification

B.Sc.N

GNM

M.Sc. N

Experience

<1 years

1-3 years

>3 years

46

Figure (9) Bar diagram showing the distribution previous classes regarding

needle stick injury among Staff Nurses.

Based on the previous classes regarding needle stick injury: 60% were distributed

in No and 40% were distributed in Yes.

Figure (10) Pie Diagram showing the distribution of the Area of working among

Staff Nurses.



0

10

20

30

40

50

60

Yes No

36

27

19

7

11

Area of working

Wards

Causality

ICU

Dialysis

OPD

47

SECTION –B

Table- 2: Frequency and percentage distribution of knowledge of Staff Nurses

KNOWLEDGE LEVEL Score

N %

INADEQUATE( < 50 % ) 64 64%

MODERATE ( 51 - 75 % ) 36 36%

ADEQUATE ( >75 % ) 00 00%

TOTAL 100 100%

Table 2: Depicts Percentage and frequency distribution of knowledge of Staff Nurses

With regard to knowledge scores of Staff Nurses on importance of needle stick

injury, majority of the Staff Nurses 64% had inadequate knowledge, 36% of them had

moderate knowledge and none of them had adequate knowledge.

Figure 11: Percentage distribution of knowledge of Staff Nurses

0

10

20

30

40

50

60

70

INADEQUATE( <50 % )

MODERATE ( 51 -75 % )

ADEQUATE ( >75% )

48

Table-3

Distribution of overall knowledge scores of staff nurses on Needle

stick injury

The above table represents that overall mean knowledge score of staff nurses

regarding Needle stick injury is 11.13.

Sl. no.

No. of items

Max Score

Mean

SD

Mean%

1 30 30 11.13 3.12

49.76

49

SECTION 3

Table- -4 Chi square test associate the selected Socio demographic

Variables with the level of knowledge on Needle stick injury

N=100

Socio demographic variables Inadequate

knowledge

Moderate

Knowledge

Chi-square

value

1.Age in years

χ2 = 6.01

P> 0.05

NS

a. 20-30yrs 51 19

b. 31-40 yrs 10 7

c. 41 yrs and above 13 0

2.Sex χ2 =0.114

P>0.05

NS

a. Male 37 12

b. Female 37 14

3. Educational qualification

χ2 = 0.35

p <0.05

S*

a. B.Sc. N 58 13

b. GNM 12 7

c. M.Sc. N 4 6

4. Religion:

χ2 =1.4

p> 0.05

NS

a) Christian 45 19

b) Hindu 14 4

c) Muslim 15 3

5. Residence belongs to χ2 =0.756

P>0.05

NS

a) Urban 27 12

b) Rural 47 14

6. Experience

χ2 = 0.35

p <0.05

S*

a) <1 years 58 13

b) 1-3 years 12 7

c) >3 years 4 6

50

7. Whether attended any previous classes regarding needle

stick injury χ

2 =0.554

P<0.05

S*

a) Yes 28 12

b) No 46 14

8. Area of working

χ2 =6.22

P>0.05

NS

a) Wards 28 8

b) Causality 19 8

c) ICU 17 2

d) Dialysis 4 3

e) OPD 6 5

S* -Significance P < 0.05 NS – No Significance P > 0.05

Table- 4 shows that the association between knowledge and socio demographic

variable

Based on the third objectives, the chi square test used to associate the level of

knowledge and selected socio demographic variables such as age, sex,

residence, educational qualification, previous classes, experience, religion,

area of working.


age, sex, residence area, religion, area of work and level of knowledge with

socio demographic variable.(P > 0.05)


association the level of knowledge.

51

DISCUSSION

52

6. DISCUSSION

Needle stick injuries are a hazard for people who work with hypodermic

syringes and other needle equipment. These injuries can occur at any time when

people use, disassemble, or dispose of needles. When not disposed of properly,

needles can become concealed in linen or garbage and injure other workers who

encounter them unexpectedly. As a nurse, it is essential to have adequate knowledge

regarding the needle stick injury, as it can spread so many diseases.

The present study is to assess knowledge regarding needle stick injury among staff

nurses of selected hospital (Srilakshmi Multi Specialty Hospital and Ashraya hospital)

Bangalore.

The findings were discussed under following sections.

1. To assess the knowledge regarding needle stick injury among nurses.

2. To determine the association between knowledge of staff nurses with the

selected demographic variables.


1. Knowledge scores of participants on needle stick injury

The mean knowledge score obtained by staff nurses was 11.13; mean

percentage was 49.76, and standard deviation 3.12

The knowledge scores of Staff Nurses on importance of needle stick injury,

majority of the Staff Nurses 64% had inadequate knowledge, 36% of them had

moderate knowledge and none of them had adequate knowledge.

This study is supported by the study, carried out in three hospitals of Karachi.

Total of 222 health care providers in which 52 were nurses participated in the study.

53

Approximately 60% of health care providers had experienced needle stick injury at

least once during their service. The most frequency source of injury occurred while

recapping the syringe. None of the health care provider had adequate knowledge

regarding immediate measures following in needle stick injury.

2. To determine the association between knowledge of staff nurses with the

selected demographic variables.

Distribution of demographic characteristics of staff nurses.







in rural.

Based on the Educational qualification: 71 % were distributed in B.Sc. N, 19%

were distributed in GNM and 10% were distributed in the M.Sc.N.





Based on the Area of working 36% were in the Ward, 27% were from the Causality,

19 % were from the ICU, 7% were in Dialysis, 11% of them in OPD

54

Association of knowledge score with selected demographic variable.


age, sex, residence area, and religion, area of work and level of knowledge with socio

demographic variable. (P > 0.05)

There is a significant association between the knowledge and demographic

variables like experience (χ2 = 0.35), qualification (χ2 = 0.35) and previous classes

(χ2=0.554).

This study is supported by the quasi- experimental study, conducted to assess

the impact of structured training on prevention of occupational exposure to blood-

borne pathogens on knowledge, behaviour and incidence of medical sharp injuries

among 106 student nurses in Changsha, People’s Republic of China. The 106 students

taken for the study were divided into two classes, one class served as experimental

group while the other served as a control group. Students in the experimental group

participated in structured training interventions. Results revealed that the group that

received the structured training scored significantly higher than the standard education

group on both knowledge and behaviour.

