Needlestick and sharps injuries among nursing students

AIMS: This paper reports the first investigation of the prevalence and nature of needlestick injuries among Australian nursing students. BACKGROUND: Needlestick and sharps injuries are the most efficient method of transmitting blood-borne pathogens between patients and healthcare staff. Although nurses are known to be a high-risk subgroup for these events, nursing students may be at even greater risk due to their limited clinical experience. Despite this fact, the epidemiology of needlestick and sharps injuries among nursing students has not been clearly elucidated in Australia. METHODS: A questionnaire-based methodology adapted from other international investigations was conducted among nursing students. We recruited a complete cross-section of students from a large university nursing school in North Queensland, Australia, in March 2004, and analysed needlestick and sharps events as a percentage of all students and also as a proportion of all cases. Risk factors were evaluated using logistic regression. RESULTS: From a group of 319 students, 274 successfully completed questionnaires were obtained (overall response rate 85.9%). A total of 38 students (13.9%) reported a needlestick or sharps injury during the previous 12 months. By causative item, 6.2% of students had been injured by a normal hollow-bore syringe needle, 3.6% by a glass item and 3.3% by an insulin syringe needle. Regarding prior usage, 81.6% of all injuring items were unused, 15.8% had been used on a patient and the status of 2.6% was unknown. Most needlestick injuries occurred either in the nursing laboratory (45%) or the teaching hospital (37%). Opening the needle cap was the most common causative event (28% of all cases). A total of 39.5% of needlestick injuries were not reported. The main reason for non-reporting was that the item was unused (42%). Logistic regression analysis revealed that students in the third year were 14.8 times more likely to have experienced a needlestick injury than their counterparts in other years (odds ratio 14.8, 95% confidence interval 5.2-50.3, P < 0.01). These injury rates were higher among Australian nursing students than in other international studies. CONCLUSIONS: Although hepatitis B vaccination coverage among the students was excellent, it is important that the principles of infection-control training and reporting of all needlestick and sharps continue to be emphasized throughout undergraduate nursing education.     

Occupational exposure to blood and body fluids among a group of Turkish nursing and midwifery students during clinical practise training: Frequency of needlestick and sharps injuries

Aim: To ascertain the number of needlestick and sharps injuries (NSSIs) in nursing and midwifery students and to assess the use of universal precautions among injured and non‐injured students. Methods: A survey of a representative sample of nursing and midwifery students who did clinical practise in a hospital was conducted. In total, 203 students met the inclusion criterion of the study. Of these, 141 (69.46%) provided useable data. The survey form was designed by the researcher after reviewing the relevant literature. The data frequency, percentages, and χ²‐values were examined. Results: According to the data, 35.5% of the participating students had experienced a NSSI, 54% of the students had received one NSSI, and 36.0% had two NSSIs. Sixty‐six percent of the injured students had been injured by an ampoule and the majority of injuries occurred in the treatment room. Most of the students had washed their injury with antiseptic solution and 84% had not told anyone about their injury. While 86.5% of the students threw away used needles in the special sharps containers disposal box, 89.4% also stated that they always recapped used needles. Almost all the students had received the hepatitis B vaccine. Only 14% of the students stated that they always wore gloves. Conclusions: This study shows that a significant percentage of nursing and midwifery students receive NSSIs. It is very important to frequently review information about preventive measures so that the students practise them during clinical practise every semester. Moreover, the instructors should monitor if the students are taking the necessary preventive measures without fail.     

Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi-centre cross-sectional study

Yamazhan T., Durusoy R., Tasbakan M.I., Tokem Y., Pullukcu H., Sipahi O.R., Ulusoy S. & Turkish Nursing Hepatitis Study Group (2011) Nursing students' immunisation status and knowledge about viral hepatitis in Turkey: a multi‐centre cross‐sectional study. International Nursing Review 58 , 181–185 Background: The aims of this multi‐centre cross‐sectional survey were to detect Turkish nursing students' level of knowledge on viral hepatitis, to evaluate their rates of exposure to blood and to find out their hepatitis A (HAV), hepatitis B (HBV) vaccination status. Methods: This multi‐centre cross‐sectional study was conducted in 14 nursing schools located in the seven geographical regions of Turkey. A questionnaire composed of 47 questions on socio‐demographic factors, level of knowledge on HAV, HBV, hepatitis C (HCV) immunisation status, exposure history and attitudes was applied to the study group. Results: A total of 1491 third‐ and fourth‐year nursing students participated with an 89% response rate. The mean age of the participating students was 21.4 ± 1.3. Their mean knowledge score was 23.7 ± 4.6 (71/100) and was significantly higher in fourth‐year students than third‐year students. There were significant differences in mean scores among nursing schools. Among the participants, 85.3% had received HBV vaccine and 9.1% had received HAV vaccine. The percentage of students who signify themselves at increased risk of acquiring viral hepatitis was 97.3%. Of the students, 28.1% had sustained a needle‐stick injury and 5.4% had experienced conjunctival exposure to blood. Conclusions: Curriculum differences among nursing schools have a significant effect on nursing students' level of knowledge. For this reason, nursing schools should organize HBV immunisation programmes for their students to increase vaccination coverage.     

