Effect of Sharps Injury Prevention Program on the Incidence and Reporting of Sharp Injury among Nurses

Soonmi Park; Ihn Sook Jeong; Seong Sook Jun

doi:10.14192/kjnic.2013.18.1.15

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Park, Jeong, and Jun: Effect of Sharps Injury Prevention Program on the Incidence and Reporting of Sharp Injury among Nurses

Original Article

Korean J Nosocomial Infect Control 2013;18(1):15-25.

Published online: 6 January 2013

DOI: https://doi.org/10.14192/kjnic.2013.18.1.15

Effect of Sharps Injury Prevention Program on the Incidence and Reporting of Sharp Injury among Nurses

Soonmi Park¹, Ihn Sook Jeong², Seong Sook Jun²

Department of Nursing, Pusan National University Yangsan Hospital, Yangsan, Korea

College of Nursing, Pusan National University, Yangsan, Korea

⋆This work was supported by a 2-Year Research Grant of Pusan National University.

Correspondence: Ihn Sook Jeong, College of Nursing, Pusan National University, 49, Busandaehak-ro, Mulgeum-eup, Yangsan 602-739, Korea Tel: 051-510-8342, Fax: 051-510-8308 E-mail: jeongis@pusan.ac.kr

Received 25 November 2012 Accepted 12 February 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

This study aimed to identify the effects of a multifaceted needlestick injury (NSI) prevention program on changes in knowledge about bloodborne infectious diseases and postexposure coping, attitudes toward postexposure reporting, preventive measures, the number of NSIs, and postexposure reporting pre- and post-intervention among nurses.

Methods

A total of 429 and 420 nurses participated in the pre- and post-intervention periods, respectively. The intervention was performed from April to September 2007, comprising NSI guideline education, the use of containers with enhanced engineering, and the supply of safety devices.

Results

The average score of knowledge about bloodborne infectious diseases increased significantly from 8.3 to 8.9 out of 14 points (P<0.001), but the change in score of knowledge about postexposure coping was insignificant. The average score of attitude toward postexposure reporting increased significantly from 8.9 to 9.6 out of 12 points (P<0.001). Preventive measures such as “gloves are provided whenever needed” (P<0.001), “use one-hand technique” (P<0.001), and “needle containers are provided whenever needed” (P=0.031) increased significantly. The number of NSIs decreased by 40.4%, and the postexposure reporting rate increased by 552.8%.

Conclusion

The multifaceted NSI prevention program positively affected knowledge about infectious diseases and postexposure coping, attitudes toward postexposure reporting, preventive measures, the number of NSIs, and postexposure reporting after intervention. Therefore, we recommend that this program be applied to various healthcare workers in hospitals.

Keywords: Education, Needlestick injuries, Post-exposure prophylaxis, Prevention and control

References

1. Stringer B, Infante-Rivard C, Hanley J. Quantifying and reducing the risk of bloodborne pathogen exposure. AORN J. 2001; 73:1135–46.

2. Adams D. Needlestick and shaprs injuries: practice update. Nurs Stand. 2012; 26:49–57.

3. Costigliola V, Frid A, Letondeur C, Strauss K. Needlestick injuries in European nurses in diabetes. Diabetes Metab. 2012. 38(Suppl 1):S9–14.

4. O'Malley EM, Scott RD 2nd, Gayle J, Dekutoski J, Foltzer M, Lundstrom TS. et al. Costs of management of occupational exposures to blood and body fluids. Infect Control Hosp Epidemiol. 2007; 28:774–82.

5. US DHHS, CDC, NIOSH. NIOSH alert: Preventing needlestick injuries in health care settings [DHHS (NIOSH) Publication No. 2000.108. http://www.cdc.gov/niosh/docs/2000-108/ (Updated on 15 October 2012).

6. Gabriel J. Reducing needlestick and sharps injuries among healthcare workers. Nurs Stand. 2009; 23:41–4.

7. Yang L, Mullan B. Reducing needle stick injuries in healthcare occupations: an integrative review of the literature. ISRN Nurs. 2011; 2011; 315432.

