Sharps Injuries in Healthcare Settings: Risks, Prevention

A quantitative research proposal on how lack of awareness of needle-stick injuries effects health care professional in secondary care

1 Introduction

Background

Royal College of Nursing (RCN,2013) stated that sharp equipment in the health care setting is referred to as medical sharps these include equipment such as needles and scalpels. (RCN,2013) explains injuries presenting a higher risk would be those where the sharps are contaminated with blood where there is the potential of transmitting infectious agents such as hepatitis B or V and human immunodeficiency virus (HIV). Most sharps injuries can be prevented, and there are legal requirements for employers to take steps to prevent health care staff from being exposed to infectious agents from sharps injuries. (RCN,2013). Moreover, the Health Protection Agency (HPA, 2012) reported data indicated needle stick injuries (NSI) occur during use or after use, before disposal, between steps in procedures and during disposal. Also, while re-sheathing or recapping a needle. However, one of the recent studies such as King &Strony (2020) stated despite the high number of needle sticks that occur in healthcare settings, most healthcare workers do not develop any infection. Even if the skin is punctured or there is a spill in the mucous membranes, most individuals do not acquire any organisms. King &Strony (2020) study showed although there is a concern that healthcare workers are at remarkably high risk of developing disease following a needlestick, but the data do not support this belief. The risk of a healthcare profession for developing any infection depends on the type of needle, the severity of the injury, type of organism in the patient's blood, and prior vaccination status. The study identified one major determining factor whether an infection will develop is the availability of post-exposure prophylaxis (PEP). On the other hand (HPA, 2012) studies have shown some procedures have a higher-than-average risk of causing a sharps injury, these include intra-vascular (IV) cannulation and venipuncture these devices involved in high-risk procedures are: IV cannula, winged steel needles (known as butterfly needles), hypodermic needles and syringes, phlebotomy needles. Lancets, scalpels, suture needles, razors, scissors, test tubes and even fragments of bones or patients’ teeth can all cause sharps injuries.

(RCN, 2013) suggested the risk of infection will depend on several factors. These factors are the depth of the injury, the type of sharp used (hollow bore needles are higher risk although subcutaneous needles also present a risk), whether the device was previously in the patient's vein or artery, how infectious the patient is at the time of the injury. When all these factors are considered, the risk of infection by a contaminated needle can be as high as one in three for hepatitis B, one in 30 for hepatitis C, one in 300 for HIV.

– Statement of the problem: The aim of this study is to examine and find the causes of needle stick injuries and the lack of awareness among healthcare professionals

Why NSI occur?

What are the associated factors with NSI?

What is the training or education provided in dealing with NSI?

What are the measures put in place to prevent such incidents?

– Rationale & significance of study

The rational of this study is to explore and identify the reasons behind lack of awareness of needle stick injury among healthcare professionals and if it associated with the lack of training and education for such incidents. National Health Service Employer (NHS Employer, 2011) reported that in the National Audit Office (NAO) report of April 2003, (A safer place to work ) the report highlighted the need for the better management of needlestick and sharps incidents in the NHS. At least four UK healthcare workers are known to have died following occupationally acquired HIV infection (NHS Employer, 2011), another healthcare worker was known to have been infected. Between 1996 and 2010, the Health Protection Agency received reports of fifteen healthcare workers who had been infected with Hepatitis C virus due to occupational exposure (NHS employer, 2011).

The aim of this study: is to explore the contributary factors for NSI and the factors effecting the management NSI among health care professionals in secondary care.

The objectives of this study: are to identify the aetiology of NSI and to evaluate the understanding of health care professionals of NSI and finally to identify the role of occupational health nurses in managing NSI

-Research questions: How to raise awareness about the risks of needle stick injuries among health care professionals? The PICO of this research questions as follows

P: Health care professionals or health care worker

I: Needle-stick injuries

C: Nil found

O: Raise awareness Research assumptions: limited or no awareness of needle stick injuries among healthcare professionals.