Needlestick and sharps injuries in the nursing student population

Needlestick injuries (NSIs) and sharps injuries are a potential source of harm. Such injuries can cause considerable distress and have an economic effect on both the person who is injured and the healthcare organisation. Although data regarding trained nurses are more plentiful, there is a dearth of published information and research on the incidence and causes of NSIs and sharps injuries in the nursing student population, especially in the UK. This article provides an overview of the available evidence. There is a need for better education of nursing students and more effective supervision in relation to NSIs and sharps injuries.     

Sharps injuries and job burnout: A cross-sectional study among nurses in China

The present study investigated the relationship between sharps injuries and job burnout in nurses. Sharps injury questionnaires and the Maslach Burnout Inventory (MBI) questionnaires were used to investigate and analyze job burnout among 468 nurses, of which 458 effective questionnaires were collected, for a response rate of 97.86%. A total of 292 nurses had at least one sharps injury (63.76% of the 458 nurses). The dimension scores were higher for injured nurses compared with non‐injured nurses. The difference between the dimensions of emotional exhaustion and depersonalization for nurses with sharps injuries was statistically significant (P < 0.05). A rank correlation analysis showed that these two dimensions had a positive correlation with sharps injuries (r = 0.69–0.78). The prevalence of sharps injuries in nursing is associated with depersonalization, as measured by the MBI. Nursing administrators should pay more attention to clinically burned‐out nurses, and provide more opportunity to nurses for training and education to reduce the prevalence of sharps injuries.     

Organizational risk management and nurses' perceptions of workplace risk associated with sharps including needlestick injuries in nurses in New South Wales, Australia

This study aimed to determine nurse reported organizational risk management and nurses' perceptions of workplace risk associated with sharps-related injuries. A cross-sectional survey was carried out on a sample of nurses from the New South Wales Nurses' Association, Australia in 2007 (n =7423), and there were 1301 eligible participants. Overall, 73% participants reported that organizational policies were followed in the event of a "sharps including needlestick" injury. Participants reported working in sharps safety oriented organizations, routine hepatitis B vaccination, sharps disposal containers at point-of-use locations and availability of safety engineered devices in their organizations. Sharps including needlestick injury data were not routinely provided to staff, many nurses reported recapping and just one-third had recently attended sharps injury prevention training. Nurses' perceptions of risk associated with sharps including needlestick injury were variable. Health-care organizations are responsible for provision of safe workplaces and work practices, policies, workplace culture and prevention strategies, and appropriate responses when nurses are injured. These results have been used to propose recommendations to improve some of these risk management strategies.     

Reducing needlestick injuries: a review of a community service

Community nurses provide care to patients in a variety of settings; for example, health centres, community hospitals, patients' homes, and residential and nursing homes. Administering intramuscular (IM)injections to patients in the community is an everyday activity for many nurses in clinical practice. A great deal of problems related to being 'sharps safe' are common to both community nurses and hospital staff. There had been a reported six needlestick injuries (NSIs) from community clinics administering depot IM injections, which required a review. An audit of practice was undertaken in clinics administering depot injections. The audit was undertaken to monitor compliance in sharps management and investigated how community nurses were administering IM injections. The review highlighted a lack of resources, gaps in knowledge and training deficits. The infection prevention and control nurses worked hard to improve practices and procedures. After a year, there had been a significant reduction in NSIs.     

