Epidemiology of needlestick and sharps injuries in a tertiary care center in Saudi Arabia

Prevalence and Characteristics of Needle Stick and Sharp Injuries Among King Salman Armed Forces Hospital Personnel in Tabuk City: A Retrospective Hospital-Based Study

BACKGROUND

This study aimed to determine the prevalence and associated characteristics of needle stick and sharp injuries (NSSIs) among King Salman Armed Forces Hospital (KSAFH) personnel.

METHODS

Data was collected by reviewing all reported NSSIs among KSAFH personnel between January 2020 to December 2022.

RESULTS

The prevalence of NSSIs was 2.05%, with nurses being the most commonly affected. Most injuries occurred in patients' rooms/wards and among health care workers (HCWs) aged < 40 years. Of the injured workers, 93.8% were immunized against hepatitis B virus (HBV).

CONCLUSION

Educational and training programs targeting high-risk age groups and professions should be developed. Policies related to locations and situations where injuries occur frequently should be reviewed regularly to reduce the risk of NSSIs.

Needlestick and sharps injuries among secondary and tertiary healthcare workers, Saudi Arabia

Aim

The study aimed to assess the incidence of needlestick and sharps injuries among healthcare workers (HCWs) in the Jazan region of Saudi Arabia, as well as to determine whether there exists an association between hospital level and needlestick and sharps injuries rate.

Design

A cross‐sectional survey was conducted among 609 randomly selected HCWs from nine general hospitals.

Methods

A self‐administered questionnaire, which covered the structure and process of injection safety, was used for data collection.

Results

The overall needlestick and sharps injuries incidence rate was 24%. The needlestick and sharps injuries rates were 30% and 14% in secondary and tertiary hospitals, respectively. HCWs working in tertiary hospitals were 61% less likely to have needlestick and sharps injuries than those employed in secondary hospitals. This was mainly the impact of better and continuous training. High safety level maintenance and health education provision are vital in such settings.

A quasi-experimental trial of the clinical and economic impact of implementing of hepatitis B immunoglobulin policy post needle stick and sharp injuries in reducing its unnecessary use at a tertiary care hospital

INTRODUCTION

Hepatitis B virus infection has the highest rate of transmission out of the blood-borne viruses in health care workers. Exposure to HBsAg positive source should be managed based on Hepatitis B serology results. Given that Hepatitis B immunoglobulin (HBIG) is an expensive medication with limited stock levels, it should be given more attention to make sure of its optimum use. This trial aims to evaluate the effectiveness of a policy on the use of HBIG following needle stick and sharp injuries among health care workers.

METHODS

It is a quasi-experimental trial conducted at a Tertiary Care hospital in Saudi Arabia. The participants were health care workers who received HBIG following needle stick and sharp injuries from January 2018 to May 2020. Before and after implementing departmental guidelines and education on the post-exposure procedure, the trial re-evaluated the need for HBIG among the receivers.

RESULTS

A total of 60 health care workers received HBIG for needle stick and sharp injuries between the trial period (pre- and post-implementation). The percentage of patients who received inappropriate HBIG was significantly lower during the post-implementation of the guideline (30%) than that among the pre-implementation period (60%). Thus, the direct cost associated with the inappropriate use was reduced from SAR 30000 to SAR 13500 post-implementation.

CONCLUSION

The implementation of HBIG guidelines of use and education has led to a statistically significant decrease in its inappropriate use and led to cost reduction.

Needlestick injuries among Malaysian healthcare workers

BACKGROUND

Needlestick injury (NSI) is a significant occupational health issue among healthcare workers (HCWs).

AIMS

To determine the national self-reported incidence and risk factors for NSI among Malaysian Ministry of Health (MOH) HCWs.

METHODS

Using data from the MOH national sharps injury surveillance programme, information on reported NSIs over a 1-year period (2016) for different HCW subgroups were extracted and analysed.