2.1 Introduction

From the literature accessed investigating NSI is a continuing concern within health care setting the aim of this literature review is to study and identify the lack of awareness, knowledge and training among health care professional on NSI is increasingly being recognized as a serious, worldwide public health concern. Newson-Smith et al 2010 stated the World Health Organization (WHO) estimates that 1 in 10 health care workers (HCWs) worldwide sustain a needlestick injury each year. Although risk factors for sharps injuries among HCWs are now well established for highly developed nations, but the picture in developing countries is less clear. (Jacob et al., 2010).

Health care workers who have work-related exposures such as blood and body fluids incidents are at increased risk of acquiring blood-borne infections. The level of risk depends on the number of patients with that infection in the health care facility and the precautions the health care workers observe while dealing these patients. There are more than 20 blood-borne diseases, but those of primary significance to health care workers are hepatitis due to either the hepatitis B virus (HBV) or hepatitis C virus (HCV) and acquired immunodeficiency syndrome (AIDS) due to human immunodeficiency virus (HIV) (Newson-Smith et al., 2010)

For a quantitative research approach Polit & Deck (2010) stated Literature reviews can inspire new research ideas and help to lay the foundation for studies. A literature review is a crucial early task for most quantitative researchers. Polit & Deck (2010) stated literature review in a quantitative study can help to shape research questions, contribute to the argument about the need for a new study, suggest appropriate methods, and point to a conceptual or theoretical framework.

Literature Review

2.3 Findings

In the study after following the inclusion and exclusion criteria, a total of five studies are included all of which followed the quantitative study paradigm. The study following the quantitative paradigm is selected because it allows gathering data from wide number of participants within limited time which enables in greater generalisation of the results (Bloomfield and Fisher, 2019). Moreover, quantitative studies are found to contain accurate and objective information as well as includes few variables to present close-ended and effective information in the study (Bloomfield and Fisher, 2019). Thus, the quantitative articles are chosen so that effective data are presented in the enriched execution of the current research.

All five studies are found to be cross-section study and all the studies gathered data through a survey of selected participants. All the studies used statistical data analysis methods in evaluating and presenting the data in the research. This is evident as Sardesai et al. (2018) used chi-square, Dilie et al. (2017) used regression, bivariate and multivariate analysis, Walle et al. (2013), Suliman et al. (2017) and Ersin et al. (2016) used SPSS for statistical analysis of the collected information. The critique tool to be used for critical analysis of the selected articles is the Quantitative Critical Analysis tool mentioned by the Joanna Briggs Institute (JBI) (jbi.global, 2019). This is because the tool mentions a set of questions to be followed for assessing all aspects of the quantitative studies such as methodology, data collection, data analysis, sampling and others. It helps to systematically determine to the extent they are addressed in the study and if they are responsible for creating any bias in the execution, analysis and design of the quantitative study leads to effective critical analysis of the research articles (jbi.global, 2019).

2.4 Themes

In presenting the gathered information from the five selected studies, three themes are being developed which are mentioned below. No sub-themes are developed from the study.

Theme 1: Factors leading to the needle-stick injuries impact among healthcare professionals

The theme explains the factors which are related to make the prevalence of needle-stick common in healthcare professionals. The facts to be explained under the theme are methodically covered in the studies by Dilie et al. (2017) and Walle et al. (2013). The study by Walle et al. (2013) mentions that job pressure and professional experience and the study by Dilie et al. (2017) informs that job-related stress, recapping after use of the needle, precautionary measure information and lack of needed skills are responsible factors for needle stick injuries in healthcare professionals. The critical analysis of both articles mentions that they express effective congruity between the philosophical perspective of the study and the research methodology used. This is evident as both the studies Dilie et al. (2017) and Walle et al. (2013) mentioned the philosophical perspective of executing them by gathering objective information from the participants for which in congruence they used quantitative techniques of data collection.

The research methodology used in both the studies of Dilie et al. (2017) and Walle et al. (2013) were found to be in congruence with research objectives, data collection and data analysis method. This indicates that relevant research techniques are appropriately used as per need of the topic by the researcher to effectively explore them and present relevant data. The statistical information collected from both the studies are presented in statistically significant manner (𝑝 value < 0.05). These acted as an advantage for both the studies because they ensured the data presented are reliable and credible and not presented based on chance. In regard to sample size, the study by Dilie et al. (2017) used 332 healthcare workers and study by Walle et al. (2013) used 193 healthcare workers which indicates that the study sample is quite large. This acts as advantage for both the studies large sample are statistically more powerful and less variable due to which it provides them the opportunity to allow generalisation of their results (Schreiber, 2020). The limitation of both the studies that are Dilie et al. (2017) and Walle et al. (2013) is that they used cross-sectional research design due to which it cannot present the cause-effect relationship in the study and subjects the responses gathered may have a bias from the respondents.