Long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan: A national survey

BackgroundNeedlestick and sharps injuries are prevalent work-related injuries among nurses. Safety devices prevent only one-quarter of related injuries. More studies of modifiable risk factors are needed.ObjectivesTo examine whether long work hours and chronic insomnia are associated with needlestick and sharps injuries among hospital nurses in Taiwan.DesignCross-sectional survey.Settings/participantsThis analysis included 19,386 full-time bedside nurses working in 104 hospitals across Taiwan.MethodsParticipants filled out an anonymous questionnaire from July to September 2014. Chronic insomnia, needlestick injuries, and sharps injuries during the past year were each measured by a yes/no question. Multivariate logistic regression models were applied to examine the effects of long work hours and chronic insomnia on needlestick and sharps injuries, given with control for sex, marital status, educational level, age, years of practice, work unit, and hospital level in the model.ResultsMore than 70% of study nurses worked long hours during the previous week (>50 h: 27.5%; 41–50 h: 43.2%), and 15.5% of nurses reported chronic insomnia. The percentage of sharps injuries (38.8%) was higher than that for needlestick injuries (22.4%) during the previous year among nurses. After adjusting for potential confounders, logistic regression yielded significant results showing that those who worked 41 to 50 h per week, >50 h per week, and had chronic insomnia were 1.17 times (95% C.I. = 1.04–1.32), 1.51 times (95% C.I. = 1.32–1.72), and 1.45 times (95% C.I. = 1.25–1.68) more likely to experience needlestick injuries, and 1.29 times (95% C.I. = 1.17–1.42), 1.37 times (95% C.I. = 1.23–1.53), and 1.56 times (95% C.I. = 1.37–1.77) more likely to experience sharps injuries, respectively, than those who worked fewer hours and did not have insomnia.ConclusionsThis nationwide nurse survey showed that high rates of needlestick and sharps injuries persist in hospital nurses in Taiwan. The common problems of long work hours and chronic insomnia increase the risk of these injuries. We suggest that hospital managers follow regulations on work hours and optimize shift schedules for nurses to decrease related injuries.     

Association of overtime work and obesity with needle stick and sharp injuries in medical practice

BACKGROUNDNeedle stick and sharps injuries (NSIs) may cause infections among medical personnel. Obesity and overtime work among medical personnel increase the incidence of work injuries.AIMTo investigate whether overtime work and obesity increase the risk of NSIs.METHODSThis cross-sectional study used the data of 847 hospital personnel, including 104 doctors, 613 nurses, 67 medical laboratory scientists, 54 specialist technicians, and nine surgical assistants. Of them, 29 participants notified the hospital of having at least one NSI in 2017. The data collected included age, overtime work, body mass index, medical specialty such as doctor or nurse, and professional grade such as attending physician or resident. The χ² and Fisher’s exact tests were used to compare categorical variables. Multiple logistic regression analysis and the Sobel test were used to assess the risk of NSIs.RESULTSOvertime work, body weight, and medical specialty were significantly associated with NSIs (P < 0.05). After adjustment for risk factors, heavy overtime work was an independent risk factor for NSIs, and healthy body weight and nursing specialty were independent protective factors against NSIs. After adjustment for risk factors, medical personnel with healthy body weight has half as many NSIs as those with unhealthy body weight; the proportion of NSIs in doctors with healthy body weight was 0.2 times that in doctors with unhealthy body weight; the proportion of injuries among residents was 17.3 times higher than that among attending physicians; the proportion of injuries among junior nurses was 3.9 times higher than that among experienced nurses; the proportion of injuries among nurses with heavy overtime work was 6.6 times higher than that among nurses with mild overtime work; and the proportion of injuries among residents was 19.5 times higher than that among junior nurses. Heavy overtime work mediated the association of medical specialty with NSIs.CONCLUSIONIn addition to promoting the use of safety needles and providing infection control education, managers should review overtime schedules, and medical personnel should be encouraged to maintain a healthy weight.     

Characteristics of dog bites among nursing students and knowledge about their emergency management

IOANNIDOU C., GALANIS P., TSOUMAKAS K. & PAVLOPOULOU I.D. (2012) Characteristics of dog bites among nursing students and knowledge about their emergency management. International Nursing Review 59 , 245–251 Background: Dog bites represent a significant health concern leading to a variety of consequences. Nursing students should be appropriately educated in order to manage and help prevent such injuries. Aim: This paper is the first to report the lifetime experience and characteristics of dog bites among Greek nursing students and their knowledge in managing the above injuries. Methods: A cross‐sectional quantitative study was performed using an anonymous questionnaire distributed to first and fourth year nursing students from April though June 2009. A knowledge score based on key questions was set on a scale from 0 to 7, to assess their competence on bite injuries management. Results: Of 237 nursing students recruited, 56 (23.6%) had experienced a dog bite. Men outnumbered women as dog bite victims [n = 15 (39.5%) vs. n = 41 (20.6%), P = 0.012]. Mean age at the attack was 11.1 (standard deviation = 5.6) years and legs sustained the majority of injuries (n = 31; 55.4%). Most bites (n = 39; 69.9%) involved a dog known to the victim, were provoked (n = 30; 53.6%) and occurred in a public place (n = 35; 62.5%). Ten (17.9%) of the victims sustained a moderate or severe injury. The majority (67.9%) of students answered correctly to less than or equal to three out of seven key knowledge questions. After multiple linear regression analysis, previous educational course attendance was the only factor associated with increased score (b = 0.48, standard deviation = 0.17, 95% confidence interval = 0.12–0.84, P = 0.009). Conclusions: Dog bites were common and presented characteristic patterns among nursing students, but knowledge in their management was suboptimal. Improved education should be provided during undergraduate studies.     

