ABSTRACT
Exposure to percutaneous injuries and blood/body fluids are
serious occupational hazards that contribute to the transmission of a variety
of blood borne pathogens. The study was conducted to determine the prevalence
and risk factors associated with percutaneous injuries and exposure to
patients’ blood and other body fluids among nurses in the Tamale metropolis. A
cross-sectional design was adopted for the study. A total population of 572 was
targeted with a sample size of 224 nurses obtained for the study. However,
analysis was done with a sample size of 215 based on a 96% response rate. The
researcher used descriptive and inferential statistics to analyse the data.
Results from the study indicate that the prevalence of percutaneous injuries
(PIs) and blood/body fluid exposures (BBFEs) in the two hospitals was high
(61%). Sex, highest level of education, work experience, availability of
Personal Protective Equipment (PPEs) and having a procedure/protocol for
reporting, following standard operational protocols, wearing PPEs, working in
haste, engaging in improper disposal and reporting accidental exposures all
showed statistically significant association (p≤ .05). In conclusion, the
prevalence of PIs and BBFEs among nurses in the two hospitals was high. Also
some, personal factors, organizational factors and behavioural factors
influenced the occurrence of these exposures among the nurses. Heads of the
health facilities in the Tamale Metropolis should therefore sensitize their
nurses to understand the risks associated with these injuries and exposures to
encourage them to comply with the standard precautions.
CHAPTER ONE
INTRODUCTION
Any healthcare worker handling sharp objects or devices such
as scalpels, sutures, hypodermic needles, blood collection devices, or
phlebotomy devices is at risk of occupational exposure to blood borne
pathogens. However, the risk varies across disciplines, with nurses seen to be
the most at risk due to the nature of their work (Desalegn, Beyene, &
Yamada, 2012). Studies have shown that even though all healthcare workers
[HCWs] whose work demand contact with patients are at risk of exposure to sharp
injuries and patients’ blood and other body fluids, nurses report majority of
these injuries and exposures. This is because nurses are more likely to handle
sharp devices and also have more contact periods with patients than other
healthcare professionals (Mbaisi, 2013).
Some of these injuries and exposures may result from time
pressures leading to nurses working in haste, misunderstandings among health
team members, fatigue, inadequate staffing, lack of awareness, reduced
attention during procedures, and lack of cooperation from patients (Cicconi,
Claypool, & Stevens, 2010). Exposure to blood borne pathogens has been
identified as one of the most serious occupational health risks encountered by
nurses in the healthcare profession worldwide (Leow,Groen, Bae, Adisa, Kingham,
& Kushner, 2012 ; Wicker, Jung, Allwinn, Gottschalk, & Rabenau, 2008).
Background to the Study
Globally, more than 35 million healthcare workers face the
risk of percutaneous injuries with contaminated sharp objects every year
(Wicker et al., 2008). The Centers for Disease Control and Prevention [CDC]
estimated that, 385,000 sharp injuries occurred yearly among hospital workers
in the United States (CDC, 2008). It is also estimated that 100,000 of these
injuries occur annually in the United Kingdom and 500,000 annually in Germany
(Rampal, Rampal, Rosidah, Whye-Sook, & Azhar, 2010).
Percutaneous injuries [PIs] are well known occupational
hazards among healthcare workers. They are significant sources of infections
with blood borne pathogens among healthcare workers including nurses (Aderaw,
2013). The major source of blood borne infections among hospital workers is
through injuries either from needles or other sharp instruments (World Health
Organization [WHO], 2011). Percutaneous injury is defined by the CDC (2011) as
“a penetrating stab wound from a needle, scalpel, or other sharp object that
may result in exposure to blood or other body fluids”.
In the healthcare setting, sharp objects such as needles and
ampoules are the most common items causing PIs, and their handling is one of
the most performed daily activities. Handling sharp objects therefore represent
a major risk for Healthcare Workers (HCWs) and more particularly for nurses
(Elseviers, Arias-Guillén, Gorke, & Arens, 2014). Also, a percutaneous
exposure occurs when the skin is cut or penetrated by a needle or other sharp
object that may be contaminated with blood or other body fluid (CDC, 2009).
Blood and body fluids on the other hand are described as
fluid contained in the fluid compartments of the body, they include: semen,
vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid,
pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental
procedures and body fluids visibly contaminated with blood (Cherie, Allen &
Kevin 2010).
Exposure to Percutaneous injuries and blood/body fluids are
serious occupational hazards in the transmission of a variety of blood borne
pathogens such as; Hepatitis B virus [HBV], Hepatitis C virus [HCV], and Human
Immunodeficiency Virus [HIV] among HCWs. The number of these workers annually
exposed to sharps injuries contaminated with HBV, HCV, and HIV has been
reported to be 2.1 million, 926,000, and 327,000, respectively (Wicker et al.,
2008). Blood borne pathogen exposures can result from PIs or through contact of
blood and body fluids [BBFEs] with mucous membranes or non-intact skin. These
exposures pose a risk of transmission of HIV, HBV, HCV and other pathogens to
healthcare workers (Kessler, McGuinn, Spec, Christensen, Baragi, & Hershow,
2011). Studies in Nigeria have shown that occupational injuries and illnesses
among healthcare workers are ranked among the highest of any industry though
this situation could be reversed or eliminated (Amosun, Degun, Atulomah,
Olanrewaju, & Aderibigbe, 2011).