This study is supported by the survey, conducted on epidemiology of needle stick

injuries among health care workers working in Buraidah Central Hospital in Buraidah,

Saudi Arabia. The data was collected by a retrospective survey of all self-reported

documents related to needle stick injuries. Result revealed that of the total 73 injuries

reported, nurses were involved in 66% of instances, physicians in 19%, technicians in

10% and non-clinical support staff in 5.5%.The study emphasized the importance of

awareness, training and education of health care workers for reporting and prevention

of needle stick injuries.

55

This study is supported by the study, conducted on risk of needle stick injuries

among healthcare workers of L.T.M. Medical College and General Hospital, Sion

over a period of one year. The data collected was based on self-reported incidence of

needle stick injuries and other exposures to patient’s blood and body fluids. Result

revealed that a total of 38 cases were reported and no sero-conversion in any of the

reported accidental injury cases. This data emphasized that needle stick injuries

present the single greatest risk to medical personnel and the importance of increased

awareness and training is in universal safety precautions for prevention of nosocomial

infections.

57

CONCLUSION

Many studies state the importance of proper knowledge of staff nurses

regarding needle stick injury. The study helps the nurses to aware about the effects

and precautions for needle stick injury

The findings shows that only 36% of staff nurses have moderate knowledge

regarding needle stick injury and the aim is to increase the knowledge by providing

informational booklet

Nursing implication:

The finding of this study has brought out certain facts that have far-reaching

implications for nursing, particularly in the areas of practice, education,

administration and research.

Nursing Practice:

Safe practices during procedures are vital for the patient as well as health

workers. The findings of the study can be utilized by practicing nurse in alleviating

the needle stick and sharp injuries.

Nursing education

Nurses with higher education and up to date knowledge can provide cost

effective and quality patient care. Nurse educators need to include various aspects of

needle stick injury and precautions in the curriculum of basic nursing education as a

part of practical and should encourage their students to practice the same in the

clinical setting.

Nursing Administration:

Today there is an increasing demand for quality care. Nurse administrators are

in a key position to prepare policies and its execution of quality nursing care based on

research findings. In- service education should be organized periodically to upgrade

58

the knowledge and skills of health care professionals in regarding needle stick

injuries.

Nursing Research:

Nursing researchers should be aware of the new trends and existing health care

system. Emphasis should be laid on research in the areas of quality care. The findings

of the research need to be disseminated through publications so that the utilization of

such research findings could be encouraged.

Limitations

The study is limited to staff nurses working in selected hospitals (Srilakshmi

Multi Specialty Hospital and Ashraya hospital) at Bangalore

Assessment of knowledge based on responses of the participants to items

included in the questionnaire.

Recommendations:

On the basis of the findings of the study the following recommendations

have been made:

The study can be replicated in different hospital

Experimental study can be conducted with structured learning programme on

knowledge and practice.

Follow up study can be conducted to evaluate effectiveness of VAT.

A comparative study can be conducted between government and private

hospitals.

Summary

The investigator felt satisfaction and fulfillment for having undertaken the

present study. The result of the present study shows that there is a great need for the

health personnel to implement appropriate practice in preventing needle stick injury.

60

8. SUMMARY

This chapter presents the summary of the study, its discussion, conclusion, its

nursing implications and recommendations.

The main objective of the study was to assess the knowledge among staff nurses

regarding needle stick injury at selected hospitals, Bangalore.

OBJECTIVES OF THE STUDY:





HYPOTHESIS:

H1 - There will be inadequate knowledge regarding needle stick injury staff nurses.



CONCEPTUAL FRAMEWORK:

The conceptual frame work for this study was based on Imogene KING’s

goal attainment theory to assessing the knowledge regarding the needle stick injury.

The review of related research and non-research literature helped the investigator to

develop the conceptual frame work, structured interview schedule and to plan for data

analysis.

The study was conducted at Srilakshmi Multi Specialty Hospital and Ashraya

hospital, Bangalore from 20st of May 2018 to 21

th of June 2018, adopted descriptive

61

survey approach with random sampling technique. Sample of the study consisted of

100 staff nurses.

The tool used for the collection of data was structured interview schedule. It

consisted of following sections:

Sections -1



Sections -2

The structured Questionnaire on knowledge related to needle stick injury and

it consists of 30 items

The steps involved in the development of instruments were preparation of

their print, construction of items, content validity, pre-testing, reliability, conducting

pilot study and preparation of the final copy of the tool.

After obtaining the formal permission from Srilakshmi Multi Specialty

Hospital and Ashraya hospital, Bangalore and taking consent from the subjects, the

validated tool was used to collect data from staff nurses for 50-55 minutes.

Then the collected data were analyzed using descriptive and inferential

statistics and interpreted in terms of objective and hypothesis of the study. The level

of significance was set at 0.01 & 0.05 level of significance.

On the basis of the obtained knowledge score score an information booklet

was prepared on needle stick injury and was validated by subject experts.

62

MAJOR FINDINGS OF THE STUDY:

Section I

Distribution of participants according to their demographic variables.

Based on the age: 71 %were distributed in the 20-30 years, 17% were distributed in



Based on the religion: 71 % were distributed in Hindu, 19% were distributed in



in rural.

Based on the Educational qualification: 71 % were distributed in B.Sc. N, 19%

were distributed in GNM and 10% were distributed in the M.Sc.N.







Section II (Knowledge score)

Knowledge level of the participants regarding the needle stick injury

With regard to knowledge scores of Staff Nurses on importance of needle stick injury,

majority of the Staff Nurses 64% had inadequate knowledge, 36% of them had

moderate knowledge and none of them had adequate knowledge

63

Section III

Association of knowledge score of participants with selected demographic

variables.


age, sex, residence area, religion, area of work and level of knowledge with

socio demographic variable.(P > 0.05)


association with level of knowledge

65

9. BIBLIOGRAPHY

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ManjuBala.