护理专业实习学生锐器伤发生状况的调查与分析

目的调查实习学生锐器伤发生的原因、处理及防护,了解护理职业安全教育状况。方法运用自行设计的调查表对随机抽取的180名实习学生进行问卷调查。结果实习期间锐器伤的发生率为98.89%,实习期间个人受伤最大值为21次;伤后接种乙肝疫苗的只有19.66%;在医院得到防护指导为62.78%,在学校为13.33%。结论实习学生锐器伤发生率高,影响了学生的身心健康。认为增加职业安全教育势在必行,通过培养教师防护理念,积极预防接种乙肝疫苗,提高实习学生的防护能力,以减少锐器伤的发生机率。     

New needlestick law means take steps now

To comply with requirements from the Occupational Safety and Health Administration and a new federal law, you'll need to take steps to prevent and track needlestick injuries: The Needlestick Safety and Prevention Act requires you to keep a sharps injury log listing where and how the injury occurred, and the type and brand of device used. Review data to spot trends in needlestick injuries caused by equipment design flaws and behavior patterns. ED staff must be trained annually in needlestick injury prevention, including proper disposal of sharps, universal precautions, and what to do if a needlestick occurs. To enforce universal precautions, give staff verbal and written warnings and role-model appropriate behavior.     

Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study

Scand J Caring Sci; 2011; 25; 185–193
Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study Aim: To study the epidemiology of unintentional injuries in a population of 21 000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier. Method: This is a retrospective epidemiologic cross‐sectional study based on a 1‐year data set of all the 1753 registered injury events from a well‐defined population. Result: The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65–74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11 569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed‐days for trauma in all ages (0–102 years). Conclusion: Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40–50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.     

30名医务人员职业暴露调查分析

目的了解医务人员职业暴露情况,探讨职业暴露的危险因素,制定有效防范措施。方法采用安徽省医院感染管理控制中心《医院感染监控管理系统》对2007年1月～2011年12月医务人员职业暴露案例进行分析。结果 2007年1月～2011年12月全院共发生职业暴露30名,护士发生锐器伤的概率最大,占90%;引起锐器伤最常见的原因是由操作者不小心刺伤自己,占93.33%;暴露源主要为乙型肝炎、丙型肝炎;医院共30名医务人员发生锐器伤职业暴露后经过预防措施的实施,进行了6个月的临床医学观察后,未发生1例感染。结论临床医务人员在医疗护理过程中易发生锐器伤职业暴露,应加强医务人员岗前培训,增强职业防护意识,按照操作常规进行规范安全的操作,可有效防范控制职业暴露及暴露后感染。     

Adverse events encountered during clinical placements by undergraduate nursing students in Spain

BackgroundDuring clinical placements, nursing students are exposed to adverse events generated by the clinical tasks they must perform.ObjectivesTo describe the profile of adverse events encountered and the risks facing nursing students in clinical practice, as well as the severity and incidence of these events.DesignObservational retrospective longitudinal study.SettingClinical placements of undergraduate nursing students from the University of Málaga, in hospitals and primary health care.ParticipantsA total of 4284 undergraduate nursing students, enrolled during seven consecutive years (2011–2018).MethodsStudy data were obtained from students' notifications of adverse events during their clinical placements. The form for making this notification is available online, in the virtual campus for the practicum and notification is mandatory.ResultsA total of 1638 reports of adverse events were made during the study period. The adverse events most commonly reported were clinical accidents, followed by sharp and needle-stick injuries, and medication errors. By clinical settings, adverse events occurring in critical care were most frequently reported (35.9%). By the severity of the event, the largest proportion (32.4%) were classified as serious. By the risk of recurrence, 49.8% of the events reported were classified as accidents that “could happen again at some time”. In this respect, there were significant differences among the respondents, with fourth-year students reporting up to four times more events of this type than second and third-year students (p < 0.001).ConclusionsNursing students are subject to clinical safety-related events during their practices, mostly concerning medication errors and sharps and needlestick injuries. The pattern of these events changes over time, as students evolve in their competences. To improve clinical safety competencies among student nurses, priority attention should be paid to medication management, dose calculations and reactions to situations of aggression and violence in healthcare settings.     

