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“A STUDY TO ASSESS THE KNOWLEDGE OF OPERATION

THEATRE STAFF ON PREVENTION OF NEEDLE STICK INJURY


IN SELECTED HOSPITAL IN BANGALORE”

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

ASHLEY SEEGOLAM
MEDICAL AND SURGICAL NURSING
COLUMBIA COLLEGE OF NURSING
BANASWADI
BANGALORE

2011-2012

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES


BANGALORE, KARNATAKA.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR


DISSERTATION

1 NAME OF THE CANDIDATE AND ASHLEY SEEGOLAM


ADDRESS 1STYEAR MSc NURSING
COLUMBIA COLLEGE OF
NURSING, OMBR LAYOUT,
BANASWADI, BANGALORE
560043.

2 NAME OF THE INSTITUTION COLUMBIA COLLEGE OF


NURSING, BANGALORE

3 COURSE OF THE STUDY AND 1st YEAR M.Sc NURSING


SUBJECT MEDICAL AND SURGICAL
NURSING

4 DATE OF ADMISSION 04/06/2010


“A STUDY TO ASSESS THE
5 TITLE OF THE TOPIC KNOWLEDGE OF OPERATION
THEATRE STAFF ON
PREVENTION OF NEEDLE
STICK INJURY IN SELECTED
HOSPITALS IN BANGALORE”
6 Brief resume of intended work:
6.1 Need for study Enclosed
6.2 Review of literature Enclosed
6.3 Statement of problem Enclosed
6.4 Objectives of study Enclosed
6.5 Hypothesis Enclosed
6.6 Operational definitions Enclosed
6.7 Assumptions Enclosed
6.8 Delimitations Enclosed

7 Materials and methods:


7.1 Source of data: operation theatre staffs
working in several hospital in Bangalore.
7.2 Methods of data collection
Research method: Quasi-Experimental
method.
Experimental design: One group pre-test,
post-test design
Sampling of the study: Study will be
conducted in several hospitals in
Bangalore.
Sampling Technique: Purposive Sampling
Operation theatre staffs: 50 operation
theatre staffs.
Setting on the study: Study will be
conducted in several hospitals in
Bangalore.
7.3 Does the study require any
interventions or investigations to the
patients or other human being or animals?
Yes, intervention as planned teaching
program on prevention of needle stick
injury among operation theatre staffs
7.4 Has ethical clearance been obtained
from your institution?
Yes ethical committee’s report is here with
enclosed.

8 List of reference Enclosed


BRIEF RESUME OF THE INTENDED WORK
Introduction
“Illness is the doctor to whom we pay most heed; to kindness, to knowledge, we make

promise only; pain we obey”.

Marcel Proust

In the past, percutaneous injuries and mucocutaneous exposures were considered

to be accepted occupational hazards for surgeons. Although the potential for injury,

exposure and contraction of blood borne disease was well known, there were no attempts

to reduce risk of such events. When HIV was described in 1981 we started to pay greater

attention to health worker safety in the operation room. In 1983 the center for disease

control and prevention recommended “caution” when handling body fluids from patients

suspecting of having AIDS. Initially HIV and AIDS were considered to be rare and

confined to a particular group of high risk.

The inaccurate notion changed rapidly as the diseases reached epidemic

proportions and by 1987 the CDC recommended universal precaution which states that

body and body fluids precaution which be used with all patients. It was at this time that

CDC made their first recommendations for the use of appropriate barrier protection and

against reheating of contaminated needles. In 1991 the occupational safety and health

administration required the use of universal precaution and the enactment of the blood

borne pathogen standard.

The operation room environment is unique because of the carefully orchestrated

team approach to surgical care. Surgeons, scrub nurses and operation room technicians

work very closely together handling the same instruments in a confine space.

Consequently surgeons and scrubs are injured in similar ways with similar equipments
and not infrequently by each other. At team approach to safety in operation room is

critical if injury is to be reduced.

Increase in the incidence of deadly infections due to greater exposure to micro-

organisms and viruses that cause blood-borne diseases, such as the human

immunodeficiency virus (HIV) and the Hepatitis B and C viruses, has led the medical

community to initiate efforts to prevent and limit exposure among health care workers.

Needle stick injury (NSI) means the par literal introduction into the body of healthcare

worker, during the performance of their duties, of blood or other potentially hazardous

material by a hollow bore needle or sharp instruments, including, but not limited to,

needles, lancets, scalpels, and contaminated broken glass.

The World Health Organization defines ‘a safe injection’ as one that does not

harm the recipient, does not expose the provider to any avoidable risk, and does not result

in any waste that is dangerous to the community. Irrational and unsafe injection practices

are rife in developing countries. More than 80% of the needle stick injuries can be

prevented through the use of safety devices and effective safety programs. Needle stick

injuries can be prevented by applying “Universal precautions” as a safety measure.

Potential exposures are not limited to needle sticks alone, because manipulation of

other sharp instruments or mucous membrane exposures to infected bodily fluids also can

result in the transmission of infectious diseases. Quantifying the precise risk for disease

transmission following mucocutaneous exposures is difficult because many go

unreported. House staff; for example, fail to report between 60% and 95% of exposures.
Even though the risk of injury per use is low, so many needles are used in health

care settings that even a very low injury rate translates into an imposing number of

injuries.

