The effective needle stick injury prevention strategies for nursing students in the clinical settings: a literature review

Current challenges in teaching healthcare-associated infections prevention and control in nursing education in Vietnam and Cambodia: a qualitative study

Background: There is an insufficient understanding of factors that impede nursing students' learning of healthcare-associated infection prevention and control in developing countries. This study aimed to explore current challenges in healthcare-associated infection control and prevention education in the nursing curriculum in two Vietnamese and two Cambodian universities. Methods: Exploratory research was conducted through consultation of education programs and a qualitative study design utilizing interviews and focus group discussions. Data collection was conducted through interviews with university board members and focus group discussions with lecturers and tutors. The data were analyzed by using content analysis methods. Results: The research results indicated that there were three generic themes of challenges in teaching HAIs-PC in nursing education in Vietnam and Cambodia. They were Implementation of healthcare associated infections prevention and control education into nursing curriculum, Positive aspects fostering healthcare associated infections prevention and control learning, Negative aspects hindering healthcare associated infections prevention and control learning. Conclusions: The study results provided evidence of challenges in healthcare associated infections prevention and control education in some Asia higher education institutions. To improve professional safety, universities should pay more attention to developing appropriate teaching methods for healthcare-associated infections prevention and control education to improve students' practice outcomes.

Predictors of hospital nursing staff's adherence to safe injection guidelines: application of the protection motivation theory in Fars province, Iran

BACKGROUND

Needle stick injuries (NSI) can lead to dangerous infectious diseases for health care workers. This study aimed to determine the predictors of observance of safe injection guidelines in hospital nursing staff, based on protection motivation theory.

METHODS

This cross-sectional study was conducted on the nursing staff of five randomly selected teaching and general hospitals of Shiraz University of Medical Sciences, Fars province, Iran, in 2021. Data were collected using a researcher-made questionnaire which was developed based on protection motivation theory. Data were processed and analyzed using SPSS 22 and Amos 24 at a significance level of  < 0.05. Pearson's correlation coefficient, Multiple linear regression, and Structural Equation Modeling were used.

RESULTS

The mean age of the participants (No = 280) was 32.5 ± 8.09 years. Most of the participants [80%] had encountered NSI, patients' blood, or body fluids at least once. Protection motivation was the only predictor of protective behaviors (β = 0.573), while perceived efficacy (β = 0.142) and perceived rewards (β = -0.229) were the strongest predictors of motivation. The structural equation modeling analysis showed that standardized total effects of protection motivation, perceived response costs, rewards, and efficacy on the protective behaviors were 0.573, -0.159, -.104, and 0.81, respectively. While standardized total effects of perceived rewards, efficacy, and response cost on protection motivation were -0.229, 0.142, and -0.033, respectively. The model fit indices indicated the acceptable final model fit.

CONCLUSION

The results suggest that perceived efficacy, perceived effectiveness, and perceived rewards were the most important predictors of adherence to Safe Injection Guidelines in nursing staff.

Determination and prioritization of factors affecting the occurrence of needle stick injuries among healthcare workers using techniques of Delphi and fuzzy analytical hierarchy process (FAHP)

INTRODUCTION

Needlestick injuries (NSIs) are a major hazard in the workplace for healthcare workers. To prevent these injuries, it is essential to determine the important factors affecting the occurrence of them. This study aimed to identify, classify and prioritize these factors using techniques of Delphi and fuzzy analytical hierarchy process (FAHP).

METHODS

This descriptive-analytical study was conducted in 2022. Firstly, the factors affecting the occurrence of needlestick injuries were identified by the literature review. Moreover, the Delphi technique was used to identify the factors. 20 experts (physicians, nurses, and occupational health experts) participated in the steps of the Delphi method. Then, these factors were grouped into six groups. In the next step, the fuzzy analytical hierarchy process (FAHP) was applied to prioritize the factors. For this purpose, the pairwise comparison questionnaire was designed and filled out by 20 experts. Finally, data were analyzed using MATLAB software (version 2018a).

RESULTS

42 factors (31 factors extracted from the literature review and 11 factors obtained from the Delphi technique) were identified in this study. These factors were categorized into six groups. Based on the results, the relative weight of non-demographic personal factors, tool and technology factors, job factors, organizational factors, demographic personal factors, and environmental factors were computed by 0.200, 0.185, 0.184, 0.157, 0.142, and 0.133, respectively.