4. Indian J Med Res 131,March 2010,pp no 406

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.Med 2005; 48: 482–90. @www.google.com

6. Cone JE, Hagadone K, Boyd A. The epidemiology of sharp injuries in the

epidemic of healthcare worker injury. Journal of epidemiology 1999 3:6-7

7. Susan Q. Wilburn, MPH, RN

8. Susan Q, Wilburn BSN,MPH, Gerry Eijkemans MD, “Preventing needle stick

injuries among health care workers”, International Journal of Occupational and

Environmental Health 2004; 10:451-456

9. Purnima Gupta, “Needle stick injury- consequences and prevention.”, Health Care

Management 2006 June

10. McCormick RD, Maki DG. Epidemiology of needle sticks injuries in hospital

personnel. American Journal of Medicine. 1981; 70:928-932.

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attributable to contaminated sharp injuries among health care workers. Am J Ind

Med 2005;48:482-90.

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No3Sept04/InjuryPrevention.html#Wilburn

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12. © Copyright 1997-2017 Canadian Centre for Occupational Health & Safety

13. Ebrahami H. Khosravi A. needle stick injuries among nurses, J.R. Health sciences,

vol. 7, No.2 (2007), pp. 56-62.

14. Rishi Buli, Parveen Sharma. Needle stick injuries in health care providers. The

nursing journal of India, Nov-2008, pp. 251-254.

15. .Nsuduga, Fredrich M, Maritta S. Jalkkola. Tropical medicine and international

health, volume 10, 2005, pp. 773-777.

16. Elmiyeh B, Whitaker S, Tames MT, Chahal CAA, Galea A, Alshafi K, Journal of

the royal society of medicine, volume 97, No. 7, pp. 326-372, 2004.

17. Syed F. Shah, Abdul Bari, Bener, Suad Al Kaabi, Abdul Latif Al Khal,

SofiSamson : Science direct –safety sciences, volume 44, issue 5, June 2006, pp.

387-394.

18. Robert C. Improving the knowledge of trained nurses, Department of public

health medicine, North Wales, health authority, Mold.

19. Varma M, Mehta G. Journal of the Indian medical association, 2000, vol. 95, pp.

436-438.

20. Lee JM 1,.Botteman MF 1, Nicklasson L 2, Cobden D 2, Pashos CL. Needle stick

injury in acute care nurses caring for patients with diabetes melitus: A

Retrospective Study. Current Medical Research and Opinion 2005;21(5):741-47.

21. Jahan S. Epidemiology of needle stick injuries among health care workers in a

secondary care hospital in Saudi Arabia. Ann Saudi Med 2005 May-Jun;

25(3):233-8.

22. Rele M, Mathur M, Turbadkar D. Risk of needlestick injuries in healthcare

workers- A report. Indian J Med Microbiol 2002 Oct-Dec;20(4):206-7.

https://www.ccohs.ca/oshanswers/diseases/needlestick_injuries.html

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23. Askarian M, Malekmakan L. The prevalence of needle stick injuries in medical,

dental, nursing and midwifery students at the university teaching hospitals of

Shiraz, Iran. Indian J Med Sci 2006 jun;60(6):227-32.

24. Husoyam,mindeT,KnudenH,Tidsskr No Laegeforen,.Needle stick injury

routines.2010 April:130(7),Nowerign. www .pubmed. gov. in

25. RujisWH,Timen .A Guidelines of needle stick injuries risk assessment and post

exposure management in practices Ned TijdschrGeneeskd. 2008 Sep 6;

152(36):1967-71. Review. Dutch. PMID: 18807333.www.pubmed.gov

26. Von OverbeckJ,Wess D Furrer HNeedle stick accident procedure following

potentially infectious exposure in medical personelIn

Geneva.www.pubmed.gov.in

27. Lum D, Meyer-Rochow G, Neveldson GB, Siriwardena M, Turner P, Firth H,

“Needle stick injuries in country general practice.”, Newzealand Medical Journal

1997; 110(1041): 122-5

28. Rio de Janeiro, “Frequency of needle stick injuries and its knowledge among

health care providers in public hospitals of Karachi.”, International AIDS Society

2005 July 24-27

29. Alam M. Knowledge, attitude and practices among healthcare workers on needle

stick injuries. Ann Saudi Med. 2002;22(5-6).

30. Gurubhacharya DL, Mahura KC, Karki DB. Knowledge attitude and practices

among health care workers on needle-stick injuries. Kathmandu univ Med J

2003;1(2):91-4.

31. Zafer A, Aslam N, Nasir N, Meraj R, Mehraj V. 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.

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32. A Flores, DJ Pevalin, “Health care workers knowledge and attitude to glove use.”,

British Journal of Infection Control 2006(7): 18-22

33. D Debnath, “Improving reporting of sharp injuries.”, Hospital Medicine 2000

Dec, (61): 852-854

34. Juan, Chi-wen MD, Siebers, Chia-Ju RN BS, Chang, Yu-Jun Bcom, “The

attitudes, concerns, gloving practices and knowledge of nurses.”, International

Journal of Nursing Practice 2004; 10(1): 32-38

35. International Journal of Collaborative Research on Internal Medicine & Public

Health Vol. 6 No. 5 (2014)

36. Wang H, Fannie K, He G, Burgess J, Williams AB, A training for prevention of

occupational exposure to blood borne pathogens: Impact on knowledge, behavior

and incidence of needle stick injuries among student nurses in Changsha, Peoples

Republic of China. J AdvNurs 2003 Jan;41(2):187-94

37. Ya-Hui-Yang, Saou-HsingLiou, Chiou-Jong Chen, Chun-Yuh Yang, Chao-Ling

Wang,Chiu-Ying Chen and Trong-Nengwu. The Effectiveness of a Training

Program on reducing needle stick injuries / Sharp object injuries among soon

graduate vocational nursing school students in southern Taiwan. Journal of

Occupational Health 2007;49(5)424-9.

38. Simon LP. Prevention and management of needle stick injury in Delhi. Br J Nurs

2009 Feb 26- Mar11;18(4):252-6.

39. Richard VS, Kenneth J, Ramaprabha P, Kirupakaran H, Chandy GM. Impact of

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Feb;47(2):163-5.

70

ANNEXURES- A 1

LETTER REQUESTING PERMISSION TO CONDUCT A PILOT STUDY.

