KNOWLEDGE, ATTITUDE AND PRACTICE OF SHARP INJURIES AMONG NURSES AT KNH OPERATING THEATRESBy

BackgroundThe operating room environment is unique because of the carefully orchestrated team approach to surgical care.

Surgeons, nurses and operating room technicians work very closely together handling the same instruments in a confined space.

BackgroundNeedlestick and sharps injuries represent a major occupational hazard especially among this group.Contaminated needlestick injuries are very efficient at transmitting blood borne pathogens between patients and healthcare staff

Background.Nurses are vulnerable to serious infectious diseases such as human Immunodeficiency virus (HIV), hepatitis B virus and hepatitis C virus following a needlestick injury

Background.It is reported that 6-16% of these injuries occur during hand to hand passing of sharp instruments, suture needles and other sharp devices.

A team approach to safety in the operating room is critical if injury rates are to be reduced.

Conceptual Framework

Conceptual FrameworkThe Neuman Systems Model served as the theoretical framework for this study. This model identifies the client as a central core surrounded by three types of defense mechanisms: flexible line of defense (FLD), normal line of defense (NLD), and lines of resistance (LOR).

Conceptual FrameworkThe Neuman Systems Model also focuses on interventions, including primary, secondary, and tertiary. Primary prevention prevents encounters with stressors. Secondary prevention involves screening for stressor penetration, while tertiary prevention is centered on reconstitution of the FLD and NLD.

Conceptual FrameworkPrimary prevention includes engineered safety devices, no recapping of needles, and educational programming. Secondary interventions for the nurse include continuing assessment of incidence of needlestick injuries.

Conceptual FrameworkAn example of tertiary intervention would be post-exposure prophylaxis following a needlestick injury.

Study ObjectivesDetermine the Socio - economic and demographic characteristics of nurses working at KNH main theatres.Assess the Knowledge, attitude and practices of disposing needles/sharps in KNH main theatresDetermine the frequency of needlestick injuries among nurses working at KNH operating theatres.Determine the relationship between socio-demographic and frequency of sharp injury

METHODOLOLOGYA descriptive cross-sectional study design was used by means of self administered questionnaire from 75 randomly sampled nurses. Data was entered and analyzed using statistical package for social science (SPSS) Version 13.0.

Results75 nurses were recruited from whom 75 completed questionnaires were obtained (Overall response rate 100%)The respondents were mostly female nurses (58.8%) . Males were 41.2%.

Results

Results Slightly above two third of the respondents (88.2%) had a working experience of 1 year and above in operating room. Those with experience of less than 1 year accounted for 11.8% .

ResultsHighest percentage of nurses had worked in the operating theatre for period above 1 year

Results85.3% of nurses reported no needlestick/sharp injuries events.However 14.7% reported at least 1-2 pricks in the past 1 year.

ResultsThere was a significant association between an incident of sharp or needlestick injury and knowledge on safety precaution guidelines (P > 0.001) Nurses who had adequate knowledge, good attitude and right practice had minimal or no needlestick injury

Knowledge on Universal P. No Knowledge on universal P.

Universal Precaution

Diseases Transmitted by Sharps Incidences of sharps or needlestick injuries was significantly associated with adequate knowledge on diseases transmitted by this sharps ((P= 0.002)

Diseases Transmitted by Sharps

Wearing of Gloves Wearing gloves when disposing needles or sharps was significantly associated with a case of Sharp or needlestick injury (P= 0.004) O.R 3.2(95% C.I 1.8-5.5) Nurses who wear gloves always when disposing sharps had minimal or no sharp injury

Wearing of Gloves

Recapping of needles A case of sharp or needlestick injury was significantly associated with recapping needles (P= 0.034).Nurses who did not practice needle recapping got minimal or no sharp/needlestick injury

Recapping of needles Never had Needlestick Ever had Needlestick

Discussion85.3% of nurses reported no experiencing NSI/Sharp injury in the past 12 months which compares well with similar studies done in Turkey(78%) and Uganda(87%)

DiscussionAlthough majority of the nurses reported no incidences of NSI, a sizeable proportion (14.7 %) got the NSI or still went unreported.The non-reporting of NSI event is a contentious issue within nursing profession and appears to be widespread .

DiscussionFor example, in the USA , it has been shown that NSI are more common than institutional figures suggested and do not occur at random.

RecommendationsThere is need for continuous refresher course especially on safety precautions when handling sharps/needlesSince it was a small project , there is also a need for further research on NSI to ratify the findings

ReferencesShah S.M. A., Barbara S., David B, Michael F., John K,(2003) Safety & Health Assessment & Research for Prevention, (SHARP) Retrieved on 5/10/2008 from http://www.lni.wa.gov/Safety/Research/files/NeedleStick.pdf

Smith. D., Choe. M, Jeong. J., Jeon. Y, Chae. M & An. G. (2006) Epidemiology of Needlestick and Sharps Injuries among Professional Korean Nurses. Journal of Professional Nursing,Volume 22,Issue 6,Pages 359 - 366

ReferencesSmith. D. R., & Leggat. P. A (2004) Needlestick and Sharps Injuries among nursing Students: Journal of advanced Nursing. Vol 51. Issue 5. pp 449-455.

Nsubuga F. M. & Jaakkola M, S., (2005) Needlestick injuries among nurses in sub-Saharan Africa. Journal of Tropical medicine and International health Volume 10 Number 8 page 773-781