Needle stick Injury in Jr Doctors

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152 APRIL 2013Indian Medical Gazette

In Practice

Address for correspondence: Dr. H. Sanayaima Devi, Associate Professor, Wangkhel Lourembam Leikai, Near Durga Puja Lampak,

Imphal East 795 004. E-mail : [email protected]

Needle Stick Injuries among Junior Doctors

Sh. Praveen,Associate Proessor, Microbiology,

H. Sanayaima Devi,Associate Professor, Community Medicine,

Ebenezer Phesao, PGT, Community Medicine,

N. Shugeta Devi, PGT, Community Medicine

Regional Institute of Medical Sciences, Lamphelpat, Imphal, Manipur.

Th. Netajini Devi,Assistant Professor,

Dept. of Obs & Gyne, JNIMS, Porompat, Imphal West, Manipur.

Abstract

Objective:To determine the prevalence of needle stick

injuries (NSIs) among junior doctors of RIMSand to assess

the measures undertaken by the respondents after the NSI.

Methods:A cross sectional study was conducted in RIMS,

Imphal, Manipur among internees, house officers and post

graduate trainees from Sept to Oct 2011. Self-administered

questionnaire was used to collect data.Descriptive statistics

like mean, percentage and standard deviation were used.

Analysis was done using Chi square test. And P-value of


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APRIL 2013 153Indian Medical Gazette

Needlestick injuries are a common event in the healthcareenvironment. 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. Needlestick

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 week3.

Hepatitis B carries the greatest risk of transmission, with37 to 62% of exposed workers eventually showing

seroconversion and 22 to 31% showing clinical Hepatitis B

infection. The hepatitis C transmission rate has been reported

at 1.8%4, but newer, larger surveys have shown only a

0.5% transmission rate5. The overall risk of HIV infection

after percutaneous exposure to HIV-infected material in the

health care setting is 0.3%6.

Junior doctors have the greatest risk of exposure to

blood-borne pathogens, given their numerous encounters

involving the use of sharp instruments on patients and the

increased propensity for injury while learning new technical

skill sets. The hazard of injury is further compounded by

the high prevalence of human immunodeficiency virus

(HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)

among hospitalized patients. Therefore this study was

conducted to determine the prevalence of needle stick

injuries among junior doctors and to assess the measures

undertaken by the respondents after the needle stick injuries.

Material and Methods

A cross sectional study was conducted in Regional

Institute of Medical Sciences (RIMS), Imphal, Manipur

among all junior doctors from Sept to Oct 2011. The total

number of junior doctors were 382 which included 92

Internees, 245 PGs and 45 House Officers. Data were

collected using a pre-tested and pre-designed self-

administered questionnaire that consisted questions eliciting

the particulars of respondent, number of needlestick injuries

during last one year and an expanded set of questions about

the recent needlestick event. For those who had more than

one NSI, information for the most recent NSI was taken.

After taking an informed verbal consent from the

respondents, the questionnaires were distributed during the

day in the hospital and during the night at the hostels. Thecompletely filled questionnaires were collected on the same

day or the next day. PGs in Community medicine,

Physiology, Forensic medicine, Pharmacology and Anatomy

were not included in the study. Ethical approval was sought

from Institutional Ethics Committee, RIMS, Imphal.

Confidentiality of the respondents was maintained.

Statistical analysis

Descriptive statistics like mean, percentage and standard

deviation were used. Analysis was done using Chi square

test. Data were analyzed using SPSS version 11. And P-value of


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Discussion

Needle stick injuries pose a significant occupational risk

for health care providers. In our study we found that nearly

40% of the junior doctors had needlestick injury during the

last one year. Different prevalence rates (30% to 71.1%)

were reported from many studies conducted among

different study populations7,8,9,10,11. A higher prevalence

(83%) was recorded in a study done among postgraduate

trainees in United States and it was reported that the

frequency of injury was higher among surgical trainees

than among all medical trainees12. Our study revealed that

50.9% of NSI occurred by open bored needles. A higher


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APRIL 2013 155Indian Medical Gazette

percentages (60% to 76%) were reported by otherworkers7,13. Drawing blood for laboratory test and during

suturing were the main activities when junior doctors got

NSI in the present study. In other studies8,12, suturing was

the most common accident situation (45%-52%) followed

by blood drawing (24%), whereas another study reported

that recapping of a needle after use and drawing blood

were the common reasons of injury14. In our study recapping

was not practiced by majority of the respondents, this might

be because 63% of the doctors had attended workshop or

seminars related to it. Similar findings were reported by

other workers10,12. Of the injured doctors, 62 (54.4%) were

not using gloves which is consistent with other reports8.

However, in another study only 28% of the nursing care

workers in Iran did not use any personal protective

equipment10. In the present study, respondents indicated

that being in a hurry was the leading cause of their injury

which is consistent with other findings12. In other studies,

it has been shown that lack of experience in many

procedures, insufficient training, work overload and fatigue

leads to occupational sharp injuries15.