From,

Mr. JAGADEESHA D S

II Year M.Sc. Nursing.

Sri Lakshmi College of nursing.

Bangalore – 91.

To

………………………………

………………………………

………………………………

Forwarded through Principal,


Bangalore

Respected Madam/ Sir,

SUB: LETTER FOR SEEKING PERMISSION TO CONDUCT MAIN STUDY IN

YOUR HOSPITAL.

I Mr. JAGADEESHA D S, Second year student of M.Sc. Nursing (MSN) at Sri

Lakshmi College of nursing, Bangalore. I have selected the following topic for my Research

Project to be submitted to Rajiv Gandhi University of Health sciences, Bangalore, Karnataka

in partial fulfillment of Master of Science in Nursing Programme.

TITLE OF THE TOPIC:

“A Study To Assess The Knowledge Of Staff Nurses On Needle Stick

Injury In Selected Hospitals At Bangalore With A View To Develop

Informational Booklet.”

I am in need of your permission and esteemed help as I intend to conduct a study to

assess the knowledge of staff nurses on needle stick injury in selected hospitals at Bangalore

with a view to develop information booklet. I am herewith request you to kindly grant

permission and inform the concerned authorities to extend the necessary facilities for me in

your hospital to enable my work on the proposed study personally.

Thanking you in anticipation

Date:

Place: Bangalore Yours faithfully,

[JAGADEESHA D S]

71

ANNEXURES- A 2

72

ANNEXURES- B 1

LETTER REQUESTING PERMISSION TO CONDUCT A MAIN STUDY.

From,

Mr. JAGADEESHA D S



Bangalore – 91.

To

………………………………

………………………………

………………………………



Bangalore



YOUR HOSPITAL.





TITLE OF THE TOPIC:










Date:

Place: Bangalore yours faithfully,

[JAGADEESHA D S]

73

ANNEXURES- B 2

74

ANNEXURES- B 3

75

ANNEXURE – C

LETTER TO HOD REQUESTING PERMISSION TO CONDUCT STUDY

From,

Mr. MR. JAGADEESHA D S

II year M.Sc. Nursing.

Sri Lakshmi College of Nursing.

TO,

The Head of the department

Department of Medical Surgical nursing


Bangalore,

Respected sir/Madam

Sub: Permission to conduct research at Department of Medical Surgical nursing,

SriLakshmi College of Nursing, Bangalore.

With reference to above subject, I would like to bring to your kind notice that,

I Mr. JAGADEESHA D S, II year M.Sc. Nursing student of Sri Lakshmi College of

Nursing, Bangalore, has to submit a Dissertation in my specialty of Medical Surgical

nursing to the Rajiv Gandhi University of Health Sciences as a partial fulfillment of

my requirement. My subject of Dissertation is



Informational Booklet..”

Thanking yours faithfully

Date Yours faithfully

Place: Bangalore.

MR. JAGADEESHA D S

76

ANNEXURE – D

LETTER SEEKING PERMISSION FOR VALIDATION OF THE TOOL

From,

Mr. JAGADEESHA D S

2nd

year M.Sc. Nursing

Sri Lakshmi College of nursing, Bangalore.

To,

..............................................

...................................................

Forwarded through principal

Sri Lakshmi College of nursing

SUB; Request for acceptance to validate the research tool

Respected madam/sir,

I am a post graduate student (medical and surgical nursing) of Sri Lakshmi

College of nursing, Bangalore. I have selected below mentioned topic for research project to

be submitted to Rajiv Gandhi University of health science, Bangalore as a partial fulfilment of

M.Sc. nursing programme.

TOPIC: “A Study to Assess the Knowledge of Staff Nurses On Needle Stick

Injury in Selected Hospitals at Bangalore with a View to Develop Informational

Booklet”

With regards to this may I kindly request you to validate my research to structured interview

schedule for its appropriateness and relevancy. I am enclosing the tools along with objectives

of study for your reference

I would be highly obliged and remain thankful for your great help if you could validate the

tool as early as possible

Thanking you, Yours faithfully

(JAGADEESHA D S)

Enclosure

Reply letter

Envelop

77

ANNEXURE – E

LETTER SEEKING EXPERT’S OPINION AND SUGGESTIONS FOR

CONTENT VALIDITY OR RESEARCH TOOL

From,

Mr. JAGADEESHA D S

2nd

year M.Sc. Nursing


To,

..............................................

...................................................


Sri lakshmi College of nursing

SUB; Request for opinion and suggestions of experts for establishing content validity of

research tool.








Booklet”







(JAGADEESHA D S)

Enclosure

Objectives and hypothesis.

Tools.

Content validity certificate.

78

ANNEXURE- F

CRITERION RATING SCALE FOR VALIDATING THE STRUCTURED

QUESTIONNAIRE ON KNOWLEDGE RELATED TO NEEDLE STICK

INJURY

Respected Madam / Sir,

Kindly go through the content and place tick mark () against

questionnaire in the following columns ranging from very relevant to not relevant,

when found to be not relevant and needs modification kindly give your opinion in the

remarks column.

SL

NO

Item Very

Relevant

Relevant Needs

Modification

Not

Relevant

Remarks

Part -1

Demographic

variables

1

2

3

4

5

6

7

8

79

SL

NO

Item Very

Relevant

Relevant Needs

Modification

Not

Relevant

Remarks

Part 2

Knowledge questionnaire

regarding needle stick

injury

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

80

22

23

24

25

26

27

28

29

30

SUGGESTIONS:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

__________________

SIGNATURE OF THE VALIDATOR

81

ANNEXURE-G

CONTENT VALIDITY CERTIFICATE

I hereby certify that I have validated the tool of Mr. JAGADEESHA D S,

M.Sc. Nursing student who is undertaking a study on “A Study To Assess The

Knowledge Of Staff Nurses On Needle Stick Injury In Selected Hospitals At Bangalore

With A View To Develop Informational Booklet.”

Name:

Designation:

Place:

Date:

Signature of the expert

88

ANNEXURE H

CERTIFICATE OF ANALYSIS OF DATA

This is to certify that dissertation done by Mr. JAGADEESHA D S,

2nd

year M.Sc. student of Sri Lakshmi College of Nursing on “A Study to Assess the

Knowledge of Staff Nurses on Needle Stick Injury in Selected Hospitals at

Bangalore with a View to Develop Informational Booklet”. The data analysis for the

study is done by me.

