SUMMARY

Needle prick and sharps injuries (NP/SI) are common among health care workers (HCWs). The NP is the commonest route by which health care providers acquire blood born diseases from patients. PHC workers get exposed to accidental NP/SI during their routine hospital activities. Abuse of injection, lack of occupational health services, and lack of sharps bins expose HCWs to NP/SI, while awareness and compliance to protective measures prevent NP/SI and related consequences. However lack of data on NP/SI in this area, initiated this research to provide data for Tangaza LGA.

To determine the prevalence and circumstances of NP/SI among PHC workers in Tangaza LGA, Sokoto State.

It was a cross sectional descriptive study. Subjects were PHC workers who are most likely to be exposed to used needles and other sharp instruments.

The instrument of the study was a self administered questionnaire and analysis was done using SPSS version 15.0 soft ware.

Up to 75 4% of HCWs were aware of NP/SI hazards. There was a relationship between categories of HCWs and awareness of NP/SI hazards (p<0.05). About 76.1% and 73.9% of HCWs identified HIV and HBV to be associated with NP/SI respectively.

Majority, 81.7% of HCWs administered injections and 61.8% of these recapped needles.

More than half, 56.1% of the respondents incurred NP injuries with needle recapping accounting for 67. 4% of all the prick injuries. In this study NP are not related to cadre of HCWs (p>0.05). Use of protective measures were not practiced by majority HCWs. Only, 16.4% used gloves all the time, post exposure HBV immunization was 12.4% and HIV PEP had not been attempted by any of the respondents.

In conclusion the study showed clearly that the population of primary health care workers are at risk of needle prick/sharps injures and related hazards, and only very few of them adhere to preventive or protective measures despite high level of awareness of the associated hazards. Training on preventive measures must be recommended as well as avoidance of needle recapping, reduction in over use of injection in treatment, provision of adequate sharps and none sharps disposal bins and reporting NP/SI.

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CHAPTER ONE

1.1 INTRODUCTION

Needle prick and sharp injuries are common accidents among health care workers and frequently

expose them to occupational health hazards. Needle prick and sharps gain more recognition from

the report on a health care worker (HCW) infected with human immunodeficiency virus (HIV)

by needle prick (NP) published in 1984.1 Health care workers incurred 2 million needle prick per

year that result to blood born infections.2 Thus prevention of needle prick and post exposure

management are necessary for promoting the health of individual HCW.

Healthcare personnel (HCP) are defined as persons (e.g., employees, students, contractors,

attending clinicians, public-safety workers, or volunteers) whose activities involve contact with

patients or with blood or other body fluids from patients in a health-care, laboratory, or public-

safety setting.3 Generally, workers represent half of the global population and contribute greatly

to the economic and social value of contemporary society. A substantial part of the general

morbidity of the working population is related to work.4 It is known that the ultimate goal of

ensuring that all workers in the world enjoy full physical and mental health is still far from being

achieved. As a concern that despite the availability of effective interventions for occupational

health, too many workers are still exposed to unacceptable levels of occupational risks and fall

victim to occupational diseases and work accidents, lose their working capacity and income

potential, and still too few have access to occupational health services.5 Yet occupational health

is not widely acknowledged as part of public health care among health regulators and policy

makers.6

1

The healthcare workforce, constitute 35 million people worldwide, representing 12% of the

working population. The occupational health of this significant group has also long been

neglected both organizationally and by governments. The misconception exists that the

healthcare industry is “clean” and without hazard, when in fact the chemical and blood-borne

exposures encountered can be career- and life-ending.2

Health care environment expose health workers to a variety of health hazards; physical,

biological, chemical, mechanical(ergonomics) and social(psychological) harzards.7,8        Despite

this, hospital premises should not be detrimental to health and well-being, it serves as a setting

for delivery of other essential public health interventions, and for health promotion.

Industrialized countries, catered for medical workers in organized comprehensive occupational

health service and with both curative and preventive in content, but in developing countries these

services are purely curatives at general out patient department (GOPD) staff clinic.7,8

However poor waste management, lack of retraining in service, non teaching of occupational

health hazards in teaching curricula, non application of universal basic      precaution in

management procedures, inadequate logistics supplies, poor work motivation and lack

occupational health services, little knowledge and skill are identified as not uncommon risk

factors that expose health care workers to NP/SI hazards in hospital environment.9,10

Needlestick injuries (NSIs) are wounds caused by needles that accidentally puncture the skin.

Needlestick injuries are hazardous for people who work with hypodermic syringes and other

2

sharp equipments. These injuries can occur at any time when people use, disassemble, or dispose

of needles. When not disposed properly, needles can become concealed in linen or garbage and

injure other workers who encounter them unexpectedly.9

Needlestick injuries transmit infectious diseases, especially blood-borne viruses. In recent years,

concern about AIDS (Acquired Immune Deficiency Syndrome), hepatitis B, and

hepatitis C has prompted research to find out why these injuries occur and to develop measures

to prevent them. Despite published guidelines and training programs, needlestick injuries remain

an ongoing problem.1

The risk of infection after exposure to infected blood varies by type of blood borne pathogen.

The risk of transmission after a contaminated needle prick injury had been estimated for HIV to

be up to 0.3%, whereas Hepatitis B virus as much as 100 times greater than HIV (30%) and

about 10% for hepatitis C.2

Needle prick/sharps injuries (NPSI) are the most common source of occupational exposure to

blood and    the commonest route of blood-borne infections    to healthcare workers6. Such

infections serve as high occupational risks and threats to healthcare workers, especially where

basic rules of occupational safety and health care are not implemented; and hazards to health

workers are dimly perceived by authorities, especially in low industrialized countries.4

In developing world overuse of injections in medical care is common; due to patient demand on

assumption it gives rapid recovery, injection promotion by provider to reduce non compliance

and aggressive promotion of injections by pharmaceutical companies; unsafe injection practice

3

and poor health care waste management are the common predisposing factors to medical worker

for incurring needle prick and blood born pathogens exposure.11,12

1.2 JUSTIFICATION FOR STUDY

To enhance knowledge of primary health care workers on health safety promotion on the basis

of strengthening primary preventive strategies through: promotion of universal basic precaution,

proper hospital waste management and safe injection.

To generate information for health care provider at primary health centers, about this

occupational health hazard, and the associated risk of blood born infections (HIV, Hepatitis, etc).

This is necessary as trends of HIV epidemics are changing every year both nationally and states

wide, so that precaution and preventive measures can be strengthened by workers and authorities

in all treatment procedures requiring use of needles/sharp instruments.

Data unavailability on this occupational health hazards among primary health care providers,

triggers this study to be carried out, to provide data for Tangaza Local Government Area, Sokoto

State and the country as a whole for research and intervention needs.