The World Health Organization defines ‘a safe injection’ as one that does not

harm the recipient, does not expose the provider to any avoidable risk, and does not result

in any waste that is dangerous to the community. Irrational and unsafe injection practices

are rife in developing countries. More than 80% of the needle stick injuries can be

prevented through the use of safety devices and effective safety programs. Needle stick

injuries can be prevented by applying “Universal precautions” as a safety measure.

The operation theatre is, is where needle stick injuries and blood and blood fluid

exposure occur with regular frequency. Up to a fifth of all health care associated sharp

injuries occur in the OT, and therefore it is logical to suppose that surgeons suffer from

occupational related NSI, while at work. It is estimated the surgeon in practice for 10

years has a 95% chance of suffering from sharp injuries, most of which is self inflicted.

Measure such as use of blunt needles, using diathermy to cut instead of knife has been

suggested to avoid injuries among surgeons and surgical nurse.

6.1 Need for the study

“In the sick room, ten cents' worth of human understanding equals ten dollars' worth of

medical science”.

Martin H. Fischer

The occurrence of needle stick injury has increased since the past few years as

there has been more and more awareness on the importance of reporting any kind of

injury and to get treated for the same, on the other hand there is a lot of education
required to increase the awareness on prevention of needle stick injury specially in

operation theatre as it affects operation theatre staffs by a margin of almost 30%. The

prevention and management of needle stick injury must be taken up into the curriculum

as an important topic concerning safety of staffs.

Needle stick injuries are a frequent occurrence among healthcare nurses. The

Centers for Disease Control (CDC) estimates that about 600,000 to one million needle

stick injuries occur each year. Unfortunately, about half of these needle stick injuries go

unreported (CDC, 2007). The American Nurses Association (ANA) estimates that of the

numerous needle stick injuries only about 1,000 healthcare workers actually contract an

infection. Besides exposure to blood borne pathogens, the nurse is also at risk for about

20 other infections that can be transmitted through a needle stick, including tuberculosis,

syphilis, and malaria. When a nurse is exposed to a needle stick, the risk of transmitting

various types of blood borne pathogens (i.e. Human Immunodeficiency Virus [HIV],

Hepatitis B, or Hepatitis C) from an infected patient to a health care worker is greatly

increased (ANA, 2007). Despite the growing body of knowledge concerning needle

sticks in practicing nurses, there has been little research focusing on needle sticks in the

student population. The purpose of this study was to determine the incidence of needle

sticks among the nursing students at a small liberal arts university and evaluate the

circumstances around this situation.

Two hundred and forty-three sharp injuries and 22 incidents of blood or body

fluid exposure were encountered in the cumulated 50 months of our study. The incidence

of sharp injuries was the highest among nurses (55%) of all the health care workers, akin

to the global data. An injury rate of nearly 20% among housekeeping staff seems to be
specific to the Indian data. Patient's room followed by Operation Theater appeared to be

common locations of injury in our study. The source of the injury was identified in

majority (64%) of the injuries. A major part of the group was not the primary users of the

sharp (38%). Disposable needles caused nearly half of the injuries. Suture needles

contributed to a reasonable number of injuries in one of the hospitals.

Of 342 injuries, 254 were from known sources and 88 from unknown sources.

From known sources, 37 were seropositive; 13 for HIV, 15 for HCV, nine for HBV. Sixty

six sharp injuries were sustained through garbage bags, 43 during IV line administration,

41 during injection administration, 35 during needle recapping, 32 during blood

collection, 27 during blood glucose monitoring, 24 from OT instruments, 17 during

needle disposal, 16 while using surgical blade, 7 during suturing and 34 from

miscellaneous sources.

Through the 1990s, between 600,000 and 800,000 needle stick injuries (NSI)

were believed to occur annually - on the order of 2000 every day. As a result, more than

1000 HCW contracted serious blood-borne diseases, such as Hepatitis C or HIV.

Majority of people question i.e. 73.3% (n=220) were aware about definition of needle

stick injuries and the diseases caused by them, out of the total 13.3% (n=40) and 10%

(n=30) HCW were unaware of the fact that Hepatitis B and hepatitis C can be transmitted

by this route respectively. Only 6% (n=9) HCW were aware about transmission of HIV

by this route. 82.7% (n=248) healthcare workers had vaccination against hepatitis B. 94%

(n=282) subjects had history of needle stick injuries, in 28.7% (n=86) needle was

sterilized, in 38% (n=115) the needle was used while in 27.3% (n=82) needle was blood

stained. None of the incidence was reported to the hospital authority.


Sharps injury (SI) and blood and body fluid exposure are occupational hazards to

healthcare workers (HCWs). Although data from the developed countries have shown the

enormity of the problem, data from developing countries, such as India, are lacking. The

purpose of this study was to cumulate data from four major hospitals in India and analyze

the incidence of SI and blood and body fluid exposure in HCWs. Four Indian hospitals

(hospital A, B, C and D) from major cities of India participated in this multicentric study.

Data ranging from 6 to 26 months were collected from these hospitals using Exposure

Prevention Information network (EPINet) which is the database created by International

Healthcare Worker Safety Research and Resource Center, University of Virginia. