Professional Documents
Culture Documents
ASHLEY SEEGOLAM
MEDICAL AND SURGICAL NURSING
COLUMBIA COLLEGE OF NURSING
BANASWADI
BANGALORE
2011-2012
Marcel Proust
to be accepted occupational hazards for surgeons. Although the potential for injury,
exposure and contraction of blood borne disease was well known, there were no attempts
to reduce risk of such events. When HIV was described in 1981 we started to pay greater
attention to health worker safety in the operation room. In 1983 the center for disease
control and prevention recommended “caution” when handling body fluids from patients
suspecting of having AIDS. Initially HIV and AIDS were considered to be rare and
proportions and by 1987 the CDC recommended universal precaution which states that
body and body fluids precaution which be used with all patients. It was at this time that
CDC made their first recommendations for the use of appropriate barrier protection and
against reheating of contaminated needles. In 1991 the occupational safety and health
administration required the use of universal precaution and the enactment of the blood
team approach to surgical care. Surgeons, scrub nurses and operation room technicians
work very closely together handling the same instruments in a confine space.
Consequently surgeons and scrubs are injured in similar ways with similar equipments
and not infrequently by each other. At team approach to safety in operation room is
organisms and viruses that cause blood-borne diseases, such as the human
immunodeficiency virus (HIV) and the Hepatitis B and C viruses, has led the medical
community to initiate efforts to prevent and limit exposure among health care workers.
Needle stick injury (NSI) means the par literal introduction into the body of healthcare
worker, during the performance of their duties, of blood or other potentially hazardous
material by a hollow bore needle or sharp instruments, including, but not limited to,
The World Health Organization defines ‘a safe injection’ as 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. Irrational and unsafe injection practices
are rife in developing countries. More than 80% of the needle stick injuries can be
prevented through the use of safety devices and effective safety programs. Needle stick
Potential exposures are not limited to needle sticks alone, because manipulation of
other sharp instruments or mucous membrane exposures to infected bodily fluids also can
result in the transmission of infectious diseases. Quantifying the precise risk for disease
unreported. House staff; for example, fail to report between 60% and 95% of exposures.
Even though the risk of injury per use is low, so many needles are used in health
care settings that even a very low injury rate translates into an imposing number of
injuries.
The World Health Organization defines ‘a safe injection’ as 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. Irrational and unsafe injection practices
are rife in developing countries. More than 80% of the needle stick injuries can be
prevented through the use of safety devices and effective safety programs. Needle stick
The operation theatre is, is where needle stick injuries and blood and blood fluid
exposure occur with regular frequency. Up to a fifth of all health care associated sharp
injuries occur in the OT, and therefore it is logical to suppose that surgeons suffer from
occupational related NSI, while at work. It is estimated the surgeon in practice for 10
years has a 95% chance of suffering from sharp injuries, most of which is self inflicted.
Measure such as use of blunt needles, using diathermy to cut instead of knife has been
“In the sick room, ten cents' worth of human understanding equals ten dollars' worth of
medical science”.
Martin H. Fischer
The occurrence of needle stick injury has increased since the past few years as
there has been more and more awareness on the importance of reporting any kind of
injury and to get treated for the same, on the other hand there is a lot of education
required to increase the awareness on prevention of needle stick injury specially in
operation theatre as it affects operation theatre staffs by a margin of almost 30%. The
prevention and management of needle stick injury must be taken up into the curriculum
Needle stick injuries are a frequent occurrence among healthcare nurses. The
Centers for Disease Control (CDC) estimates that about 600,000 to one million needle
stick injuries occur each year. Unfortunately, about half of these needle stick injuries go
unreported (CDC, 2007). The American Nurses Association (ANA) estimates that of the
numerous needle stick injuries only about 1,000 healthcare workers actually contract an
infection. Besides exposure to blood borne pathogens, the nurse is also at risk for about
20 other infections that can be transmitted through a needle stick, including tuberculosis,
syphilis, and malaria. When a nurse is exposed to a needle stick, the risk of transmitting
various types of blood borne pathogens (i.e. Human Immunodeficiency Virus [HIV],
increased (ANA, 2007). Despite the growing body of knowledge concerning needle
sticks in practicing nurses, there has been little research focusing on needle sticks in the
student population. The purpose of this study was to determine the incidence of needle
sticks among the nursing students at a small liberal arts university and evaluate the
Two hundred and forty-three sharp injuries and 22 incidents of blood or body
fluid exposure were encountered in the cumulated 50 months of our study. The incidence
of sharp injuries was the highest among nurses (55%) of all the health care workers, akin
to the global data. An injury rate of nearly 20% among housekeeping staff seems to be
specific to the Indian data. Patient's room followed by Operation Theater appeared to be
common locations of injury in our study. The source of the injury was identified in
majority (64%) of the injuries. A major part of the group was not the primary users of the
sharp (38%). Disposable needles caused nearly half of the injuries. Suture needles
Of 342 injuries, 254 were from known sources and 88 from unknown sources.
From known sources, 37 were seropositive; 13 for HIV, 15 for HCV, nine for HBV. Sixty
six sharp injuries were sustained through garbage bags, 43 during IV line administration,
needle disposal, 16 while using surgical blade, 7 during suturing and 34 from
miscellaneous sources.
Through the 1990s, between 600,000 and 800,000 needle stick injuries (NSI)
were believed to occur annually - on the order of 2000 every day. As a result, more than
Majority of people question i.e. 73.3% (n=220) were aware about definition of needle
stick injuries and the diseases caused by them, out of the total 13.3% (n=40) and 10%
(n=30) HCW were unaware of the fact that Hepatitis B and hepatitis C can be transmitted
by this route respectively. Only 6% (n=9) HCW were aware about transmission of HIV
by this route. 82.7% (n=248) healthcare workers had vaccination against hepatitis B. 94%
(n=282) subjects had history of needle stick injuries, in 28.7% (n=86) needle was
sterilized, in 38% (n=115) the needle was used while in 27.3% (n=82) needle was blood
healthcare workers (HCWs). Although data from the developed countries have shown the
enormity of the problem, data from developing countries, such as India, are lacking. The
purpose of this study was to cumulate data from four major hospitals in India and analyze
the incidence of SI and blood and body fluid exposure in HCWs. Four Indian hospitals
(hospital A, B, C and D) from major cities of India participated in this multicentric study.
Data ranging from 6 to 26 months were collected from these hospitals using Exposure
Healthcare Worker Safety Research and Resource Center, University of Virginia. Two
hundred and forty-three sharp injuries and 22 incidents of blood or body fluid exposure
were encountered in the cumulated 50 months of our study. The incidence of Sis was the
highest among nurses (55%) of all the HCWs, akin to the global data. An injury rate of
nearly 20% among housekeeping staff seems to be specific to the Indian data. Patient's
study. The source of the injury was identified in majority (64%) of the injuries. A major
part of the group was not the primary users of the sharp (38%). Disposable needles
caused nearly half of the injuries. Suture needles contributed to a reasonable number of
According to previous studies the investigator finds out that there is a still lot to
Operation theatre staffs are among the health care workers who are affected the
most by needle stick injury. Hence the investigator is interested in accessing the
occurrence of needle stick injury in the operation theatre by more than 80%.
known about a particular situation and the knowledge gap that exists between the
problem statement and the research subject problems and lays a foundation for the
research plan.
The literature review was based on an extensive survey of journals, books and
international nursing indicates. A review of research and non research literature relevant
to the study was undertaken which helps to investigation to develop deep insight with the
problem and gain information on what has been done in the past.
A study concerning exposures to blood and bodily fluids in health care workers,
findings revealed that on average 93.7 per 1000 health care employees were exposed
annually. The majority of these exposures were found to occur in nursing personnel, with
35% of total exposures occurring via needle sticks (Goob, Yamada, Newman, &
Cashman, 1999). Gershon and Flanagan (2000) reported that the number of needle stick
injuries in the United States exceeds 500,000 per year, with 1 in 100 involving known
HIV infected needles. This same study identified that the majority of needle sticks
happened in female nurses between the ages of 23 -65. Most of those exposed reported
30% of the workers surveyed were unaware that HIV and Hepatitis C could be
transmitted by needle sticks, and that as many as 70% admitted to having a previous
A seven-year study of the incidence of needle sticks among medical students concluded
that workload and education of safe practice should be taken into consideration (Osborn,
Another study explored how different levels of education and work environment
influenced needle stick exposures in a medical student population, concluding that there
is more risk between the fourth and fifth year of medical training (Deisenhammer, Radon,
& Nowak, 2001). McCarthy and Britton (2000) reported that 27% of the nursing students
they studied experienced exposure to blood borne pathogens through needle sticks. They
suggested that a high risk for non sterile occupational injuries existed because these
One study, focused solely on nursing students, determined that uncapping needles
resulted in the highest incidence of injury. The researchers suggested that additional
emphasis should be placed on reporting injuries (Smith, & Leggat, 2005). Knowledge
deficit regarding reporting practices seemed to be a major reason that students do not
report an injury.
One study found that students did not report needle stick injuries due to lack of
knowledge of how to report the injuries (Cervini &Bell, 2005). In another study, Mendias
and Ross (2001) identified that having a clear policy pertaining to reporting and post-
to blood and body fluid: A multicentric prospective analysis. Four Indian hospitals
(hospital A, B, C and D) from major cities of India participated in this multicentric study.
Data ranging from 6 to 26 months were collected from these hospitals using Exposure
Prevention Information network. Two hundred and forty-three sharp injuries and 22
incidents of blood or body fluid exposure were encountered in the cumulated 50 months
of our study. The incidence of sharp injuries was the highest among nurses (55%) of all
the HCWs, akin to the global data. An injury rate of nearly 20% among housekeeping
staff seems to be specific to the Indian data. Patient's room followed by Operation
Theater appeared to be common locations of injury in our study. The source of the injury
was identified in majority (64%) of the injuries. A major part of the group was not the
primary users of the sharp (38%). Disposable needles caused nearly half of the injuries.
A study conducted among operation theatre room staff on the efficacy of hands-
free technique in reducing sharp injuries. Wright and colleagues reviewed 249 glove tears
and 70 sharp injuries and reported that only 6%of the injuries occurred during passage of
instruments. The study suggested that even if hands-free technique reduced sharp injuries
during instrument passage between scrub nurse and surgeons, this benefit would only
perforation with the use of hands-free technique compared with control during 156
caesarian sections. In contrast with a recent study 3,765 operation reported that when
hands-free techniques was judge by the scrub nurse to have been ≥ 75% of the time
during the operation, there was 59% reduction in the incidence in operation with a blood
loss of ≥ 100ml.
A study to assess the knowledge, attitude and practices amongst health care workers on
needle stick injuries in Departments of Holy Family Hospital, Rawalpindi from October
to December 2007. A 20-item questionnaire was provided to three hundred health care
workers including doctors, nurses and paramedical staff from various to assess
knowledge, attitude and practices regarding needle stick injuries. Results were calculated
on the basis of frequency and percentages using. Results showed 282 subjects (94%) had
(43.3%) were most frequently affected and the commonest place was Emergency room
(42.2%). Hasty work (37.9%) and recapping needles (19.5%) were commonest causes
respectively. Only 49% were in the habit of using gloves for phlebotomy procedures.
21.6% were aware of Universal Precaution Guidelines. 16.7% were aware about their
immune status after being pricked while 82.7% were vaccinated against hepatitis B.
injury.
2. To assess the effectiveness of structured teaching program regarding prevention of
3. To find out the association between knowledge of operation theatre staff regarding
6.5 HYPOTHESIS
H1: There will be significant increase in knowledge level regarding prevention of needle
stick injury after structured teaching program among operation theatre staffs.
H2: There will be significant the association between knowledge of operation theatre
2) Operation theatre staffs: Refers to nursing staff working in operation theatre selected
hospitals in Bangalore.
3) Needle stick injury: Refers to injury which occurs during the work process from
sharp instruments.
6.7 ASSUMPTIONS
1. The knowledge gain by the operation theatre staffs after the planned teaching program
will be retained and utilized for the prevention of needle stick injury.
2. Acquisition of knowledge regarding prevention of needle stick injury will enable the
demographic variables.
6.8 DELIMITATION
6.9. VARIABLES
6.9.2 Demographic variables: of this study are Age, Sex, Religion, previous exposure
to teaching on needle stick injury and Source of information on needle stick injury.
Data will be collected from operation theatre staffs of selected hospitals in Bangalore.
Research design adopted for the present study quasi experimental research design.
7.1.4. POPULATION
Structured questionnaire
The data will be collected with the prescribed period from selected hospitals in
Bangalore.
stick injury
Chi square test will be used to find out association between selected variables.
Yes
secondary care hospital in Saudi Arabia. Ann Saudi Med 2005; 25:233-8.
injuries among nurses in a Japanese teaching hospital. J Hosp Infect 2006; 64(1):
44-49.
9. Alam M. Knowledge, attitude and practices among health care workers on needle
11. Needle sticks injuries. Diseases, disorders and injuries [cited January 15, 2008];
Available from:
http://www.ccohs.ca/oshanswers/diseases/needlestick_injuries.html.
13. Calver J. Occupational Health Services. Am J Infect Control. 1997; 25: 363-365.
10 Remarks of the guide The topic selected for the study is relevant
12.2 Signature
13 13.1 Remarks of the Chairman or Relevant
Principal
13.2 Signature