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KNOWLEDGE AND AWARENESS ABOUT NEEDLE STICK INJURIES AMONG DENTAL STUDENTS OF BOLAN MEDICAL COLLEGE, QUETTA.

Byline: ABDUL SAMAD GICHKI, ANAAM ISLAM and WAHEED MURAD

ABSTRACT

One of the most serious threats to Dental students, which they face during their clinical training, is the possibility of exposure to blood borne pathogens by Needle Stick Injuries (NSIs). Injuries from occupational accidents are associated with the agents of biological risk, as they are the gateway to serious and potentially lethal infectious diseases that can be spread by contact between people.

A cross-sectional observational study was carried out among Dental students and House Officers in Dental Section Bolan Medical College, Sandeman Provincial Hospital, Quetta. A total of 100 Dental students and House Officers participated in the study. Out of one hundred 56% were female and 44% were male. The ages of Students and House Officers were between 21-29 years. Majority of the respondents (50%) aged between 21-23 years, and the mean age was 23.6 years. In this study 98% of respondents knew that the transmission of pathogens occurs through needle stick injuries (NSI). About 83% believed that there is no effective vaccine available against HCV. A majority of participants (69%) knew that recapping of needle prevents the risk of NSI. Data shows that 67% of Students and House Officers had never been exposed to NSI.

Results indicated that the students of Bolan Medical College, Quetta had good knowledge and adequate awareness about Needle Stick Injury.

Key Words: Knowledge, Awareness, Needle stick injury, Dental students.

INTRODUCTION

The National Institute of Occupational Safety and Health (NIOSH), USA, defines Needle Stick Injuries (NSIs) as those caused by needles such as hypodermic needles, blood collection needles, intravenous (IV) stylets and needles used to connect parts of intravenous delivery systems.1 Health care workers (HCWs) who use or may be exposed to needles are at increased risk of acquiring NSIs. Hundreds and thousands of HCWs are out in the open to deadly viruses every year. They are exposed to preventable injuries involving over 20 different blood borne pathogens.2

NSIs are preventable common occupational accidents exposing health care workers to different blood borne pathogens including HIV and Hepatitis B and C. According to World Health Report 2002, 40% of the hepatitis B and C infections and 2.5% of the HIV infections among HCW are attributable to exposures at work. Avoiding occupational blood exposures is the primary way to prevent transmission of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in health-care settings. Hepatitis B immunization and post exposure management are integral components of a complete program to prevent infection following blood borne pathogen exposure and are important elements of workplace safety.3,4

The risk of exposure to occupational hazards is the greatest for an inexperienced individual, working in a new environment, for example Medical/Dental students and House Officers during their clinical training rotations. Needle Stick Injuries from a hollow bore needle pose a greater risk of transmission of blood-borne pathogens than from a solid needle, because blood remaining inside the bore of the needle after use contains a large volume of viruses than the relatively small amount of blood remaining on the outside of a solid core needle such as suture needle. After a needle stick exposure to an infected patient, the health care worker's risk of infection depends on the pathogen involved, the immune status of the worker, the severity of the Needle Stick Injury, and the availability and use of appropriate Post Exposure Prophylaxis (PEP).5

Effectiveness of administration of PEP varies from 75% to more than 90% to prevent HBV infection. Post exposure prophylaxis for HIV also lowers the risk of infection after NSIs. However, there is no prophylaxis against HCV infection.6

More than 80% of the Needle Stick Injuries can be prevented through the use of safety devices and effective safety programs. NSIs can also be prevented by applying "Universal Precautions" as a safety measure.7

The objective of present study was to assess the knowledge and awareness about Needle Stick Injury among the Dental students and House Officers of Bolan Medical College Quetta.

METHODOLOGY

The study design was cross-sectional observational, which was conducted from March 2013 to July 2013. A total number of 100 Dental Students and House Officers, both male and female were included during their clinical training at the Dental Section, Bolan Medical College, Sandeman Provincial Hospital, Quetta. The study was conducted by distributing a self-administered questionnaire amongst the participants. Permission was taken from principal Bolan Medical College and Head of Dental Section Quetta. Each participant signed the informed consent form and filled the questionnaire by their self. All the information was kept confidential and anonymous. The data were analyzed in Statistical Package for the Social Sciences (SPSS 16). The statistical tests were applied including proportions and chi-square tests for significance.