RESULTS

A total of 1234 NSI cases were reported in 2016, giving an overall incidence of 6 injuries per 1000 HCWs. Medical doctors recorded the highest incidence (21.1 per 1000 HCWs) followed by dental staff (7.5), pharmacy staff (4.2), nurses (3.7), medical assistants (3.4) and allied and auxiliary staff (1.0). Doctors had significantly increased risk of NSI compared with allied and auxiliary staff (relative risk [RR] = 20.7, 95% confidence interval [CI] 15.5-27.5), medical assistants (RR = 6.1, 95% CI 4.5-8.2), nurses (RR = 5.7, 95% CI 5.0-6.6), pharmacy staff (RR = 5.0, 95% CI 3.7-6.6) and dental staff (RR = 2.8, 95% CI 2.2-3.5). Significant differences were found in age and sharps- handling experience between occupational subgroups (P < 0.001 for both variables). Male employees had higher risk than females (RR = 1.33, 95% CI 1.18-1.50), with a significant difference seen in their sharps-handling experience (P < 0.01). Important risk factors included unsafe practices such as recapping of needles and their improper disposal.

CONCLUSIONS

The national incidence of NSI amongst Malaysian HCWs was lower compared with other countries, but unsafe practices remain an important concern. There is a need to formulate, implement and monitor safe and consistent practices for the different healthcare professionals.

Epidemiology and clinical consequences of occupational exposure to blood and other body fluids in a university hospital in Saudi Arabia

OBJECTIVES

To describe the epidemiological characteristics, clinical impact, and adequacy of post-exposure management of occupational exposure to blood and body fluids (BBFs). 

METHODS

Retrospective chart review of individuals reporting exposure to BBFs from 2007 to 2013 at King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia. 

RESULTS

The total number of exposures reported was 326 exposures, of which 302 (92.6%) exposures were percutaneous, 21 (6.5%), mucocutaneous, and 3 (0.9%), bites. Nursing staff/students had the highest rate of exposure (149, or 45.6%), followed by physicians (57, or 17.5%). Surgeons were found to have a significantly higher risk for sharp injuries compared with other physicians (26.3%, or 15 exposures, p less than 0.005). Most (216, or 72.5%) percutaneous injuries were caused by hollow-bore needles. Majority of exposures (124, or 42.6%) occurred after using the needle/sharp item and before disposal. Two-thirds (219, or 67%) of exposed individuals were immune to hepatitis B at the time of exposure. With appropriate post-exposure management, none of exposed individuals seroconverted to HIV, hepatitis B or C virus infections. 

CONCLUSION

Occupational exposure to BBFs remains a concern among healthcare workers. Educational programs targeting high-risk groups entailing reinforcement of prevention and adherence to post-exposure management guidelines are needed.

Seroprevalence Survey of Varicella, Measles, Rubella, and Hepatitis A and B Viruses in a Multinational Healthcare Workforce in Saudi Arabia

Objective.

To determine the prevalence of the vaccine-preventable diseases caused by varicella, measles, rubella, and hepatitis A and B viruses in a multinational healthcare workforce.

Design.

Prospective cohort study.

Setting.

A 750-bed tertiary care center located in Riyadh, Saudi Arabia.

Methods.

In compliance with hospital policy, newly recruited healthcare workers (HCWs) were enrolled in the study from September 2001 to March 2005. Serum samples were collected from all HCWs during the initial hiring process and tested for IgG antibodies against each of the 5 viral agents. Nonimmune HCWs were subsequently vaccinated at the earliest opportunity.

Results.

A total of 4,006 newly hired (international and local) employees were included in the study. All underwent serologic testing for IgG antibodies against varicella, measles, rubella, hepatitis A, and hepatitis B viruses. Of the total, 63% were female and 37% were male. Middle Eastern employees comprised 47% of the total, followed by employees from the Far East (35%), the West (10%), and Africa (8%). Forty-two percent were nurses, 27% were in administration, 18% were medical technicians, and 13% were physicians. Among the 4,006 newly hired HCWs, 14% had negative IgG antibody test results for varicella virus, 13% for measles virus, 10% for rubella virus, 33% for hepatitis A virus, and 43% for hepatitis B virus. More women than men were susceptible to hepatitis A (40% vs. 24%; P< .001), whereas more men were susceptible to hepatitis B (55% vs. 35%; P< .001). Varicella susceptibility was more common among HCWs from the Far East (19%), whereas susceptibility to measles, rubella, hepatitis A, and hepatitis B was highest among HCWs from the Middle East. Both relative youth and male sex were associated with lack of antibodies against hepatitis B virus and rubella virus. In contrast, female sex and younger age were associated with lack of antibodies against hepatitis A virus (P< .001).