Empathy: the effects of undergraduate nursing education in Turkey

OZCAN C.T., OFLAZ F. & SUTCU CICEK H. (2010) Empathy: the effects of undergraduate nursing education in Turkey. International Nursing Review Aim: To evaluate the empathic skills and the empathetic tendency of nursing students throughout their years of undergraduate education. Background: Empathy is a major component of the relationships between patients and nurses, and is an observable and teachable skill that nurses are claimed to possess. Methods: A cross‐sectional study was designed to determine the differences in the empathic skills and tendency of nursing students in the successive years of undergraduate nursing education. A longitudinal study was also designed to evaluate the changes between the beginning and the end of the nursing education in the same group. All the registered students were asked to participate in the study. The total population was 466 nursing students of whom 438 participated (94%) in the cross‐sectional study and 81 in the longitudinal study. The Empathic Communication Skills Scale (ECSS) and the Empathic Tendency Scale (ETS) were used to collect data. Findings: An increase in the ECSS and a decrease in the ETS were observed in both the cross‐sectional and longitudinal studies. Comparing the years, fourth‐year students have higher empathic skills level, whereas newly registered students have a higher empathic tendency score (P < 0.05). Conclusions: The findings have shown that empathic skills developed during undergraduate nursing education. However, empathetic tendency has shown a decline during these educational years. The decrease in empathetic tendency during undergraduate education should be taken into account, and educators and researchers should consider possible reasons for this outcome. Further research is indicated.     

Hepatitis B and C seropositivity among nursing students at a Turkish university

IRMAK Z., EKINCI B. & AKGUL A.F. (2010) Hepatitis B and C seropositivity among nursing students at a Turkish university. International Nursing Review 57 , 365–369 Background: Viral hepatitis infections are major health problems, which are especially prevalent in developing countries. In particular, health care workers are at high risk for contracting viral hepatitis. Therefore, preventive measures to minimize occupational exposure to blood borne pathogens are needed to protect both health care workers and nursing students. Objectives: To determine the prevalence of Hepatitis B and C infections and risk factors among nursing students. Methods: Venous bloods were obtained from nursing students and were serologically tested using the ELISA method. A questionnaire form was also used to obtain data related to demographic and socio‐economic characteristics of the participants. Results: 0.7% of the nursing students were serologically positive for HBsAg, 17.0% for Anti‐HBs and 7.5% were positive for Anti‐HBc (IgG). No statistical relationship was determined between all independent variables and the results of serologic tests.     

Needlestick and sharps injury prevention

Every day while caring for patients, nurses are at risk to exposure to bloodborne pathogens potentially resulting in infections such as HIV or hepatitis B and C. These exposures, while preventable, are often accepted as being a part of the job. In the United States, needlestick injuries have begun to decrease from an estimated one million exposures per year in 1996 to 385,000 per year in 2000. This decline has resulted from the protections afforded by the Occupational Safety and Health Administration's (OSHA) Bloodborne Pathogens Standard. Reasons for the success in decreasing needlestick and sharps injuries may be attributed to the elimination of needle recapping and the use of safer needle devices, sharps collection boxes, gloves and personal protective gear, and universal precautions. The prevention of needlestick injuries has made slow progress over the past 20 years since the HIV epidemic drew attention to the deadly nature of health care work and to protection of health care worker health and safety. In Africa, where the AIDS virus originated and where the prevalence of the human immunodeficiency virus (HIV) among hospitalized patients is highest in the world, attention has been directed only recently at protecting health care workers. Nurses, especially those infected from a preventable exposure, have been at the forefront of advocacy for prevention. This article includes a review about the hazard of exposure to bloodborne pathogens and epidemiology of occupational infection. The author discusses how to apply standard methods of occupational health and industry hygiene using the hierarchy of controls framework to prevent exposure to blood, and discusses evidence-based prevention and efficacy of particular control measures. Legislative progress and implementation of enforceable policy to protect health care workers is outlined.