Theme 2: Awareness level regarding needle stick injuries among healthcare professionals

The theme explores the awareness level of knolwdege present among the healthcare professional regarding needle-stick injuries. For this purpose, the studies by Sardesai et al. (2018) and Suliman et al. (2017) are to be explored as they contain the relevant data in presentation of the theme. The study by Sardesai et al. (2018) is organised in Maharashtra, India where it is found that the healthcare workers lack any awareness regarding needle-stick injuries. However, the study by Suliman et al. (2017) organised in Jordan mentioned that healthcare professionals in the country presented moderate awareness and understanding regarding needle-stick injuries. The critical analysis of Sardesai et al. (2018) and Suliman et al. (2017) mentioned that both the studies develop effective research methodology which are congruent with the research objectives, research philosophies, data collection methods and others been used. This is evident as both the studies used quantitative research methodology matching with which they set the research objectives which demanded objective responses from the sample. Moreover, both the studies used survey and statistical way of gathering and analysing data which are in congruence with the quantitative research methodology.

In both the studies, a statistical significance of p-value < 0.05 is followed to ensure the data collected are real and reliable. The study by Sardesai et al. (2018) used a sample size of 100 healthcare workers whereas the study by Suliman et al. (2017) a sample size of 279 healthcare workers. This indicates that the study by Suliman et al. (2017) used larger sample size compared to Sardesai et al. (2018) which ensure its greater generalisation of the results due to low variable out of the large sample. The limitation of the study by Suliman et al. (2017) us that the frequency of response was based on self-reports by participants which may have created a bias in collecting data. Moreover, the online survey was unable to prevent multiple collections of data from same individual which may have added bias in the study. The limitation of the study of Sardesai et al. (2018) is the use of cross-sectional study design that lead to prevent development of information for cause-effect relationship in variables.

Theme 3: Impact of training on managing needle stick injuries among healthcare professionals

The theme mentions if training is effective to create awareness and management of needle-stick injures among healthcare worker. For this purpose, the study by Ersin et al. (2016) is been explored that mentions training is effective to minimise and aware regarding needle-stick injures among healthcare workers to be reported. In the study, the quantitative methodology is been used which is congruent with the objective of the study as it helped in gathering statistical data to explain to what percentage change in action among healthcare workers were experienced after training regarding awareness of needle-stick injury reporting and management. The study used 144 sample which is a moderate size and may have compromised to create bias in gathering of information. The limitation of the study is the use of the cross-sectional study method.

2.5 Strength and Limitation

The strength of the review is that it used a deductive research approach that allowed to gather data from existing studies to measure the concepts in quantitative manner and create possibility of generalisation of the results (Bergdahl et al., 2019). The other strength is that the inclusion and exclusion criteria are thoroughly mentioned which helped to determine the aspects focussed in gathering the data. The limitation of the review is use of small sample due to which effective exploration of the research variables to answer the research questions could not be reached in enhanced manner. Moreover, the rigour and transferability in the studies are not explained due to which the quality of articles could not be appropriately determined.

2.6 The Role of Specialists Occupational Health Nurse in secondary care setting

WHO (2001) described the occupational health nurse(OHN) is skilled in primary prevention of injury or disease therefore, the nurse may identify the need for assessing and planing interventions such as modifying working environments, systems of work or change working practices in order to reduce the risk of hazardous exposure. Moreover, WHO (2001) stated the OHN is a Registered Nurse with a great deal of clinical experience and expertise in dealing with sick or injured people. In addition WHO (2001) stated OHN will be able to give advice on a wide range of health issues, and particularly on health and safety at work or where modifications to the job or working environment can be made to take account of the changing health status of employees.