Conclusion.

Seroprevalence surveys of vaccine-preventable diseases among HCWs, although labor intensive, are invaluable in caring for a multinational workforce.

Benchmarking of percutaneous injuries at the Ministry of Health hospitals of Saudi Arabia in comparison with the United States hospitals participating in Exposure Prevention Information Network (EPINet™)

Background:

Exposure to blood-borne pathogens from needle-stick and sharp injuries continues to pose a significant risk to health care workers. These events are of concern because of the risk to transmit blood-borne diseases such as hepatitis B virus, hepatitis C virus, and the human immunodeficiency virus.

Objective:

To benchmark different risk factors associated with needle-stick incidents among health care workers in the Ministry of Health hospitals in the Kingdom of Saudi Arabia compared to the US hospitals participating in Exposure Prevention Information Network (EPINet ™).

Methods:

Prospective surveillance of needle-stick and sharp incidents carried out during the year 2012 using EPINet™ ver 1.5 that provides uniform needle stick and sharp injury report form.

Results:

The annual percutaneous incidents (PIs) rate per 100 occupied beds was 3.2 at the studied MOH hospitals. Nurses were the most affected job category by PIs (59.4%). Most PIs happened in patients' wards in the Ministry of Health hospitals (34.6%). Disposable syringes were the most common cause of PIs (47.20%). Most PIs occurred during use of the syringes (36.4%).

Conclusion:

Among health care workers, nurses and physicians appear especially at risk of exposure to PIs. Important risk factors of injuries include working in patient room, using disposable syringes, devices without safety features. Preventive strategies such as continuous training of health care workers with special emphasis on nurses and physicians, encouragement of reporting of such incidents, observation of sharp handling, their use and implementation of safety devices are warranted.

Risk analysis of needle stick and sharp object injuries among health care workers in a tertiary care hospital (Saudi Arabia)

Objective: To study different risk factors associated with needle stick injury among health care workers of a tertiary care hospital in Saudi Arabia.

Subjects and methodology: Retrospective study involving all reported cases of needle stick and sharp object injury among health care workers through using Epinet™ access U.K. version 1.3 program in King Saud Medical City (KSMC) during the period (January 2007–December 2011).

Results: During the study period, 477 needle stick and sharp object injuries were reported with peak incidence (13.84%) during 2009. Distribution of needle stick and sharp object injuries according to the location of their occurrence clarified that patient room/ward was the most common place of occurrence of NSSIs 150/477, followed by emergency department 82/477, then the intensive and critical care units 70/477. The study presented that nurses were encountered as the most affected job category and use of items is the most common activity associated with the incidents. Most of the incidents were caused by needles with disposable needle and hands were the most affected body parts.

Conclusion: Needle stick and sharp object injuries represent a major occupational challenge to health care workers. Prevention should be based on different working lines including immunization, education of health care workers and proper engineering control measures.

Occupational exposure to blood-borne pathogens in a tertiary hospital: benchmarking using patient days

Incidence and risk factors for occupational exposure to blood-borne pathogens (OEBBPs) in a tertiary hospital in Saudi Arabia was assessed. Reported sharps injuries from 2009 to 2010 were analyzed and benchmarked using patient days. OEBBPs caused by sharps injuries increased from 41 in 2009 to 65 in 2010, with an incidence rate of 4.09/10 000 patient days in 2009 and 5.9/10 000 patient days in 2010. Most episodes (41%) occurred during recapping of hollow bore needles after obtaining blood specimens. The highest incidence was among nursing staff(n/N = 87/106; 82%), and injuries also occurred in housekeeping staff (3.7%). A correlationbetween morning shift and OEBBPs was observed, and the highest number of episodes occurred in the emergency room (21.5%) and renal dialysis unit (16.9%). There was exposure to HCV (n = 13) and HBV (n = 4) but not to HIV (n = 0), and no seroconversions were documented. Education on adherence to universal precaution measures and use of safety engineered devices as well as the introduction of an OEBBP notification hotline are recommended.

Impact of infection control educational activities on rates and frequencies of percutaneous injuries (PIs) at a tertiary care hospital in Saudi Arabia

OBJECTIVE

To study the impact of educational activities on the rates and frequencies of percutaneous injuries (PIs) at a tertiary care hospital in Saudi Arabia.