The gravity of workplace risks is seen in the International
Labour Organization [ILO] estimates that, among the world’s 2.7 billion
workers, at least 2 million deaths per year were due to occupational infections
and injuries. The ILO also noted that nearly 4 per cent of GDP could be lost due
to work-related diseases and injuries (ILO, 2003). These constitute deaths
related to only infectious injuries and diseases. O’Malley et al. (2007) in
2006 conducted an economic analysis of the management costs of occupational
exposure to blood and body fluids, including post-exposure prophylaxis in the
United States of America. The study revealed that the overall cost ranged from
US$ 71 to US$5000.
Apart from the economic factors, these exposures also cause
psychological trauma to HCWs. The challenges are further complicated if
potential chronic disability is developed leading to loss of employment, denial
of compensation claims and even liver disease requiring liver transplant
(Moazzam, Salem, & Griffith, 2010). NIOSH (2008) considers exposure to
needle stick injuries and infectious diseases as factors leading to
occupational stress among most healthcare workers. They are also known to be
responsible for psychological distress, burn-out, absenteeism, reduced patient
satisfaction and treatment errors among health care workers.
Despite the consequence and negative effects of these
exposures among nurses and other HCWs, several reports from both developed and
developing countries still show a continued high prevalence of needle stick
injuries, sharp injuries and splashes of patients’ blood and body fluids (Seyed
& Kaveh, 2009). Some studies further indicated that about three-quarters
(40-70%) of these injuries are mostly unreported in developing countries
(Habib, Ahmed, & Aziz, 2011).
Sharp injuries are the most common type of percutaneous
injury sustained by nurses (Subratty & Moussa, 2007). In a study of US
hospitals, the results revealed that nurses accounted for almost half of all
reported needle stick injuries (Chen & Jenkins, 2007). This is because
nurses are directly at risk of transmission of blood borne pathogens through
their handling of contaminated body fluids (Lee, 2009 ; Wicker et al., 2008). In Ethiopia,
Alemayehu, Worku and Assefa (2016) indicated that among nurses, midwives and
medical doctors, nurses were the most exposed to sharp injuries (28.8%) whiles
medical doctors were the most exposed to BBFEs (42%). Similarly, in Saudi
Arabia, a 5 year surveillance study also found that most reported injuries
involved the nursing staff, followed by doctors, then downstream staff (El-Hazmi
& Al-Majid, 2008). A cross-sectional study among nurses in Turkey, Iran and
Uganda reported a prevalence rate of 30.1%, 75.6% and 3.94% respectively of
sharp injuries in the previous year.
At the local level, a study conducted among nurses at the emergency
unit of the Komfo Anokye Teaching Hospital in Ghana indicated that, sharp
injuries were very prevalent, with about one-third of respondents reporting
four (4) or more injuries in the past 12 months (Lori, McCullagh, Krueger,
& Oteng, 2016). This high rate of repeated exposures may put these nurses
at a high risk for acquiring serious infection which may result in chronic
infectious diseases like HIV, hepatitis B and hepatitis C. If a tertiary
facility with all the proper surveillance systems that ensures the safety of
their workers could record such high rate of repeated exposures to sharp
injuries. It therefore shows that at the lower level care facilities the
situation could be worse considering the fact that surveillance systems in most
cases are either weak or absent.
Certain work practices such as administering injections,
taking blood samples, recapping and disposing used needles, handling trash, and
during the transfer of body fluids from a syringe to a specimen container have
all been identified as some major activities causing PIs and splash exposures
(Lakbala, Ebadiazar, & Kamali, 2012). Despite these levels of exposures,
reports still indicate that non-reporting of injuries and exposures are
highly prevalent (Irmak, 2012 ; Nasiri, Vahedi, Siamian, Mortazavi, &
Jafari, 2010 ; Nsubuga & Jaakkola, 2005).
In developing countries, studies have revealed that
occupational infections are mostly less often documented because of the lack of
routine surveillance of sharp injuries and blood and body fluid exposures
(Phillips, Simwale, Chung, Parker, Perry, & Jagger, 2012). The situation in
Ghana is not different as data on occupational exposure to PIs and BBFEs in
most health facilities are scarce despite the risk these injuries and exposures
pose to nurses and other HCWs.
Statement of the Problem
Even though there is a national guideline on infection
prevention and occupational health and safety practices in Ghana, little is
known about the prevalence and risks factors associated with PIs and BBFEs.
Furthermore, studies have shown that occupational injuries
occur highest among nurses (Amosun, Degun, Atulomah, Olanrewaju, &
Aderibigbe, 2011; Chen & Jenkins, 2007). However, there is little
information as to the cadre of nurses mostly affected, this is because majority
of the studies mostly focused on all HCWs and just a few actually looked at the
different cadre of nurses.
As a result of the lack of data, authorities are mostly
unable to estimate the impact of these exposures in other to inform policy. The
research was necessitated out of the need to obtain information on the
prevalence of these exposures and assess their associated risk factors among
nurses in the Tamale Metropolis, Ghana.
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