8. André F. Hepatitis B epidemiology in Asia, the Middle East and Africa. Vaccine. 2000; 18:S20–2.

9. Choe KW. Epidemiology of HIV/AIDS: current status, trends, and prospects. J Korean Med Assoc. 2007; 50:296–302.

10. Ministry of Labor. Occupational safety and health law. 2012; http://www.moleg.go.kr/main.html (Updated on 15 October 2012).

11. Ministry of Labor. Occupational health standard. 2012; http://www.moleg.go.kr/main.html (Updated on 15 October 2012).

12. Smith DR, Choe MA, Jeong JS, Jeon MY, Chae YR, An GJ. Epidemiology of needlestick and sharps injuries among professional Korean nurses. J Prof Nurs. 2006; 22:359–66.

13. Jeong I, Cho J, Park S. Compliance with standard precautions among operating room nurses in South Korea. Am J Infect Control. 2008; 36:739–42.

14. Seo JM, Jeong IS. Post-exposure reporting of needlestick and sharp-object injuries among nurses. Korean J Nosocomial Infect Control. 2010; 15:26–35.

15. Kim OS, Choi JS, Yoon SW, Park ES, Jeong JS, Jung SY. et al. Survey of under reporting rate and related factors after blood and body fluid exposure among hospital employees. Korean J Adult Nurs. 2010; 22:466–76.

16. Kim OS, Jeong JS, Kim KM, Choi JS, Jeong IS, Park ES. et al. Underreporting rate and related factors after needlestick injuries among healthcare workers in small-or medium-sized hospitals. Korean J Nosocomial Infect Control. 2011; 16:29–36.

17. Beltrami EM, Williams IT, Shapiro CN, Chamberland ME. Risk and management of Blood-borne infections in health care workers. Clin Microbiol Rev. 2000; 13:385–407.

18. Tabak N, Shiaabana AM, Shasha S. The health beliefs of hospital staff and the reporting of needlestick injury. J Clin Nurs. 2006; 15:1228–39.

19. Osborne S. Perceptions that influence occupational exposure reporting. AORN J. 2003; 78:262–72.

20. Elmiyeh B, Whitaker IS, James MJ, Chahal CA, Galea A, Alshafi K. Needle-stick injuries in the National Health Service: a culture of silence. J R Soc Med. 2004; 97:326–7.

21. Makary MA, Al-Attar A, Holzmueller CG, Sexton JB, Syin D, Gilson MM. et al. Needlestick injuries among surgeons in training. N Engl J Med. 2007; 356:2693–9.

22. Grimmond T, Bylund S, Anglea C, Beeke L, Callahan A, Christiansen E. et al. Sharps injury reduction using a sharps container with enhanced engineering: a 28 hospital nonrandomized intervention and cohort study. Am J Infect Control. 2010; 38:799–805.

23. Jagger J. Reducing occupational exposure to bloodborne pathogens: where do we stand a decade later? Inf Control Hosp Epidemiol. 1996; 17:573–5.

24. Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for postexposure prophylaxis. MMWR Recomm Rep. 2001; 50(RR-11):1–52.

25. Cho E, Lee H, Choi M, Park SH, Yoo IY, Aiken LH. Factors associated with needlestick and sharp injuries among hospital nurses: a cross-sectional questionnaire survey. Int J Nurs Stud. 2012; [Epub ahead of print] http://dx.doi.org/10.1016/j.ijnurstu.2012.07.009.

26. Grady GF, Lee VA, Prince AM, Gitnick GL, Fawaz KA, Vyas GN. et al. Hepatitis B immune globulin for accidental exposures among medical personnel: final report of a multicenter controlled trial. J Infect Dis. 1978; 138:625–38.

27. Seeff LB, Zimmerman HJ, Wright EC, Finkelstein JD, Garcia-Pont P, Greenlee HB. et al. A randomized, double blind controlled trial of the efficacy of immune serum globulin for the prevention of post-transfusion hepatitis: a Veterans Administration cooperative study. Gastroenterology. 1977; 72:111–21.

28. Prince AM, Szmuness W, Mann MK, Vyas GN, Grady GF, Shapiro FL. et al. Hepatitis B “immune” globulin: effectiveness in prevention of dialysis-associated hepatitis. N Engl J Med. 1975; 293:1063–7.