METHODS

PI surveillance is a routine activity in King Abdulaziz Medical City (a 900-bed teaching tertiary health care hospital) in Riyadh using the Exposure Prevention Information Network (EPINet) data collection tool. From 2001 through 2003, educational activities were conducted for health care workers (HCWs) to prevent PIs. The education included lectures on the risk of unsafe practices that may lead to PIs and how to avoid them. Data from before (1997-2000) and after (2004-2008) the intervention were imported from our surveillance system and statistically analyzed.

RESULTS

The total overall rate of PIs per 1000 HCWs was significantly lower in the post-intervention period than in the pre-intervention period (14 vs. 32.8/1000 HCWs, respectively). The rates of PIs among nurses and housekeepers showed a significant decrease (15 vs. 37.6/1000 HCWs and 10 vs. 34.5/1000 HCWs, respectively). The frequency of PIs in the emergency department (ED) and intensive care units (ICUs) showed a significant decrease (3.4% for both vs. 12.4% and 13.7%, respectively). PIs associated with devices, such as needles on IV lines, IV catheters, lancets and suture needles, showed a significant decrease. PIs occurring during device disassembly and from inappropriately discarded devices also decreased significantly.

CONCLUSION

The educational program reduced some categories of PIs, including the overall rate, the rate among nurses and housekeepers, the frequency in the ED and ICUs and the frequency among needles on IV lines, IV catheters, lancets and suture needles. Other PI categories did not change significantly.

Benchmarking of percutaneous injuries at a teaching tertiary care center in Saudi Arabia relative to United States hospitals participating in the Exposure Prevention Information Network

BACKGROUND

Despite recent improvements in policies, practices, and device design, percutaneous injuries (PIs) from needles and sharp instruments continue to expose health care workers to the risk of bloodborne pathogens.

METHODS

Prospective surveillance was instituted to study the epidemiologic characteristics of PIs at King Abdulaziz Medical City, Riyadh, Saudi Arabia (KAMC-R) from 2004 through 2008 and to benchmark these characteristics relative to those of a network of US hospitals participating in the Exposure Prevention Information Network (EPINet) research group (2004-2007).

RESULTS

The mean PIs rate per 100 daily occupied beds in KAMC-R was significantly lower than that reported by teaching and nonteaching US EPINet hospitals. Similar to US EPINet hospitals, nurses at KAMC-R reported more PIs than physicians. Compared with US EPINet hospitals, nurses at KAMC-R experienced more PIs (52.8% vs 38.1%, respectively), whereas physicians experienced fewer PIs (18.4% vs 28.6%, respectively). The majority of PIs happened in patient wards (50.6%) in KAMC-R and operating rooms (34.1%) in US EPINet hospitals. Suturing, which was involved in only 10% of PIs at KAMC-R, was the most frequent PIs mechanism in US EPINet hospitals (23.3%). In both KAMC-R and US EPINet hospitals, disposable syringes were the most frequent devices involved, the left hand was the most common site of injury, and the source patient was largely identifiable.

CONCLUSION

We have lower rates of PIs at KAMC-R relative to US EPINet hospitals. Whereas it is difficult to fully explain such differences, this could be due to variations in health care systems, underreporting, or the impact of the PIs prevention activities.

Hospital safety climate, psychosocial risk factors and needlestick injuries in Japan

To investigate the interactions between safety climate, psychosocial issues and Needlestick and Sharps Injuries (NSI), a cross-sectional study was undertaken among nurses at a university teaching hospital in Japan (89% response rate). NSI were correlated with various aspects of hospital safety climate including supporting one another at work, the protection of staff against blood-borne diseases being a high management priority, managers doing their part to protect staff from blood-borne disease, having unsafe work practices corrected by supervisors, having the opportunity to use safety equipment to protect against blood-borne disease exposures, having an uncluttered work area, and having minimal conflict within their department. In conclusion, this study has demonstrated the importance of hospital safety climate in Japanese health care practice, particularly its relationship with NSI. Although the provision of safer devices remains critical in preventing injuries, ensuring a positive safety climate will also be essential in meeting these important challenges for nurses' occupational health.