SEAL & SIGNATURE

INFORMATION BOOKLET ON

NEEDLE STICK INJURIES

PREPARED BY

MR. JAGADEESHA. D S

II M.Sc. NURSING, (MSN.)

SRILAKSHMI COLLEGE OF NURSING,

SUNKADAKATTE, BANGALORE-91.

NEEDLE STICK INJURIES

Needle stick injuries are wounds caused by needles that accidentally puncture the

skin.Needle stick injuries are a hazard for people who work with hypodermic syringes and other

needle equipment. These injuries can occur at any time when people use, disassemble, or dispose

of needles. When not disposed of properly, needles can become concealed in linen or garbage

and injure other workers who encounter them unexpectedly.

Sharps

"Sharps" include needles, as well as items such

as scalpels, lancets, razor blade, scissors, metal wire,

retractors, clamps, pins, staples, cutters, and glass

items. Essentially, any object that is able to cut the

skin can be considered a "sharp".

Hazards of needle stick and sharps injuries

These injuries transmit infectious diseases, especially

blood-borne viruses. More than 20 pathogens have

been reportedly transmitted from needle sticks.

Concern includes the

Human Immunodeficiency Virus (HIV) which leads

to AIDS (Acquired Immune Deficiency Syndrome),

Hepatitis B,

Hepatitis C.

Injuries have transmitted many other diseases involving viruses, bacteria, fungi, and other

microorganisms to health care workers, laboratory researchers, and veterinarian staff. The

diseases include:

Blastomycosis.

Brucellosis.

Cryptococcosis.

Diphtheria.

Cutaneous gonorrhea.

Herpes.

Malaria.

Mycobacteriosis.

Mycoplasma caviae.

Rocky Mountain spotted fever.

Sporotrichosis.

Staphylococcus aureus.

Streptococcus pyogenes.

Syphilis.

Toxoplasmosis.

Tuberculosis.

Injuries can occur at every stage of their use, disassembly, or disposal. Equipment designs,

nature of the procedure, condition of work, staff experience, recapping, and disposal have all

been mentioned as factors that influence these occurrences.

Activities with potential for needlestick injuries

Home healthcare workers can be at risk for needle sticking or

sharps injuries when they:

• Handle needles that must be taken apart or manipulated after use.

• Dispose of needles attached to tubing.

• Manipulate the needle in the client.

• Recap a needle.

• Use needles or glass equipment to transfer body fluid between

containers.

• Fail to dispose of used needles in puncture-resistant sharps

containers.

• Lack proper workstations for procedures using sharps.

• Work quickly.

• Bump into a needle, a sharp, or another worker while either person

is holding a sharp.

Specific features make certain devices more dangerous.

• Devices with hollow bore needles.

• Needle devices that need to be taken apart or manipulated by the health care worker like

blood drawing devices that need to be detached after use.

• Syringes that retain an exposed needle after use.

• Needles that are attached to tubing like butterflies that can be difficult to place in sharps

disposal containers.

Prevention of needle sticks and sharps injuries

Preventing injuries is the most effective way to protect workers.

A comprehensive sharps injury prevention program would include:

Recommended guidelines.

Improved equipment design.

Effective disposal systems.

Employee training.

Safe recapping procedures, where necessary.

Surveillance programs.

Preventing injuries from sharps and needle sticks is considered a part of the "routine

practices" used by healthcare workers.Workerswho use sharps require education and training as

part of a sharps injury prevention program. Workers should be educated in how to protect

themselves during use and to protect others who may encounter the device during or after

procedures.

PHAC recommends that:

Needles should not be recapped. Used items should be placed immediately in a

designated puncture-resistant container that is easily accessible at the point-of-care.

Healthcare workers should cover open skin areas or lesions on hands and arms with a dry

dressing at all times. Hand hygiene is still essential, so consultation is necessary if the

dressing interferes with this procedure.

Eyes, nose, and mouth should be protected if splashes with blood or body fluids are

anticipated.

First-aid should be immediate if there has been exposure to blood or body fluids. Report

to employer. Follow the employer's procedure for further testing.

First-aid will include:

o Thoroughly rinsing the injury site with running water, and gently cleaning with soap

and water if possible.

o Eyes, nose, or mouth should be flushed with running water.

o Non-intact skin should be rinsed thoroughly.

http://www.ccohs.ca/oshanswers/prevention/universa.html

http://www.ccohs.ca/oshanswers/prevention/universa.html

Steps to take following a needle stick:

If you experienced a sharps injury during your work, immediately follow these steps:

Wash wound with soap and water

Flush out mouth, nose, or skin with water

Irrigate eyes with water, saline, or sterile irrigants

Report the incident to your supervisor

Immediately seek medical treatment at the nearest ER or treatment facility.

Follow-Up:

Get confidential follow-up, post-exposure testing at six weeks, three months, and six

months, and depending on the risk, at one year.

Receive monitoring and follow-up of PEP.

Take precautions (especially by practicing safe sex) to prevent exposing others until

follow-up testing is complete.

Don’t be afraid to seek additional information or a referral to an infectious disease

specialist if you have any questions. Also, consider counseling—a needlestick injury

can be traumatic, regardless of the outcome.

Safer needle device

A safer needle device has built-in safety controls to

reduce needle stick injuries before, during, or after

use and to make needle sticks less likely.

Important Principles

PHAC refers to the CDC "Workbook for designing, implementing and evaluating a

sharps injury prevention program" as an example of a program. This workbook uses a hierarchy

of control approach, including:

Elimination - find ways to eliminate or reduce needle use during procedures, medication

delivery, and specimen collection

Engineering controls - remove or isolate the hazard by using sharps disposal containers or other

devices that have an integrated injury prevention feature. Safety devices must be chosen with

care as no one device or strategy will work in every situation.

Work-practice controls - Steps that can be taken to reduce injuries include using instruments to

grasps needles or load/unload scalpels, avoiding hand-to-hand passage of sharps, separating

sharps from other waste, not carry garbage or linen bags close to the body, etc.