CONCLUSION

These results determined the importance of the factors affecting the occurrence of needlestick injuries. These findings can be useful for planning preventive measures.

Prevalence of needle stick and its related factors in Iranian health worker: an updated systematic review and meta-analysis

Background

Healthcare workers (HCWs) are at risk of acquiring blood-borne infections such as hepatitis B, hepatitis C, and human immunodeficiency virus through needlestick injuries (NSIs). We aimed to investigate the prevalence of needlestick injuries and other related indicators among HCWs in Iran through a systematic review and meta-analysis.

Methods

We searched various databases until the end of May 2023 for studies reporting the prevalence of NSIs among healthcare workers in Iran. We used a random model with 95% confidence intervals (CIs) to analyse the data and the Joanna Briggs Institute (JBI) tool to evaluate the quality of included studies. We conducted and reported the study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

Results

We included 87 studies in the analysis and found that 47% (95% CI = 42-52, I2 = 98.9%) of Iranian HCWs experienced NSI. NSIs were most frequently related to syringe needles (58%; 95% CI = 52-65, I2 = 96.8%) and most often caused by recapping (30%; 95% CI = 22-38, I2 = 98.5%). In this study, 56% (95% CI = 45-67, I2 = 98.6%) of HCWs with NSIs did not report their injury. Moreover, the prevalence of NSIs the highest in the morning shift (0.44; 95% CI = 0.36-0.53, I2 = 97.2%), emergency unit (0.20; 95% CI = 0.16-0.24, I2 = 93.7%), and intensive care unit (0.20; 95% CI = 0.16-0.24, I2 = 94.3%).

Conclusions

To reduce the high prevalence of NSIs, HCWs, especially those in emergency departments, should use safety equipment. Healthcare managers should provide a calm and stress-free environment for HCWs, educate them on safety principles and standards, and support experienced HCWs with NSIs.

Incidence, knowledge, attitude and practice toward needle stick injury among nursing students in Saudi Arabia

Background

Needle stick injuries constitute the greatest threat to nursing students during clinical practice because of accidental exposure to body fluids and infected blood. The purpose of this study was to (1) determine the prevalence of needle stick injuries and (2) measure the level of knowledge, attitude and practice among nursing students about needle stick injuries.

Methods

Three hundred participants undergraduate nursing students at a private college in Saudi Arabia were included, of whom 281 participated, for an effective response rate of 82%.

Results

The participants showed good knowledge scores with a mean score of 6.4 (SD = 1.4), and results showed that students had positive attitudes (Mean = 27.1, SD = 4.12). Students reported a low level of needle stick practice (Mean = 14.1, SD = 2.0). The total prevalence of needle stick injuries in the sample was 14.1%. The majority, 65.1%, reported one incidence in the last year, while (24.4%) 15 students reported two incident of needle stick injuries. Recapping was the most prevalent (74.1%), followed by during injection (22.3%). Most students did not write a report (77.4%), and being worried and afraid were the main reasons for non-reports (91.2%). The results showed that female students and seniors scored higher level in all needle stick injuries domains (knowledge, attitude and practice) than male students and juniors. Students who had needle stick injuries more than three times last year reported a lower level of all needle stick injury domains than other groups (Mean = 1.5, SD =1.1; Mean = 19.5, SD =1.1; Mean = 9.5, SD =1.1, respectively).

Conclusion

Although the student's showed good knowledge and positive attitudes in NSI, the students reported a low level of needle stick practice. Raising awareness among nursing students and conducting continuing education related to sharp devices and safety and how to write an incident reporting is highly recommended.

Experiences of Nursing Instructors Related to Safety Issues Using Students as Practice Models in Laboratories: A Focus Group Study

AIM

Nursing school students perform invasive (i.e., injection, venipuncture) and/or non-invasive procedures (i.e., giving a bed bath and back massage) on each other to master these skills, and nursing instructors reported related safety issues. This study aimed to explore nursing instructors' experiences concerning their students' psychological and physical safety when using students as practice models in nursing skills laboratories.

METHODS

A qualitative design using focus group interviews and thematic analysis was employed. Two semi-structured focus group interviews were conducted with a purposive sample of eight instructors with experience in teaching nursing skills in laboratories. This study was evaluated by the Institutional Review Board at Eulji University (EU18-51) in the Republic of Korea.

RESULTS

Three main themes emerged to describe nursing instructors' safety-related experiences when using students as practice models in nursing skills laboratories: (1) a dilemma between the experimental learning of students and the need to keep students safe, (2) perception related to psychological safety, and (3) an inadequate safety reporting system.