Predictive factors for occupational bloodborne exposure in Turkish hospitals

BACKGROUND

This study was conducted to evaluate the epidemiology of percutaneous injury and/or mucosa exposure (PME) with blood or other body fluids that poses serious risks for health care workers (HCWs).

METHODS

An analytic, cross-sectional, countrywide survey study was conducted to describe the extent of and predictive factors for PME among HCWs in hospital settings in Turkey, with total of 5258 HCW participants from 30 hospitals in 19 cities throughout the country.

RESULTS

The respondent group included 41.3% nurses, 29.0% doctors, 9.3% laboratory workers, and 20.3% paramedics. The survey found that 50.1% of the participants reported at least 1 occupational PME in the previous year. Doctors (2.57/person/year) and nurses (2.56/person/year) had the highest PME incidents. In the multivariate analysis, working at a surgical site (P = .000), being a doctor (P = .000), being a nurse (P=.000), young age (P = .025), and living in a poor region (P = .005) were significant factors for high occupational exposure. The presence of a health office for HCWs at the hospital (P = .000) and working at a university hospital (P = .003) were significant predictors of less occupational exposure. Overall, the mean number of PME incidents was 2.16/person/year.

CONCLUSION

Along with the other well-known predictive factors, regional economic status and a health office for HCWs are preventive factors for PME exposure of HCWs.

Occupational exposure to blood and body fluids among health care workers in a teaching hospital in mumbai, India

OBJECTIVE

Exposure to blood and body fluids is one of the hidden hazards faced by health care workers (HCWs). The objective of the present study was to estimate the incidence of such exposure in a teaching hospital.

MATERIALS AND METHODS

A cross-sectional study among a random sample of residents, interns, nurses and technicians (n = 830) was carried out in a teaching hospital to estimate the incidence of exposure to blood and body fluids in the preceding 12-month period. Self-reported occurrence and the circumstances of the same were recorded by face-to-face interviews using a semi-structured questionnaire.

RESULTS

The response rate to the study was 89.76%. Occupational exposure to blood and body fluids in the preceding 12 months was reported by 32.75% of the respondents. The self-reported incidence was the highest among the nurses. Needle-stick injury was the most common mode of such exposures (92.21% of total exposures). Index finger and thumb were the commonest sites of exposure. Only 50% of the affected individuals reported the occurrence to concerned hospital authorities. Less than a quarter of the exposed persons underwent post-exposure prophylaxis (PEP) against HIV, although the same was indicated in about 50% of the affected HCWs based on the HIV status of the source patient.

CONCLUSIONS

Occupational exposure to blood and body fluids was a common occurrence in the study sample. There was gross under-reporting of such incidents leading to a lack of proper PEP against HIV in 50% of those in whom the same appeared to be indicated.

Epidemiology of needlestick and sharps injuries among professional Korean nurses

Although needlestick and sharps injuries (NSI) are known to affect professional nurses at high rates, most studies depend on officially reported data and few have been undertaken in Korea. Thus, we surveyed a large cross-section of nurses from a hospital in Gangneung (response rate, 97.9%). Four hundred thirty-two incidents of NSI were reported by 263 nurses (79.7%) in the previous 12-month period (average, 1.31 events/nurse/year). Syringe needles were the most common devices, affecting 67.3% and comprising 52% of all NSI events. Sixty percent of all NSI events involved contaminated devices. Opening an ampoule or vial was the most common cause (affecting 35.2% of all nurses and accounting for 15.9% of all NSI events). Logistic regression indicated that nurses working in "other" departments were 5.4 times more likely to suffer any NSI (odds ratio [OR] = 5.4; 95% confidence interval [95% CI] = 2.0-15.2; P < .05) and 4.7 times more likely to incur a syringe-needle injury than nurses in intensive care units or inpatient departments (OR = 4.7; 95% CI = 2.0-11.6; P < .05). Younger-than-average nurses (< 27 years) were 4.5 times more likely to suffer NSI (OR = 4.5; 95% CI = 1.7-12.6; P < .05) and 3.1 times more likely to incur a syringe-needle injury (OR = 3.1; 95% CI = 1.4-7.0; P < .05). Working mixed shifts also increased the risk of any NSI (OR = 4.0; 95% CI = 1.7-10.4; P < .05) or syringe-needle NSI (OR = 4.4; 95% CI = 2.0-10.1; P < .05). Overall, our study suggests that NSI are common among Korean hospital nurses and represent a significant occupational burden for this large Asian demographic. Intervention and preventive strategies to help reduce their NSI exposures are urgently required in this country.

