Abstract

NEEDLE STICK INJURY (NSI) AMONG RURAL HEALTHCARE WORKERS IN AMDANGA BLOCK IN WEST BENGAL

Dr. Anirban Chatterjee, Dr. Deblina Sarkar, Dr. Kingsuk Sarkar*, Dr. Saugat Banerjee, Dr. Arnab Ghosal, Dr. Suman Kumar Roy

ABSTRACT

Needle stick injuries (NSIs) pose a serious risk of occupational transmission of Blood Borne Viruses (BBV) to Health Care Worker (HCW) like Human Immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV). Risk of transmission for HIV, HCV, HBV are 0.2-0.5%, 5-10% and around 40% respectively. According to WHO, about 40-75% of the NSIs are unreported and 90% of the NSI occur in developing countries as a result of poor surveillance. Objectives: To find out the incidence of NSI among the HCWs serving government sector in Amdanga Block in West Bengal and to establish the common causes of NSI among those HCWs. Methodology: This cross sectional epidemiological study was conducted among the healthcare workers working in the subcentres and the primary health centres at the Amdanga block in North 24 Parganas district of the State of West Bengal, India over a period of one month. This block had 25 subcentres, 6 of each falling under 3 Primary Health Centres (PHC) and 7 under the bigger Block Primary Health Centre (BPHC). A total of 72 healthcare workers consisting of doctors, staff nurses, Public Health Nurses (PHN), laboratory technicians and health assistants were included in the study. Here, NSI was defined as percutaneous injury by hollow-bore needles (hypodermic needles, IV cannula, blood transfusion needles, winged IV needle sets) and suture needles. The study participants were explained the purpose of the study and were assured of confidentiality. The data was collected by interviewing the participants with a predesigned, pretested proforma, after obtaining their written consent. Results: Only 10% of study participants were doctors. The nurses included the staff nurses at the PHCs and the PHNs posted at Amdanga BPHC. The Health Assistants (males and females) and the health supervisors and laboratory technician were grouped together among the paramedical staff (61%), whereas the GDAs and sweepers at the different facilities who were available were put under non-medical staff (11%). Overall, 56 (77.8%) of the HCWs had at least one episode of Needle Stick Injury (NSI) in the last one year preceding the study. The incidence of NSI among the nurses was 100%, with more than 2/3rd of them experiencing multiple episodes. Also, 5 out of the 7 doctors (71.4%) in the study had an episode of NSI during the last one year. Among the paramedical staff, 79.5% had an episode of NSI, of which almost half had multiple NSI within the above mentioned period. 68(63.5%) of total number of incidents of NSI were found among the paramedical staff. It was found that 54 (52.4%) of the total cases of NSI had occurred after the use of the needle, before its disposal. This trend was most prominent among the paramedical staff, 41 out of the 68 cases (60.2%). It was noted that although all the doctors had completed a 3 dose vaccination against hepatitis B, only 9(69.2%) nurses, 35(79.5%) paramedical staff and 4(50.0%) the non medical staff, respectively, had completed a full course of hepatitis B vaccination. Overall, recapping of needles after use accounted for 34.5% of the cases of NSI, with the practise most commonly noted among the paramedical staff (29.9%). Around a third (30%) of the cases of NSI were attributed to aggressiveness or restlessness of the patient during the procedure. Inappropriate disposal of the used sharps and needles, often into polythene sheets rather than puncture proof containers, was the main cause of NSI among the non medical staff. Practise of recapping was noted in only among one doctor, but the general practise of recapping of the needles were attributed to non availability of the hub cutters in the health facilities. Conclusion: In this study incidence of NSI was noted among all categories of health care workers. The prevalent practise of recapping or bending of needles was a major cause of NSI. This pointed towards inadequate training of the HCW or negligence on their part to stick to the established guidelines, thus increasing the likelihood of getting injured. Around 10% of the HCW had suffered the injury while handing the sharps before use or handling the specimen, which were presumably preventable by exercising greater caution during the procedure. There was need for periodic priming of the healthcare workers regarding the need and importance of Universal precaution to reduce the incidence of NSI.

Keywords: Needle stick injuries, Blood Borne Viruses, Primary Health Centres, Block Primary Health Centre, Public Health Nurse.