Personal Protective Equipment (PPE) - PPE should be used as the last control approach, where

appropriate.

Vaccination– all staff should consider appropriate vaccination in particular hepatitis B

vaccination where there is a risk of exposure to blood or body fluids.

Employer’s responsibility in the workplace:

Implement the use of engineering controls to reduce needlestick injuries.

Avoid the use of needles when there are other safe alternatives.

Implement use of devices with safety features.

Set priorities and strategies for needle stick injury prevention by examining local and

national information about risk factors.

Ensure proper training of employees on the safe use and disposal of needles.

Modify work practices that have an increased risk of a needle stick injury.

Promote safety awareness in the work environment.

Establish procedures for and encourage the reporting of all needle stick and other sharps-

related injuries.

Evaluate the effectiveness of prevention efforts and provide feedback on performance.

http://www.cdc.gov/sharpssafety/resources.html

http://www.cdc.gov/sharpssafety/resources.html

Employee’s responsibility in the workplace:

Avoid recapping needles.

Before beginning any procedure using needles, plan for

safe handling and proper disposal.

Help your employer select and evaluate devices with safety

features.

Use devices with safety features.

Dispose of used needles in appropriate sharps disposal

containers.

Inform your employer of hazards from needles that you

observe at work.

Participate in blood borne pathogen training and follow

recommended infection prevention practices, including

hepatitis B vaccination

Remind employers that they are required by law to

evaluate and purchase safety devices

Make sure that you receive training on any new safety

devices

Place a sharps disposal container close to the procedure

area.

Limit interruptions during procedures

Explain the procedure to patients to gain their cooperation

and avoid potential movement during the procedure

Ask for assistance with patients that might be

uncooperative, such as children

Avoid overfilling sharps disposal containers

Care for yourself

Get a hepatitis B vaccination; this should be provided at no

cost by your employer

Report all needle stick and other injuries

Most needle stick injuries can be prevented with the use of safety devices, which in conjunction

with worker education and training and work practice controls

Training

All staff will receive annual training in:

• The risks associated with blood and body fluid

exposures.

• The correct use of medical devices

incorporating sharps protection mechanisms.

• The importance of immunization and how to

access Occupational Health services

• The reporting, response and monitoring

procedures and their importance.

Disposal of used sharps

An effective system for disposing of used

needles and sharps is crucial to preventing injuries.

Have disposal containers readily available. Workers

should place needles in wide-mouth, puncture-proof

containers. Locate disposal containers specifically

where needles and sharps are used to make safe

disposal possible. Replace the containers before they

are completely filled - sharps containers should be

removed and replaced when they are three quarters full.

Make sure they are sealed, collected, and disposed of in

accordance with local regulations for biomedical waste.

All staff should report every incident in which they

find needles or sharps left at the bedside or thrown into

the regular garbage.

Sharps disposal container height should be:

• Standing workstation: 52 to 56

inches above the standing surface of the

user.

• Seated workstation: 38 to 42 inches above

the floor on which the chair rests

• Sharps containers must be easily accessible

to employees and located as close as

feasible to the immediate area

where sharps are used (e.g., patient care

areas). In areas, such as correctional

facilities and psychiatric units, there may be

difficulty placing sharps containers in the

immediate use area.

• Sharps Containers should be disposed when

the bucket is 3/4 full, rather than waiting to

be completely filled. Most of the

time, sharps containers will have a clear lid

so one can monitor the fill levels.

All the following can be put in a sharps

container,

• Needles.

• Scalpels.

• Broken glass.

• Broken capillary tubes.

• Exposed ends of dental wires.

• Cardio-catheter wires.

• Disposable suture sets and biopsy forceps.

• Electro cautery devices (tips only)

Sharps Injury Log

The newly revised Blood borne Pathogens Standard requires employers to “maintain a sharps

injury log for the recording of percutaneous injuries from contaminated sharps.”

The log must contain, at a minimum, the following information:

• Date of the injury

• Type and brand of the device involved

• Department or work area where the incident occurred

• Explanation of how the incident occurred

You can use the data contained in the log to:

• Analyze injury frequencies by specific attributes like work units, devices, and procedures.

• Identify high-risk devices and procedures.

• Identify injuries that could be prevented.

• Evaluate the efficacy of newly implemented safe devices.

• Share and compare information and successes with other institutions.

Surveillance program

Surveillance programs that provide in-depth analysis of accidents are an important tool

for obtaining information. The goals of these programs should include:

Determining the rate of injuries.

Investigating the factors that cause the injuries.

Ensuring that injured workers receive proper treatment.

Identifying areas in which the prevention program needs improvement.

Leading to practical strategies for dealing with the problem.

xv

TABLE OF CONTENT

SL. NO. CONTENT PAGE NO.

1. Introduction 01

2. Objectives 11

3. Review of literature 18

4. Methodology 30

5. Results 39

6. Discussion 51

7. Conclusion 55

8. Summary 58

9. Bibliography 63

10. Annexure 68

69

ANNEXURES

70

ANNEXURES- A 1

LETTER REQUESTING PERMISSION TO CONDUCT A PILOT STUDY.

From,

Mr. JAGADEESHA D S



Bangalore – 91.

To

………………………………

………………………………

………………………………



Bangalore



YOUR HOSPITAL.





TITLE OF THE TOPIC:










Date:

Place: Bangalore Yours faithfully,

[JAGADEESHA D S]

71

ANNEXURES- A 2

72

ANNEXURES- B 1

LETTER REQUESTING PERMISSION TO CONDUCT A MAIN STUDY.

From,

Mr. JAGADEESHA D S



Bangalore – 91.

To

………………………………

………………………………

………………………………



Bangalore



YOUR HOSPITAL.





TITLE OF THE TOPIC:










Date:

Place: Bangalore yours faithfully,

[JAGADEESHA D S]

73

ANNEXURES- B 2

74

ANNEXURES- B 3

75

ANNEXURE – C

LETTER TO HOD REQUESTING PERMISSION TO CONDUCT STUDY

From,

Mr. MR. JAGADEESHA D S

II year M.Sc. Nursing.


TO,

The Head of the department

Department of Medical Surgical nursing


Bangalore,

Respected sir/Madam

Sub: Permission to conduct research at Department of Medical Surgical nursing,

SriLakshmi College of Nursing, Bangalore.