Mental health of healthcare workers who experience needlestick and sharps injuries

Healthcare workers (HCWs) are exposed daily to the risk of injury by needlesticks and other medical instruments. However, the psychiatric impacts of such injuries have not been evaluated. The aim of this study was to evaluate the mental health status of HCWs with experiences of needlestick and sharps injuries. A cross-sectional written survey was performed. The psychological symptoms before injury and current status were measured using the Beck Depression Inventory (BDI), Hamilton Anxiety Scale (HAM-A) and Perceived Stress Scale (PSS). The proportions of HCWs with and without needlestick and sharps injuries were 71.1% (n=263) and 28.9% (n=107), respectively. HAM-A and BDI scores were significantly higher among HCWs with injury experiences (p<0.01). HCWs with injury experiences exhibited higher PSS and BDI scores after the injury and higher levels of anxiety and depression. Particular attention should be directed towards the psychological consequences of needlestick and sharps injuries in HCWs.

Seroprevalence survey of varicella, measles, rubella, and hepatitis A and B viruses in a multinational healthcare workforce in Saudi Arabia

OBJECTIVE

To determine the prevalence of the vaccine-preventable diseases caused by varicella, measles, rubella, and hepatitis A and B viruses in a multinational healthcare workforce.

DESIGN

Prospective cohort study.

SETTING

A 750-bed tertiary care center located in Riyadh, Saudi Arabia.

METHODS

In compliance with hospital policy, newly recruited healthcare workers (HCWs) were enrolled in the study from September 2001 to March 2005. Serum samples were collected from all HCWs during the initial hiring process and tested for IgG antibodies against each of the 5 viral agents. Nonimmune HCWs were subsequently vaccinated at the earliest opportunity.

RESULTS

A total of 4,006 newly hired (international and local) employees were included in the study. All underwent serologic testing for IgG antibodies against varicella, measles, rubella, hepatitis A, and hepatitis B viruses. Of the total, 63% were female and 37% were male. Middle Eastern employees comprised 47% of the total, followed by employees from the Far East (35%), the West (10%), and Africa (8%). Forty-two percent were nurses, 27% were in administration, 18% were medical technicians, and 13% were physicians. Among the 4,006 newly hired HCWs, 14% had negative IgG antibody test results for varicella virus, 13% for measles virus, 10% for rubella virus, 33% for hepatitis A virus, and 43% for hepatitis B virus. More women than men were susceptible to hepatitis A (40% vs. 24%; P<.001), whereas more men were susceptible to hepatitis B (55% vs. 35%; P<.001). Varicella susceptibility was more common among HCWs from the Far East (19%), whereas susceptibility to measles, rubella, hepatitis A, and hepatitis B was highest among HCWs from the Middle East. Both relative youth and male sex were associated with lack of antibodies against hepatitis B virus and rubella virus. In contrast, female sex and younger age were associated with lack of antibodies against hepatitis A virus (P<.001).

CONCLUSION

Seroprevalence surveys of vaccine-preventable diseases among HCWs, although labor intensive, are invaluable in caring for a multinational workforce.

Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital

The epidemiology of needlestick and sharps injuries (NSIs) was investigated among a complete cross-section of 1,162 nurses from a large hospital in southern Japan (response rate 74.0%). Forty-six percent had experienced an NSI in the previous year. Most were caused by ampoules or vials, which injured 32.3% of all nurses and accounted for 42.9% of all NSI events. Twenty-two percent of all NSIs involved a device that had been used on a patient prior to the NSI (contaminated device), while the usage status of a further 2.8% of devices was unknown. Logistic regression indicated that nurses younger than 25 years of age were 2.18 times more likely to have sustained a single NSI in the past 12 months [odds ratio (OR) 2.18, 95% confidence intervals (CI) 1.15-4.17] and 2.39 times more likely to have sustained multiple NSIs (OR 2.39, 95% CI 1.08-5.34). Working mixed shifts (rotating day and night, as opposed to day shifts alone) was associated with a 1.67-fold increased risk of sustaining any NSI (OR 1.67, 95% CI 1.01-2.85) and a 2.72 times greater risk of sustaining an NSI from a contaminated device (OR 2.72, 95% CI 1.71-4.44). Nurses who reported significant fatigue after work were 1.87 times more likely to sustain multiple NSIs (OR 1.87, 95% CI 1.13-3.13) and 1.94 times more likely not to report their NSIs (OR 1.94, 95% CI 1.03-3.71). Perceived high mental pressure was associated with a 1.75-fold increased risk of sustaining an NSI from a contaminated device (OR 1.75, 95% CI 1.07-2.88). Nurses who reported suboptimal staffing levels in their wards were 2.21 times more likely not to report any NSIs they sustained in the previous year (OR 2.21, 95% CI 1.06-4.89). Overall, this study suggests that NSIs represent a complex and multi-faceted problem for Japanese nurses. Intervention strategies should consider the emerging complicity of psychosocial factors on NSI among hospital staff in Japan, as elsewhere.

Hospital- and community-acquired infections: a point prevalence and risk factors survey in a tertiary care center in Saudi Arabia

BACKGROUND

Point prevalence studies are useful in revealing the prevalence of hospital-acquired infections (HAIs) and community-acquired infections (CAIs). Such information allows prioritization of infection control resources and aids in overall hospital expenditure cut-backs.

METHODS

A one-day point prevalence survey was conducted on May 19, 2003 at the King Fahad National Guard Hospital in Riyadh. Since the survey included HAIs and CAIs all patients were included. Data were collected on the underlying diagnosis, infection if present and whether it was hospital-acquired or community-acquired. We identified the presence of a line-associated blood stream infection (BSI), ventilator-associated pneumonia (VAP), catheter-associated urinary tract infection (UTI) or a surgical site infection (SSI) based on the United States National Nosocomial Infection Surveillance (NNIS) definitions.

RESULTS

Five hundred and sixty-two inpatients were included in the survey. There were 38 patients with 45 (8.0%) HAIs and 76 (13.5%) patients with a CAI. Of the HAIs, 31.1% had a line-related BSI, while 28.9% and 24.4% had a VAP and catheter-related UTI, respectively. Most of the HAIs took place in the intensive care units (ICU) (21 (46.7%)), followed by the medical and surgical wards with six (13.3%) cases in each ward. For all HAIs there was a 12.7-fold increased risk with a hospital stay exceeding eight days (OR: 12.7, CI 3.2-50.6). Most of the 76 CAIs were admitted to the medical ward with community-acquired pneumonia (34.9%) as the most common diagnosis. Among the 89 pathogens isolated, Pseudomonas aeruginosa was the most common (21.3%) followed by Enterococcus spp (16.9%).

CONCLUSIONS

The overall rate of HAIs in our hospital was 8%, with significant risk factors including a hospital stay exceeding eight days. A device-related infection was more likely in a patient with a venous or bladder catheter in place for more than eight days, or a patient mechanically ventilated for more than eight days. Catheter-related UTIs were identified as an important source of infection, requiring ongoing surveillance.

Needlestick and sharps injuries among a cross-section of physicians in Mainland China

BACKGROUND

Although needlestick and sharps injuries (NSI) represent a significant occupational hazard for physicians worldwide, their epidemiology has not been previously examined in Mainland China. This study describes the prevalence, distribution, and risk factors for NSI among a cross-section of Chinese physicians.

METHODS

Data was obtained by an anonymous, self-reporting survey administered to all 361 physicians at a university teaching hospital, during 2004.

RESULTS

Seventy-nine percent of the physicians responded. Among them, 64% had experienced an NSI in the previous 12 months, 50.3% of which involved contaminated devices. By device, 22.8% were caused by hollow-bore syringe needles, 19.1% by suture needles, and 12.1% by scalpel blades. Surgical procedures accounted for 27.9% of all injuries. Only 15.3% of physicians had officially reported their NSI to management, of which 10% went unreported because the individual felt they were not unlucky enough to get a disease. A statistically significant correlation was demonstrated between NSI and working in the intensive care unit (adjusted odds ratio: 5.3, 95% CI: 1.7-23.4).