Furthermore, in this study out of the doctors who got

NSI, majority of them (91.8%) did not take post exposure

prophylaxis. Similar findings were reported by other

researchers7,11. A more recent survey of all types of providers

from Iowa medical organization found that 34% reported

their exposure to an employee health service16. The risk of

under reporting and thus delaying or foregoing treatment is

significant. HIV, Hepatitis B and Hepatitis C being highly

prevalent in the state of Manipur, the chances of being

infected by these diseases are high as our study indicates

that most needle pricks went unreported and untreated by

PEP. Our study found out that majority of the respondents

had not done HIV, HBV and HCV testing after the injury.

Reporting the injury to an authorized centre enablescounseling regarding the risk of exposure and prevention

to secondary transmission, including possible transmission

to patients.

We assessed only junior doctors because they are at

higher risk for needle stick injury. It might not be

representative of the RIMS doctors as a whole but still our

study could give some important information regarding NSI.

In our knowledge probably, this is the first survey of needle

stick injuries in Manipur and particularly in RIMS.

Information was self reporting and there is a possibility of

misclassification, although anonymous nature of the survey

would be expected to facilitate accurate reporting.

Conclusion

Needle stick injuries among junior doctors are common

and often not reported and majority of them did not take

post exposure prophylaxis. These findings warranted the

need for ongoing attention to strategies to reduce such

injuries in a systematic way and to improve reporting system

so that appropriate medical care can be delivered.

References

1. Needlestick injury. Available at URL: http://en.wikipedia.org/wiki/Needlestick_injury. Accessed on

27th Sept. 2011.

2. Occupational health. Available at URL: http://

www.who.int/occupational_health/topics/neelinjuries/

en/index.html. Accessed on 27th Sept 2011.

3. Sarrazin U., Brodt H.R., Sarrazin C., Zeuzem S.

Prophylaxis against HBV, HCV and HIV after

occupational exposure.Dtsch Arztebl.102(33):2234

2239, 2005.

4. Centers for Disease Control and Prevention, Updated

US Public Health Service guidelines for the

management of occupational exposures to HBV, HCV,

and HIV and recommendations for post exposure

prophylaxis.

5. Jagger J., Puro V. DeCarli G. Occupational

transmission of hepatitis C virus. JAMA. 288(12):

1469-1471, 2002.

6. CDC Cooperative Needlestick Surveillance Group R.

Marcus, Surveillance of health care workers exposed

to blood from patients infected with the humanimmunodeficiency virus.N Engl J Med.319:1118

1123, 1988.

7. Ghofranipour F., Asadpour M., Ardebili H.E., Niknami

S., Hajizadeh E. Needle Sticks / Sharps Injuries

and Determinants in Nursing Care Workers. EJSS.

1(2):191-197, 2009.

8. Meunier O., Almeida N., Hernandez C., Bientz M.

Blood exposure accidents among medical students.

Med Mal Infect. 31:537-543, 2004.


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9. Patterson J.M., Novak C.B., Mackinnon S.E., EllisR.A. Needlestick injuries among medical students.

Am J Infect Control. 31:226-230, 2003.

10. 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. Indianjmedsci. 60(6):227-232, 2006.

11. Shiao J.S., Mclaws M.L., Huang K.Y., Guo Y.L.

Student nurses in Taiwan at high risk for needlestick

injuries.Ann Epidemiol, 12:197-201, 2002.

12. Makary M.A., Al-Attar A., Holzmueller C.G., SextonB.J., Syin D., Gilson M.M., Sulkowski, Pronovost

P.J. Needlestick Injuries among Surgeons in

Training.N Engl J Med. 356:26-39, 2007.

13. Moghimi M., Marashi S.A., Kabir A., Taghipour H.R.,

Faghihi-Kashani A.H., Ghoddoosi I., Alavian S.M..

Knowledge, Attitude, and Practice of IranianSurgeons About Blood-Borne Diseases. J Surg

Res.151(1):80-84, 2009.

14. Azap A., Ergnl O., Memikolu K.O., Yeilkaya A.,

Altunsoy A., Bozkurt G., Tekeli E. Occupational

exposure to blood and body fluids among health care

workers in Ankara, Turkey.AJIC. 33(1):48-52, 2005.

15. Rogers B., Goodno L. Evaluation of interventions

to prevent needlestick injuries in health care

occupations.Am J Prev Med.18(4):90-98, 2000.

16. Doebbeling B.N., Vaughn T.E., McCoy K.D.,

Beekmann S.E., Woolson R.F., Ferguson K.J., Torner

J.C. Percutaneous injury, blood exposure, and

adherence to standard precautions: are hospital- based

health care providers still at risk? Clin Infect Dis.

37(8):1006-1013, 2003.

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Needle stick Injury in Jr Doctors