29. Centers for Disease Control and Prevention. Evaluation of safety devices for preventing percutaneous injuries among healthcare workers during phlebotomy procedures. Minneapolis-St. Paul, New York City, and San Francisco: MMWR. 1997; 46:21–3.

30. Charles PG, Angus PW, Sasadeusz JJ, Grayson ML. Management of healthcare workers after occupational exposure to hepatitis C virus. Med J Aust. 2003; 179:153–7.

31. Young TN, Arens FJ, Kennedy GE, Laurie JW, Rutherford G. Antiretroviral post-exposure prophylaxis (PEP) for occupational HIV exposure. Cochrane Database Syst Rev. 2007; 24(CD002835):

Table 1.

Comparison of general characteristics between pre and post intervention

Characteristics		Pre (N=429) N (%)^⋆	Post (N=420) N (%)^⋆	P value
Gender	Male	7 (1.6)	11 (2.6)	0.320
	Female	421 (98.4)	409 (97.4)
Age (yr)	Mean±SD	28.9±4.1	28.4±3.8	0.069
Working duration	<1	51 (12.1)	75 (17.9)	0.022
as a nurse (yr)	1-<3	98 (23.2)	75 (17.9)
	3-<5	103 (24.3)	110 (26.3)
	5-<10	122 (28.8)	126 (30.1)
	≥10	49 (11.6)	32 (7.7)
	Mean±SD	5.0±4.4	4.5±3.8
Education	3-year college	73 (17.1)	76 (18.4)	0.479
	4-year college	329 (77.0)	319 (77.4)
	Postgraduate	25 (5.9)	17 (4.1)
Type of employment	Full-time	315 (76.6)	290 (70.0)	0.032
	Part-time	96 (23.4)	124 (30.0)
Current working places	Wards	239 (56.0)	242 (57.6)	0.634
	ICUs	90 (21.1)	95 (22.6)
	ORs	55 (12.9)	53 (12.6)
	ERs	27 (6.3)	20 (4.8)
	Others	16 (3.7)	10 (2.4)
Taking hepatitis B	Yes	364 (85.0)	346 (82.8)	0.368
immunization	No	64 (15.0)	72 (17.2)
Hepatitis B antibody	Have	300 (70.6)	311 (74.6)	0.418
	Do not have	64 (15.1)	56 (13.4)
	Do not know	61 (14.4)	50 (12.0)

^⋆ N (%) means the number and percent of nurses who answered each question and missing data are eliminated. Abbreviations: SD, standard deviation; ICUs, intensive care units; ORs, operating rooms; ERs, emergency rooms.

Table 2.

Comparison of knowledge about bloodborne infectious disease and postexposure coping between pre and post intervention

Question	Pre (N=429) N (%)^⋆	Post (N=420) N (%)^⋆	P value
Knowledge about bloodborne infectious disease
The frequency of hepatitis B, C in hospitals compared with general population	34 (7.9)	23 (5.5)	0.151
Duration that hepatitis B immunization remains effective	224 (53.2)	220 (52.9)	0.926
HBV transmission mode	421 (98.4)	410 (97.9)	0.584
HCV transmission mode	376 (88.1)	377 (90.2)	0.319
HIV transmission mode	425 (99.3)	419 (100.0)	0.249
The risk of transmitting HBV after invasive injury by a contaminated sharps	99 (23.2)	125 (30.1)	0.023
The risk of transmitting HCV after invasive injury by a contaminated sharps	113 (26.5)	161 (38.8)	<0.001
The risk of transmitting HIV after invasive injury by a contaminated sharps	211 (49.2)	247 (59.8)	0.002
Possibility of death by hepatitis C infection	310 (72.3)	348 (82.9)	<0.001
Immunization against HBV	398 (93.0)	397 (94.5)	0.356
Immunization against HCV	339 (79.6)	346 (82.4)	0.299
Immunization against HIV	356 (83.4)	330 (78.8)	0.087
Effect of zidovudine on reducing HIV sero-conversion	57 (13.5)	85 (20.6)	0.006
Effect of passive immunization with hepatitis B immunoglobin	170 (40.5)	210 (50.5)	0.004
Mean±SD^†	8.3±1.8	8.9±1.9	<0.001
Knowledge about postexposure coping
Go on working regardless of sharp injuries	373 (91.6)	373 (93.5)	0.320
Report and fill out an injury report	410 (96.2)	407 (97.6)	0.254
Take a blood test	412 (98.1)	400 (96.9)	0.253
Observe blood test for 3 months	388 (92.4)	388 (94.4)	0.241
Need to get an anti-tetanus shot	378 (91.7)	379 (92.9)	0.538
Get advice from colleague	397 (96.4)	394 (96.6)	0.871
Mean±SD^‡	5.7±0.7	5.7±0.7	0.372