RESULTS

Respondents' Characteristics

A total of 100 Students and House Officers participated in this study. Several demographic parameters were recorded including age, gender, and position like student and house officer. Out of 100 participants majority of respondents 56 (56%) were female and 44 (44%) were male, out of one hundred 71 (71%) were students and 29 (29%) were House Officers. The ages of the participants were between 21-29 years and the mean age of respondents was 23.6 years. (Table 1)

TABLE 1: DEMOGRAPHIC DATA

Variables###No. (N=100)###%

Age (Years)

2123###50###50%

2426###45###45%

2729###5###5%

Mean Age = 23.6

Gender

Male###44###44%

Female###56###56%

Position

Students###71###71%

House Officers###29###29%

TABLE 2: PARTICIPANTS' KNOWLEDGE and AWARENESS ABOUT NSI

###Good knowledge###Poor knowledge###No knowledge %

###%###%

NSI is a percutaneous wound###97###97%###2###2%###1###1%

Risk of transmission of blood-borne disease###98###98%###2###2%###0###0.0%

Transmission of pathogens###71###71%###21###21%###8###8%

Risk of HIV transmission during NSI###13###13%###86###86%###1###1%

Availability of HCV vaccine###83###83%###9###9%###8###8%

Recapping needle prevents risk of NSI###69###69%###31###31%###0###0.0%

Improved engineering control devices re-###84###84%###11###11%###5###5%

###duce the risk of NSI

It is necessary to report the injury###99###99%###1###1%###0###0.0%

Bleeding should be encouraged at the site###88###88%###4###4%###8###8%

###of injury

PEP should be initiated within 1 hour of###91###91%###1###1%###8###8%

###exposure of NSI

Affected area should be washed with soap###60###60%###31###31%###9###9%

###and water

Does the person exposed to NSI need tet-###84###84%###11###11%###5###5%

###anus vaccination

Needle should be recapped by using one###61###61%###39###39%###0###0.0%

###hand to hold the cap and other to hold the

###needle

TABLE 3: EXPOSURE TO NSI IN DENTAL STUDENTS AND HOUSE OFFICERS

No. of###Position (n=100)###Total

exposures###Students###House Offi-

###cers

Once###15###6###21%

More than###9###3###12%

once

Never###47###20###67%

Total###71###29###100%

TABLE 4: PRACTICING UNIVERSAL PRECAUTIONS

###Position (n=100)###Total %

###Students###House

###Offices

HBV vaccinated###64###24###88%

Not vaccinated###7###5###12%

Wear gloves###49###24###73%

during work

Dont wear gloves###22###5###27%

Recap the needle###26###7###33%

after use

Dont recap###45###22###67%

Knowledge and awareness about NSI

This study showed that 71% of the sample had good knowledge about the transmission of pathogens through NSI. When asked about the availability of HCV vaccine 83% knew that there is no effective vaccine available against HCV. According to the study 99% respondents believed that the injury should be reported. Regarding management of NSI 91% agreed that the post exposure prophylaxis should be initiated within one hour of injury (Table 2).

Exposure to NSI

During their work experience Needle Stick Injuries were sustained by 33% of the Students and House Officers. According to the responses 21% of the samples were exposed to NSI only once, 12% more than once and 67% were never exposed to NSI (Table 3). While 20% participants admitted experiencing Needle Stick Injury due to their negligence.

Hepatitis B vaccination had been received by 88% of the Students and House Officers. While practicing Universal Precautions 73% wore gloves during their clinical work while 27% didn't wear gloves. Data showed that majority of the respondents (67%) didn't recap the needle after use (Table 4).

The Pearson 2 test was used to determine whether the knowledge and awareness on NSI was associated with the position of the respondents. Results indicated that none of the investigated variables was associated with the position except the knowledge about transmission of pathogens P=0.000 (Table 5). It showed that the level of knowledge and awareness about NSI was not affected by the position of the respondent.

DISCUSSION

Health care professionals are most negligent, as far as their own health is concerned. They are exposed to high risk of various infections and also become victims of lifestyle diseases due to their stressful schedules and high degree of professional responsibility. Needle Stick Injury is one of the hidden problems in the health care workers, including medical Students and House Officers who are at risk of occupational exposure to blood-borne diseases, following sharps incidents. The World Health Organization (WHO) estimates the global burden of diseases as 40% of the Hepatitis B and C infections and 2.5% of the HIV infections among health care workers to be attributable to exposures at work, while 90% of the occupational exposures occur in the developing world.8

One of the most serious threats faced by Dental students and House Officers during their clinical training is the possibility of exposure to blood-borne pathogens, especially Hepatitis B, Hepatitis C and Human Immunodeficiency Virus HIV.9 NSIs is a percutaneous piercing wound typically set by a needle point, but possibly also by other sharp instruments or objects, commonly encountered by the people handling needles in the medical setting. Such injuries are an occupational hazard in the medical community. The risk of transmission of infections from patient to the healthcare workers like Hepatitis C (3%), Hepatitis B (30%), and HIV (0.3%), depends on the viral load of the patient.10