WHO (2001) OHN is able identify and often has close contact with the workers and is aware of changes to the working environment because of the nurse’s expertise in health and in the effects of work on health they are in a good position to be involved in hazard identification. Hazards may arise due to new processes or working practices or may arise out of informal changes to existing processes and working practices that the nurse can readily identify and assess the likely risk from. This activity requires and presupposed regular and frequent work place visits by the occupational health nurse to maintain an up to date knowledge and awareness of working processes and practices. Health and Safety Executive (HSE) stated it’s a legal duty to assess the risks to the health and safety of employees. Occupational health nurses are trained in risk assessment and risk management strategies and, depending upon their level of expertise and the level of complexity involved in the risk assessment, the nurse can undertake risk assessments or contribute towards the risk assessment working closely with other specialists

2.6 Conclusion

The data is collected through electronic search by following inclusion and exclusion criteria. The JBI Quantitative Appraisal tool is used for analysing and appraising the selected studies.

3. Methodology

3.1 Research Design

According to the study by Saunders and Tosey (2013), there are mainly three types of research design which are descriptive, explanatory and exploratory research design. The descriptive research design aims to systematically as well as accurately describe a situation or phenomenon to resolve the raised question in the study. It is mainly used in studies which has a definite aim and objectives already set by the researcher (Bloomfield and Fisher, 2019). In contrast, the exploratory research design is executed when the focused research problem has little past references to be used. This nature of design is often informal and unstructured as it assists to serve as initial research support to gather hypothetical idea of the research topic (Rahi, 2017). However, the explanatory research design is the approach in which the selected topic is found to lack any previous information to explain the different aspects of the study (Bowen et al., 2017).

In this study, the exploratory study design is to be used because they are cost-effective, open-ended and requires no direct interaction with the participants. Moreover, it helps to gather potential theoretical ideas from existing researcher in supporting the explanation of the research problem and way to resolve it (Zakkar and Sedig, 2017). Since in this study, the aim is to gather data from existing study, therefore using exploratory design would help the researcher to have flexibility in analysing existing data to be effectively presented in the research. The descriptive design is not to be used in the study because they are implemented in performing quantitative studies. Moreover, they create bias in the study and unable to be repeated due to inclusion of observation nature in them (Bradshaw et al., 2017). Since the current study is qualitative and to avoid bias, therefore the descriptive design is not to be used. The explanatory research design is not to be used because it leads to development of biased information out of potential studies to reference the facts and leads to the use of hindered sample which is unable to gather effective data for the enriched execution of the study (Holland et al., 2018).

3.2 Population and Sampling

In research, the use of effective techniques for sampling is important so that potential answered can be gathered in framing the study (Rauschenberg et al., 2020). In this study, the inclusion and exclusion criteria are to be followed in selecting the sample articles for the study. In this research, no population is to be involved as they are not required because the study is to be executed by gathering information from existing study. In total, five studies are to be included in framing the study.

3.3 Data Collection Approach

The data collection approaches are of two types which are primary and secondary data collection approach. The primary data collection is the process of gathering data or information from the study directly from the participants through the use of experiment, survey, interview and others (Bjärkefur et al., 2020). In contrast, secondary data collection approach is the way of gathering data from existing studies and not directly from the main source by the researchers (Hutchings et al., 2020). In this study, the secondary data collection approach is to be used. This is because it is cost-effective helping to save extra efforts and expenses for the researchers. Moreover, secondary data collection approach is time-saving as it helps the researchers to gather data from existing studies, unlike the primary data collection approach in which direct interaction is to be made with the participants in accessing approval and gathering data from them (Carroll et al., 2017). The primary data collection approach is not to be used because they require increased amount of time and money for the collection of data. Moreover, the primary data collection approach includes the use of complex statistical and qualitative approaches in gathering data which makes it inflexible for the research to gather data in easier manner (Bjärkefur et al., 2020).

3.4 Data management and Analysis

The data management and analysis are to be executed in the study by following thematic analysis method. The thematic analysis is the way of analysing qualitative data such as texts, interview transcripts, existing referenced data and others. In the process, the data is closely examined by the researcher in identifying common themes so that the data can be presented in systematic manner for the enriched execution of the study (Valley and Stallones, 2018). The thematic analysis approach is to be used because it also leads the researcher to be flexible in modifying the needs of the study to provide a rich and detailed explanation of the complex data gathered for the study (Allen et al., 2021).