CONCLUSIONS

When instructors consider using students' bodies to practice nursing skills, they experience a dilemma between the students' experimental learning and the need to keep them safe. Thus, methods to maximize student learning and student safety guidelines should be developed.

The psychological impact of sharps injuries sustained by medical students

Much is known and reported about sharps injuries among healthcare workers, but there has been a lack of published evidence regarding the psychological impact of sharps injuries among medical students. The purpose of this narrative review was to discover the psychological impact of sharps injuries within the medical student population. Medical, health and psychology databases were searched for studies written in the English language and published between 1980 and 2021. The review identified six studies conducted in six countries which described the psychological impacts of sharps injuries among medical students as being fear, anxiety, depression and post-traumatic stress disorder. The findings highlight the potential psychological issues created by sharps injuries, and highlights that further research is needed into this topic to aid the education and prevention of this harmful problem.

The Awareness and Empowerment Aspects of the Needlesticks and Other Sharps Injuries and Reporting in Nursing Education: A Cross-Sectional Survey

BACKGROUND

Occurrence and underreporting of needlesticks and other sharps injuries (NSIs) are still immediate concerns among nursing students. This study examined the relationship between occupational health and safety (OHS) awareness and empowerment levels of nursing students and the occurrence and reporting of NSIs.

METHODS

This cross-sectional study was conducted among purposively selected 840 students in a nursing school in 2018-2019. A self-report questionnaire was used to collect data about students' sociodemographic characteristics, OHS awareness and empowerment levels, and NSIs characteristics. After bivariate analyses, multivariate logistic regression was used.

RESULTS

The number of evaluated questionnaires was 469, for a response rate of 55.8%. Participants, 21.2% (n = 99), had suffered NSIs, and 47.8% had reported their injuries. The NSIs were statistically related to age, academic year, working night shift, OHS awareness level of students, and the number of clinical placements completed by students. The odds of experiencing NSIs was 2.3 (95% confidence interval [CI] = [1.0, 5.3]) times higher in male students, 4.3 (95% CI = [2.4, 7.4]) times higher in those beyond the second academic year, and 2.5 (95% CI = [1.4, 4.4]) times higher in those who had received OHS training for a shorter period than the average duration.

CONCLUSION/APPLICATION TO PRACTICE

The levels of awareness and empowerment were higher in students who received OHS and NSIs prevention training and those who received OHS training for the above-average duration. Increasing awareness and empowerment levels of nursing students through training can reduce the occurrence and the underreporting of NSIs.

Prevalence, student nurses' knowledge and practices of needle stick injuries during clinical training: a cross-sectional survey

BACKGROUND

The incidence of needle stick injuries is higher among nurses with a low level of knowledge on the prevention of needle stick injury, and who have not received the relevant training during their undergraduate study. The aim of this study was to determine the level of knowledge of the prevention guidelines and the prevalence of needle stick injury among students in Oman.

METHODS

An online cross-sectional survey using a questionnaire and involving 167 students from a governmental university was conducted. The questionnaire consists of 30 questions; eight general questions, knowledge related questions, and questions about risk factors, prevention measures, and actions in a case of needle stick injury. Ethical approval was obtained and the link to the survey was shared with students using their university email portal.

RESULTS

Of the participants, 81.2% were females; mean age was 23.3 (SD = 4.5) years. The mean total knowledge score was 6.6 out of 10 (SD = 2.1). In addition, 18.2% (n = 32) of the students experienced needle stick injury. Most of the injuries 71.9% (n = 24) occurred during medication preparation and administration. The main cause of NSI as reported by students was recapping the needles (59%, n = 19).

CONCLUSIONS

This study demonstrates that student nurses have a moderate level of knowledge about needle stick injury prevention measures and lack many facets of safe infection control practice. These findings require the collaborative effort of nursing administrators from both academic and clinical areas, to develop effective strategies to reduce or eliminate the occurrence of needle stick injury.