With reference to above subject, I would like to bring to your kind notice that,

I Mr. JAGADEESHA D S, II year M.Sc. Nursing student of Sri Lakshmi College of

Nursing, Bangalore, has to submit a Dissertation in my specialty of Medical Surgical

nursing to the Rajiv Gandhi University of Health Sciences as a partial fulfillment of

my requirement. My subject of Dissertation is



Informational Booklet..”

Thanking yours faithfully

Date Yours faithfully

Place: Bangalore.

MR. JAGADEESHA D S

76

ANNEXURE – D

LETTER SEEKING PERMISSION FOR VALIDATION OF THE TOOL

From,

Mr. JAGADEESHA D S

2nd

year M.Sc. Nursing


To,

..............................................

...................................................


Sri Lakshmi College of nursing

SUB; Request for acceptance to validate the research tool








Booklet”







(JAGADEESHA D S)

Enclosure

Reply letter

Envelop

77

ANNEXURE – E

LETTER SEEKING EXPERT’S OPINION AND SUGGESTIONS FOR

CONTENT VALIDITY OR RESEARCH TOOL

From,

Mr. JAGADEESHA D S

2nd

year M.Sc. Nursing


To,

..............................................

...................................................


Sri lakshmi College of nursing

SUB; Request for opinion and suggestions of experts for establishing content validity of

research tool.








Booklet”







(JAGADEESHA D S)

Enclosure

Objectives and hypothesis.

Tools.

Content validity certificate.

78

ANNEXURE- F

CRITERION RATING SCALE FOR VALIDATING THE STRUCTURED

QUESTIONNAIRE ON KNOWLEDGE RELATED TO NEEDLE STICK

INJURY

Respected Madam / Sir,

Kindly go through the content and place tick mark () against

questionnaire in the following columns ranging from very relevant to not relevant,

when found to be not relevant and needs modification kindly give your opinion in the

remarks column.

SL

NO

Item Very

Relevant

Relevant Needs

Modification

Not

Relevant

Remarks

Part -1

Demographic

variables

1

2

3

4

5

6

7

8

79

SL

NO

Item Very

Relevant

Relevant Needs

Modification

Not

Relevant

Remarks

Part 2

Knowledge questionnaire

regarding needle stick

injury

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

80

22

23

24

25

26

27

28

29

30

SUGGESTIONS:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

__________________

SIGNATURE OF THE VALIDATOR

81

ANNEXURE-G

CONTENT VALIDITY CERTIFICATE

I hereby certify that I have validated the tool of Mr. JAGADEESHA D S,

M.Sc. Nursing student who is undertaking a study on “A Study To Assess The

Knowledge Of Staff Nurses On Needle Stick Injury In Selected Hospitals At Bangalore

With A View To Develop Informational Booklet.”

Name:

Designation:

Place:

Date:

Signature of the expert

88

ANNEXURE H

CERTIFICATE OF ANALYSIS OF DATA

This is to certify that dissertation done by Mr. JAGADEESHA D S,

2nd

year M.Sc. student of Sri Lakshmi College of Nursing on “A Study to Assess the

Knowledge of Staff Nurses on Needle Stick Injury in Selected Hospitals at

Bangalore with a View to Develop Informational Booklet”. The data analysis for the

study is done by me.

SEAL & SIGNATURE

90

ANNEXURE I

STRUCTURED QUESTIONNAIRE

THE TOOL CONSISTS OF THREE PARTS:

Part 1: Demographic variables

Part 2: Questionnaire on knowledge related to Needle stick injury

PART-1: DEMOGRAPHIC PERFORMA.

Instruction; - Dear participants please read the questionnaire carefully and put a tick

mark () in the appropriate places provided.

Date: Participant No.

1. Age in years:

a) 20-30. ( )

b) 31-40. ( )

c) 41-above. ( )

2. Sex:

a) Male. ( )

b) Female. ( )

3. Educational Qualification.

a) B.Sc. Nursing) ( )

b) GNM. ( )

c) M.Sc. Nursing ( )

4. Religion:

a) Christian ( )

b) Hindu ( )

c) Muslim ( )

91

5. Residence belongs to

a) Urban ( )

b) Rural ( )

6. Experience

a) <1 years ( )

b) 1-3 years ( )

c) >3 years ( )

7. Whether attended any previous classes regarding needle stick injury

a) Yes ( )

b) No ( )

8. Area of working

a) Wards ( )

b) Causality ( )

c) ICU ( )

d) Dialysis ( )

e) OPD ( )

92

PART-2

KNOWLEDGE ASSESSSMENT OF STAFF NURSES

REGARDING NEEDLE STICK INJURY.

Instruction: Please read every statement carefully and select one which is most suitable

to you.

GENERAL INFORMATION

1. What is needle stick injury?

a) IV injection. ( )

b) Accidental injury by the health worker ( )

c) Needle injury to the patient ( )

d) Invasive procedure ( )

2. What are sharps?

a) Needles, scalpels and lancets ( )

b) Razor blade and scissors ( )

c) Clamps, pins and staples ( )

d) All the above ( )

3. Expand HBV?

a) Hepatitis B Virus ( )

b) Hepatitis B Vaccine ( )

c) Hemoglobin V ( )

d) None of these ( )

4. Expand AIDS?

a) Acquired Infection Disease Syndrome ( )

b) Acquired Immune Deficiency Syndrome ( )

c) All India Drug Services. ( )


5. Needle stick injuries and exposure of mucous membranes of unintact skin to

blood may lead to which disease?

a) AIDS/ hepatitis B ( )

b) Common cold or flu ( )

c) Skin Cancer ( )

d) Dermatitis ( )

93

6. Highest risky injury is from:

a) Blood filled hollow bore needles. ( )

b) Blades ( )

c) Plain needles ( )

d) Suture needles ( )

7. HIV transfers in health workers at a ratio?

a) 1: 3000 ( )

b) 1: 300 ( )

c) 3: 100 ( )

d) 2: 100 ( )

8. Name the Blood borne Pathogens that medical staff and health personnel are

most commonly exposed to:

a) HIV ( )

b) Hepatitis B ( )

c) Hepatitis C ( )

d) All the Above ( )