CONCLUSIONS

Although this study suggests that NSI are an important workplace hazard for Chinese physicians, future measures should consider the unique cultural beliefs of Chinese people and its effect on preventive behaviors. The concept of "luck," and its relationship with NSI reporting in particular, may also need to be addressed.

Needle stick injuries among nurses in sub-Saharan Africa

OBJECTIVES

Despite a heavy burden of HIV/AIDS and other blood borne infections, few studies have investigated needle stick injuries in sub-Saharan Africa. We conducted a cross-sectional study at Mulago national referral hospital in Kampala, Uganda, to assess the occurrence and risk factors of needle stick injuries among nurses and midwives.

METHODS

A total of 526 nurses and midwives involved in the direct day-to-day management of patients answered a questionnaire inquiring about occurrence of needle stick injuries and about potential predictors, including work experience, work load, working habits, training, and risk behaviour.

RESULTS

A 57% of the nurses and midwives had experienced at least one needle stick injury in the last year. Only 18% had not experienced any such injury in their entire career. The rate of needle stick injuries was 4.2 per person-year. Multiple logistic regression analysis showed that the most important risk factor for needle stick injuries was lack of training on such injuries (OR 5.72, 95% CI 3.41-9.62). Other important risk factors included working for more than 40 h/week (OR 1.90, 95% CI 1.20-3.31), recapping needles most of the time (OR 1.78, 95% CI 1.11-2.86), and not using gloves when handling needles (OR 1.91, 95% CI 1.10-3.32).

CONCLUSIONS

The study showed a high rate of needle stick injuries among nurses and midwives working in Uganda. The strongest predictor for needle stick injuries was lack of training. Other important risk factors were related to long working hours, working habits, and experience.

Epidemiology of needlestick injuries among health care workers in a secondary care hospital in Saudi Arabia

BACKGROUND

Accidental needlestick injuries sustained by health care workers are a common occupational hazard in health care settings. The aim of this study was to review the epidemiology of needlestick injuries in Buraidah Central Hospital, a 212-bed secondary care hospital in Buraidah, Saudi Arabia.

METHODS

We conducted a retrospective survey of all self-reported documents related to needlestick injuries, for the period January 2002 through December 2003. The data was analyzed to determine the age, sex and job category of the health care worker suffering the injury as well as the risk factors responsible for needlestick injuries.

RESULTS

During the 2-year period, employees reported 73 injuries from needles and other sharp objects. Nurses were involved in 66% of instances, physicians in 19%, technicians in 10%, and nonclinical support staff in 5.5%. The majority (53.4%) of the injuries occurred after use and before disposal of the objects. Syringe needles were responsible for 63% of all injuries. Most injuries occurred during recapping of used needles (29%), during surgery (19%), and by collision with sharps (14%). Disposal-related (11%) causes as well as injuries by concealed sharps (5%) occurred while handling linens or trash containing improperly disposed needles.

CONCLUSION

This data emphasizes the importance of increased awareness, training and education of health care workers for reporting and prevention of needlestick injuries.

Infection control in Saudi Arabia: meeting the challenge

Hospital-acquired infection poses significant clinical and economic burden worldwide. In the Kingdom of Saudi Arabia, infection control is a young, rapidly growing specialty. An infrastructure to expedite the growth of this important discipline is fast being established. The kingdom faces unique challenges when addressing infection control, which are the subject of this review. Much of the policy-making in domestic infection control is driven by the preventive medicine concerns of the annual pilgrimage (Hajj) to Mecca, which are unparalleled. The Saudi Ministry of Health acts to contain and control public health risks at this gathering of 2 million. Infectious hazards at the Hajj include meningococcal meningitis, respiratory tract infections, bloodborne diseases, and zoonotic diseases, all of which have international ramifications as pilgrimaging Muslims return home. In the wake of the extraordinary pace of modernization in Saudi Arabia, deficiencies in infection control remain, which are slowly being redressed. This review examines the anatomy of infection control and its evolution in the kingdom. Future goals and infection control policy-making are given particular emphasis. Saudi Arabia seeks increasing international partnership in the area of infection control and preventive medicine. The Saudi health care system was formed on the basis of Western models to resounding success. Saudi Arabia is now in a position to provide experience and knowledge in return. International dialogue in the infection control arena is of mutual value. Important public health progress is afoot in this young kingdom, and these advances translate both regionally and on the international platform.