3.5 Ethical Considerations

The ethical considerations are significant to be abided in the study so that the researcher gathers data in ethical manner without disrupting the moral rules established through research policies and legislations (Duthie, 2019). In order to maintain ethical considerations in the research, the mentioned data are to be effectively referenced to the original authors by mentioning their name and data of publication of the research to avoid plagiarism. Moreover, no information of the participants is to be used from existing studies unless they are mentioned in ethical manner and mentioned to be informed by following informed consent from the participants.

3.6 Limitation of the study

One of the major limitations of the study is the limited time and money available for it to be executed due to detailed information in an effective manner is unable to be gathered for the enriched presentation of the study. The other limitation is lack of use of primary data collection approach because it provides updated and relevant data to be collected directly from the participants which can be used in comprising with the secondary information to ensure the credibility and viability of the data (Strongman et al., 2019). The other limitation is the small number of samples used in the study due to which reliability in presentation of the data cannot be reached as it leads to present highly variable data (Vasileiou et al., 2018).

Conclusion

The above discussion informs that the study is executed by following secondary research methods. It is identified that needle-stick injuries lead to create health hazards among healthcare workers. The injuries mainly occur due to lack of awareness along with factors such as job pressure, stress, lack of professional experience and others.

References

Allen, C.G., Ritchie, J.B., Morrison, H., Lauzon, S.D., Nichols, M., Schiffman, J.D., Hughes Halbert, C. and Welch, B.M., 2021. A thematic analysis of health information technology use among cancer genetic counselors. Journal of genetic counseling, 30(1), pp.170-179.

Anfara Jr, V.A. and Mertz, N.T. eds., 2014. Theoretical frameworks in qualitative research. Sage publications.

Bergdahl, E., Ternestedt, B.M., Berterö, C. and Andershed, B., 2019. The theory of a co‐creative process in advanced palliative home care nursing encounters: A qualitative deductive approach over time. Nursing open, 6(1), pp.175-188.

Bjärkefur, K., de Andrade, L.C. and Daniels, B., 2020. iefieldkit: Commands for primary data collection and cleaning. The Stata Journal, 20(4), pp.892-915.

Bloomfield, J. and Fisher, M.J., 2019. Quantitative research design. Journal of the Australasian Rehabilitation Nurses Association, 22(2), pp.27-30.

Bowen, P., Rose, R. and Pilkington, A., 2017. Mixed methods-theory and practice. Sequential, explanatory approach. International Journal of Quantitative and Qualitative Research Methods, 5(2), pp.10-27.

Bradshaw, C., Atkinson, S. and Doody, O., 2017. Employing a qualitative description approach in health care research. Global qualitative nursing research, 4, p.2333393617742282.

Carroll, J.K., Moorhead, A., Bond, R., LeBlanc, W.G., Petrella, R.J. and Fiscella, K., 2017. Who uses mobile phone health apps and does use matter? A secondary data analytics approach. Journal of medical Internet research, 19(4), p.e125.

Dilie, A., Amare, D. and Gualu, T., 2017. Occupational exposure to needle stick and sharp injuries and associated factors among health care workers in Awi Zone, Amhara Regional State, Northwest Ethiopia, 2016. Journal of environmental and public health, 2017.

Duthie, K., 2019, March. Ethical considerations for health leaders responsible for the care of transgender patients. In Healthcare management forum (Vol. 32, No. 2, pp. 113-115). Sage CA: Los Angeles, CA: SAGE Publications.

Ersin, F., Koruk, S.T. and Yilmaz, L., 2016. Effect of the training provided for nurses on sharp-needlestick injuries and reporting process. Int J Caring Sci, 9(2), pp.561-8.

Gorman, T., Dropkin, J., Kamen, J., Nimbalkar, S., Zuckerman, N., Lowe, T., Szeinuk, J., Milek, D., Piligian, G. and Freund, A., 2014. Controlling health hazards to hospital workers: A reference guide. NEW SOLUTIONS: A Journal of Environmental and Occupational Health Policy, 23(1_suppl), pp.1-169.