9. Which of the following is not a factor that influence the occurrences of needle

stick injury

a) Equipment design ( )

b) Nature of the procedure ( )

c) Staff experience ( )

d) Manufactures of the equipment ( )

10. Needle stick Injuries can occur at which stage of use?

a) During injection/procedure ( )

b) While assembling or disassembling ( )

c) During Disposal ( )

d) Every stage of use ( )

11. Expand PPE

a) Private Protective Equipment ( )

b) Personal Protective Equipment ( )

c) Purified Protein Element ( )

d) Patient Protective Equipment ( )

94

12. What personal protective equipment (barriers) need to be worn to protect the

Mucous membranes of the face against splash with blood/ body fluids?

a) Mask ( )

b) Goggles ( )

c) Both a and b ( )

d) None of these. ( )

13. Whom should you tell if you see needles without a safety device?

a) Charge Nurse ( )

b) Co-Worker ( )

c) Supervisor or Safety Officer ( )

d) Patient ( )

14. First-aid for needle stick injury will include:

a) Thoroughly rinsing the injury site with running water ( )

b) Bandage the site ( )

c) Wipe the blood ( )


15. As part of sharps injury prevention, workers who use sharps require

a) Medicine ( )

b) Education and training ( )

c) High salary ( )

d) Promotion ( )

16. Needle stick accidents may be avoided by:

a) Safer devices and techniques ( )

b) Gloves ( )

c) Mask ( )

d) Gown ( )

17. What is the maximum capacity for a sharp container?

a) 100% ( )

b) 75% ( )

c) 90% ( )

d) 80% ( )

https://www.proprofs.com/discuss/q/1234071/give-me-two-examples-in-which-needlestick-accidents-may-be-a

95

18. TO whom we should report after a needle stick accident?

a) Patient ( )

b) Doctors ( )

c) Supervisor ( )

d) Owner of hospital ( )

19. Sharp containers should be ______ to _______ inches from the floor at a

standing workstation

a) 50- 55 inches ( )

b) 52- 56 inches ( )

c) 56- 60 inches ( )

d) 60- 65 inches ( )

20. Sharp containers should be ______ to _______ inches from the floor at a

sitting workstation

a) 44- 48 inches ( )

b) 38- 42 inches ( )

c) 32-36 inches ( )

d) 48-52 inches ( )

21. Where should a sharps container be located?

a) Close to Patient bed ( )

b) Close to Patient care area ( )

c) Close to Doctors room ( )

d) Close to Nurse’s station ( )

22. What percentage of needle stick injury can be prevented with the use of safer

needle devices?

a) 100 % ( )

b) 90 % ( )

c) 80 % ( )

d) 70 % ( )

23. When did the Needle stick Safety and Prevention Act introduced?

a) 2000 ( )

b) 1953 ( )

c) 2001 ( )

d) 2005 ( )

96

24. When did the Needle stick Safety and Prevention Act come into effect?

a) 2000 ( )

b) 1953 ( )

c) 2001 ( )

d) 2005 ( )

25. According to Public Health Agency of Canada’s Recommendation after the

procedure the needles,

a) Should be recapped carefully ( )

b) Should be thrown in dust bin ( )

c) Should not be recapped ( )

d) Should be reused ( )

26. How should sharps be disposed of?

a) In disposal containers ( )

b) Can be reused ( )

c) In open area ( )

d) In garbage ( )

27. Which of the following is not the part of surveillance program?

a) Determining the rate of injuries ( )

b) Providing proper care for the patient ( )

c) Investigating the factors that cause the injuries. ( )

d) Ensuring that injured workers receive proper treatment. ( )

28. What's a safer needle device?

a) It can save the patient ( )

b) It may not be painful ( )

c) It has built-in safety controls ( )

d) Needles can be hold safely. ( )

29. Who all are responsible for preventing needle stick injury in a Hospital?

a) Employers and employees ( )

b) Patient and relatives ( )

c) Manufacturing companies ( )

d) Law ( )

97

30. The nurse should report:

a) All needle stick injuries ( )

b) Sharps-related injuries ( )

c) Blood splashes ( )

d) All the above. ( )

98

ANNEXURE - J

LIST OF EXPERTS

1. Mrs. Bhagyalakshmi .R

Principal,

Srilakshmi College of nursing

Bangalore.

2. Mrs. Manju Thomas

Asso.Professor

Medical and Surgical Nursing,

Srilakshmi College of nursing

Bangalore.

3. Mr. Melbin Michael Arackal

Asso.Professor

Medical and Surgical Nursing

Shantidhama College Of Nursing

Bangalore.

4. Mrs. Viji C

Professor


Brite College Of Nursing

Bangalore

99

5. Mrs. Vanamathi T

Professor


Gayathri College Of Nursing

Bangalore

6. Dr. M. L. Giridhar

Medical Director

Sri Lakshmi Multi Specialty Hospital

Bangalore.

7. Mr. D. Elakkuana Bhaskar Raj

Dept.Of Biostatistics

100

ANNEXURE - K

STATISTICAL FORMULAS

1) Spearman’s Brown Prophecy formula for reliability

2 r

r¹ =

1+ r

r- The correlation coefficient computed on the split halves

r- The estimated reliability of the entire test

For computing coefficient of correlation:

Raw score method:

r = ∑ x y – x y

n

S1 .S2

Deviation method:

r = ∑ x y

∑ x2.∑ y

2

2) Descriptive statistics

Mean X = ∑ x

n

101

Standard deviation = ∑ x2 - (∑ x)

2

n

n-1

3) Inferential statistics

Chi square χ² = ∑ (O-E) 2

E

102

ANNEXURE - L

CERTIFICATE FOR ENGLISH EDITING

This is to certify that the tool prepared by JAGADEESHA D S,

II year M. Sc. nursing student of Sri Lakshmi College of Nursing for his study “A

Study to Assess the Knowledge of Staff Nurses On Needle Stick Injury in

Selected Hospitals at Bangalore with a View to Develop Informational Booklet”

is translated and edited for appropriateness by me.

Seal and Signature

a study to assess the knowledge of staff nurses on …

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