Other than HBV, HCV and HIV, at least 20 different pathogens are known to be transmitted by Needle Stick Injuries.11 Medical students, being a part of the healthcare delivery system, are exposed to the same, if not greater, magnitude of risk as other HCWs when they come into contact with patients and contaminated instruments. In many teaching centers, medical students are the first level of contact of patients with medical care. They are expected to undertake activities related to patient care with the beginning of their clinical years. As future doctors, they will have to face the risks associated with NSIs. Being amateurs, they lack experience and skill and are, therefore, at a higher risk of infection from unsafe practices related to needles and sharps.12

In this study 98% of the respondents had a good knowledge about the transmission of blood borne diseases occurs by NSIs like hepatitis B, hepatitis C, and HIV. Although the knowledge regarding NSIs has been generally seen to improve with increasing year of medical education and this may be attributed to factors such as increasing level of clinical exposure and responsibility in patients care. This suggests that the background knowledge and exceptional training against NSIs preventive protocol, provided by the dental institute actually matters rather than the personal skills and work experience. Therefore it is the foremost responsibility of the training institution to provide its candidate the evidence based knowledge and outstanding supervised training, which can ultimately reduce the burden of bio hazards including NSIs from our society.13

Practicing universal precautions, 88% respondents in this study had been vaccinated against Hepatitis B and 73% wore gloves during their clinical procedures. This study also showed that 67% didn't recap the needle after use as this may cause spread of blood-borne diseases. As per WHO recommendations, needles should not be recapped, bent, broken, removed from disposable syringes or otherwise manipulated by hand as these procedures increase the risk of NSI. These practices should be stopped by introducing educational programs for enhancing the knowledge and skills of the dental students early in the course. As the students lack the necessary skills and training, they may be at more risk of accidental injuries. Hence making them aware of the protective steps and relevant institutional policies regarding such episodes is a necessity.14,15

Results of this study showed that the overall knowledge is better than awareness and practice of Universal Precautions. There is an essential need for further education to improve and update the knowledge and awareness about NSIs and its management by seminars, programs and workshops especially designed for this group of people. Good knowledge level among HCWs reflects the fact that being more chronic and serious infections, dissemination of information about these infections is very common from various platforms by targeting different groups of people including HCWs. However, active surveillance, analysis of injury data and periodic review for intervention are important, particularly where workload and turnover is higher, as in teaching hospitals.16

Prevention of NSIs can be achieved through elimination of needle recapping and use of safer needle devices, sharp collection boxes, gloves and personal protective gear.

The primary prevention of NSI is achieved through the elimination of unnecessary injections and handling unnecessary needles. The implementation of education, Universal Precautions, elimination of needle recapping, and use of sharps containers for safe disposal have reduced NSIs by 80%, with additional reductions possible through the use of safer needle devices.17,18

In summary, the author's like to recommend that in all health care settings, record keeping and reporting of sharp injuries should be considered as an essential part of infection control activity. Post exposure prophylaxis and follow up facility should be provided by the hospital management. Infection control teaching and training should be an integral part of the curriculum of all disciplines including medical, dental, nursing as well as for any institute providing training to paramedics.

Moreover, each health care setting should have an active and dynamic infection control programs. In due course this multifaceted approach will definitely improve the attitude, knowledge and practices of health care workers including medical students towards NSIs.

CONCLUSION

Medical and Dental Students are at a high risk of NSIs during their clinical training. Therefore, preventive measures should be taken into consideration by the relevant universities and hospital managements. Also, focusing on the importance of reporting an NSI and the possibility of prophylactic measures seem quite necessary. Setting up an NSI management center in hospital wards, as well as follow up of the injured individuals are recommended.

ACKNOWLEDGMENTS

Our extreme gratitude goes to Prof Dr Zia ul Haq, Head of the Dental Section, Sandeman Provincial Hospital, Quetta for approval of our study in the Dental Section. We also thank all the respondents (Dental Students of 3rd year, final year and House Officers) who participated in the study.

Our special thanks goes to Dr Farhat Iqbal, Department of Statistics, University of Balochistan, Quetta for the statistical analysis of our study.

REFERENCES

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15 WHO AIDS series 3 guidelines for nursing management of people infected with HIV. Geneva: WHO; 1988.

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17 Centers for Disease Control and Prevention, Evaluation of Safety Devices for Preventing Percutaneous Injuries among Healthcare Workers during Phlebotomy Procedures, St. Paul, New York City, and San Francisco. MMWR.1997; 46: 21-23.

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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Geographic Code:9PAKI
Date:Dec 31, 2015
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