Health and Safety Executive (2013) Health and Safety (Sharp Interments) in Healthcare Regulations 2013 - Guidance for employers and employees. Available at https://www.hse.gov.uk/pubns/hsis7.pdf

Health Protection Agency (2012) Eye of needle: United Kingdom surveillance of significant occupational exposures to bloodborne viruses in health care workers, London: HPA

Holland, J.J., Hatcher, W. and Meares, W.L., 2018. Understanding The Implementation Of Telemental Health In Rural Mississippi. Journal of Health and Human Services Administration, 41(1), pp.52-86.

Hutchings, E., Loomes, M., Butow, P. and Boyle, F.M., 2020. A systematic literature review of health consumer attitudes towards secondary use and sharing of health administrative and clinical trial data: a focus on privacy, trust, and transparency. Systematic Reviews, 9(1), pp.1-41.

Jacob, M. Newson-Smith, E. Murphy, M. Steiner, F. Dick, Sharps injuries among health care workers in the United Arab Emirates, Occupational Medicine, 60(5), Pages 395–397.

jbi.global 2019, The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews Checklist for Qualitative Research, Available at: https://jbi.global/sites/default/files/2019-05/JBI_Critical_Appraisal-Checklist_for_Qualitative_Research2017_0.pdf [Accessed on: 22 march 2021]

Levy, B.S.& Wegman D.H.(2000) Occupational Hygiene. Occupational health: Recognizing and Preventing Work related disease and injury. 4th ed., 161-180, Philadelphia, PA: Lippincott Williams and Wilkins.

Ongete, G. and Duffy, F.J.R., 2018. The impact of occupational splash, sharps and needlestick injuries (SSNIs) on the quality of life of healthcare workers in a Kenyan university hospital. Work, 59(1), pp.103-119.

Rahi, S., 2017. Research design and methods: A systematic review of research paradigms, sampling issues and instruments development. International Journal of Economics & Management Sciences, 6(2), pp.1-5.

Rauschenberg, C., van Os, J., Goedhart, M., Schieveld, J.N. and Reininghaus, U., 2020. Bullying victimization and stress sensitivity in help-seeking youth: findings from an experience sampling study. European child & adolescent psychiatry, pp.1-15.

Royal College of Nursing ;Sharps safety RCN Guidance to support the implementation of The Health and Safety (Sharp Instruments in Healthcare Regulations) 2013.

Saunders, M.N.K. and Tosey, P.C., 2013. The layers of research design. Rapport, (Winter), pp.58-59.

Schreiber, J.B., 2020. New paradigms for considering statistical significance: A way forward for health services research journals, their authors, and their readership. Research in Social and Administrative Pharmacy, 16(4), pp.591-594.

Strongman, H., Williams, R., Meeraus, W., Murray‐Thomas, T., Campbell, J., Carty, L., Dedman, D., Gallagher, A.M., Oyinlola, J., Kousoulis, A. and Valentine, J., 2019. Limitations for health research with restricted data collection from UK primary care. Pharmacoepidemiology and drug safety, 28(6), pp.777-787.

Suliman, M., Al Qadire, M., Alazzam, M., Aloush, S., Alsaraireh, A. and Alsaraireh, F.A., 2018. Students nurses' knowledge and prevalence of Needle Stick Injury in Jordan. Nurse education today, 60, pp.23-27.

Valley, M. and Stallones, L., 2018. A thematic analysis of health care workers’ adoption of mindfulness practices. Workplace health & safety, 66(11), pp.538-544.

Vasileiou, K., Barnett, J., Thorpe, S. and Young, T., 2018. Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC medical research methodology, 18(1), pp.1-18.

Walle, L., Abebe, E., Tsegaye, M., Franco, H., Birhanu, D. and Azage, M., 2013. Factors associated with needle stick and sharp injuries among healthcare workers in Felege Hiwot Referral Hospital, Bahir Dar, Northwest Ethiopia: facility based cross-sectional survey. International Journal of Infection Control, 9(4).

World Health Organization, 2001. The role of the occupational health nurse in workplace health management (No. EUR/01/5025463). Copenhagen: WHO Regional Office for Europe.

Zakkar, M. and Sedig, K., 2017. Interactive visualization of public health indicators to support policymaking: An exploratory study. Online journal of public health informatics, 9(2).pp.90-117.