^⋆ N (%) means the number and percent of nurses who answered correctly for each question and missing data are eliminated.

^† Mean±SD represents average score and standard deviationof 14 questions of knowledge about bloodborne infectious disease. Each question has 1 point when they answer correctly, and total is from 0 to 14 points.

^‡ Mean±SD represents average score and standard deviation of 6 questions of knowledge about postexposure coping. Each question has 1 point when they answer correctly, and total is from 0 to 6 points.

Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; SD, standard deviation.

Table 3.

Comparison of attitude toward postexposure reporting between pre and post intervention

Questions	Pre (N=429)	Post (N=420) N (%)	P value
Postexposure reporting prevents future problems for me	405 (95.7)	405 (97.1)	0.282
Postexposure reporting would benefit me and my family members	396 (93.6)	399 (96.1)	0.097
Postexposure reporting may lead to early disease transmission protection	407 (96.4)	406 (97.6)	0.328
Postexposure reporting would not be so anxious about HBV/HCV/HIV	329 (77.8)	352 (84.8)	0.009
Postexposure reporting is lengthy and time consuming^⋆	267 (63.7)	291 (69.8)	0.063
Postexposure reporting is embarrassing^⋆	200 (47.6)	234 (55.8)	0.017
Postexposure reporting involves too much paperwork^⋆	170 (40.6)	214 (51.3)	0.002
Postexposure reporting is inconvenient^⋆	168 (40.0)	224 (53.6)	<0.001
Postexposure reporting is useless if the injuries are minor^⋆	328 (78.7)	363 (87.3)	0.001
Postexposure reporting is not needed if patients do not have bloodborne infections^⋆	267 (63.7)	314 (75.7)	<0.001
Postexposure reporting is not needed if the injuries are my errors^⋆	389 (93.7)	398 (95.4)	0.276
Postexposure reporting is unknown to me^⋆	382 (91.6)	401 (96.2)	0.006
Mean±SD^†	8.9±2.3	9.6±2.2	<0.001

^⋆ reverse coding;

^† Mean±SD represents average score and standard deviationof 12 questions of attitude toward postexposure reporting. Each question has 1 point when they show positiveattitude, and total is from 0 to 12 points. Abbreviations: HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; SD, standard deviation.

Table 4.

Comparison of preventive measures between pre and post intervention^⋆

Questions	Pre (N=429) N (%)	Post (N=420) N (%)	P value
Gloving
Gloving during IV or IM injection	31 (7.5)	42 (10.1)	0.185
Gloves are provided, whenever needed	361 (86.0)	390 (93.5)	<0.001
Handling of used needles
No needle recapping	101 (23.7)	80 (19.2)	0.110
Use one-hand technique	145 (34.4)	232 (56.3)	<0.001
Remove immediately after use	390 (91.5)	391 (93.8)	0.218
Use of needle containers			0.686^†
Use needle containers	419 (99.1)	418 (99.5)
Needle containers are provided, whenever needed	419 (98.6)	420 (100.0)	0.031⁺

^⋆ The proportion comes from answers to always or almost always.

^† P value was obtained by Fisher's exact test. Abbreviations: IV, intravenous; IM, intramuscular.

Table 5.

Change of number of needlestick injuries and postexposure reporting between pre and post intervention

	Pre	Post	% change
Number of nurses	429	420
Number of needlestick injuries during 1 year	443	264	-40.4
Number of needlestick injuries per nurse during 1 year	1.03	0.63	-38.8
Number of postexposure reporting	32	124	287.5
Percent of postexposure reporting^⋆ (%)	7.2	47.0	552.8

^⋆ number of reporting/number of injuries.

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