Factors Associated with Nursing Students’ Intention to Report Needlestick Injuries: Applying the Theory of Planned Behavior

Background: Nursing students, like other healthcare workers, are prone to needlestick injuries. Over the years, studies have been conducted regarding needlestick injuries. However, its prevalence among Filipino nursing students’ is still not known. Also, nursing students’ intention to report needlestick injuries in the Philippines has not been explored.Purpose: The purpose of this research was to determine the factors associated with the intention to report needlestick injuries among nursing students applying the Theory of Planned Behavior.Methods: This cross-sectional study used the Needlestick Injuries Reporting Intention Scale (NIRIS) and was distributed among 233 senior nursing students in Iloilo City, Philippines. Descriptive statistics and Pearson’s correlation were utilized to analyze the data.Results: The results of the study revealed that 15% of nursing students had experienced a needlestick injury. However, only less than half (45.71%) of those who sustained needlestick injury reported the incident. Nursing students exhibited a positive attitude (M=5.41; SD=0.63) toward reporting needlestick injuries. They perceived a high social pressure (M=4.65; SD=0.46), high behavioral control (M=4.19; SD=0.45), and high intention (M=8.99; SD=1.15) in reporting needlestick injuries. Attitude (p=0.000), subjective norm (p=0.000), and perceived behavioral control (p=0.000) were significantly correlated with the intention to report needlestick injuries.Conclusion: This study supports the Theory of Planned Behavior in identifying factors influencing nursing students’ intention to report needlestick injuries.

Needlestick and sharps injuries in an Indonesian tertiary teaching hospital from 2014 to 2017: a cohort study

OBJECTIVE

Needlestick and sharps injuries among healthcare workers (HCWs) pose significant occupational health problems. We aim to provide incidence and other epidemiological aspects of needlestick and sharp injuries (NSSIs) among HCWs in a tertiary teaching hospital in Indonesia, to inform the evaluation of NSSIs prevention programme.

METHODS

A cohort study was conducted at Cipto Mangunkusumo Hospital in Jakarta. We analysed data of the sharps injury programme at the hospital between January 2014 and December 2017. Incidence of NSSIs was calculated per 1000 person-years (1000-PY).

RESULTS

Over the 4-year period, a total of 286 NSSIs were reported. The mean NSSIs incidence rate for 4 years was 13.3/1000-PY, peaking in 2015 (15.5/1000-PY) then decreasing afterward. Most NSSIs were experienced by nurses (42.7%), but the highest incidence was among midwives (18.9/1000-PY), followed by nurses, medical students and medical doctors (15.2/1000-PY, 12.6/1000-PY and 11.8/1000-PY, respectively). The devices causing the highest proportion of NSSIs were hollow-bore needles (66.8%), followed by suture needles (14.3%) and solid needles (10.8%). 9.4% of NSSIs were related to insulin pen injection. Of all the incidents, 31.3% occurred during surgical procedures, 25.9% during blood collections, 14.3% during administering injection of drugs and 13.3% during waste cleaning.

CONCLUSION

In conclusion, this study showed varied incidences of NSSI among different occupations, with the highest among midwives and nurses. Many unsafe work practices still continue, which is of utmost concern. We suggest opportunities for prevention including training and cultivating safer workplace practices.

Strengths and Weaknesses in the Risk Management of Blood-Borne Infections: Qualitative Research in Public Health

This article presents the research from the first phase of our study on blood-borne risk management, wherein we solicited epidemiologists' and healthcare practitioners' expert opinions on a blood-borne infection risk assessment in Poland. Forty-two experts were recommended by epidemiology consultants and recruited from all districts in Poland. We used the SWOT (Strengths, Weaknesses, Opportunities, Threats) method in the evaluation. Experts' opinions showed that there is room for improvement in the prevention of blood-borne infections. Commonly reported weaknesses in the risk assessment included gaps in knowledge and inappropriate procedures, which are largely caused by financial constraints and practitioners' lack of awareness of developments in their trade. Strengths included legal regulations for medical services and procedures, surveillance, and increasing awareness on the part of medical staff. When paired with the existing statistical data, these results provide a comprehensive view of the problem of blood-borne infections in Poland. The analysis supported the development of a strategy proposal to prevent blood-borne infections and enhance existing risk assessment procedures.

Needlestick injuries: the role of safety-engineered devices in prevention

The first documented mention of a needlestick injury (NSI) in the medical literature appeared in 1906. Despite growth in academic and clinical interest for NSI prevention, a global report identified that approximately 3 million healthcare workers have suffered percutaneous exposure to blood-borne pathogens. Legislation is an important component of NSI prevention. Unfortunately, the impact of legislation may not always reduce the incidence of NSI as much as expected. Safety-engineered device (SED) implementation has demonstrated a substantial reduction in NSI rates compared with non-SEDs. More importantly, passive SEDs are 10 times less likely to be connected with an NSI incident.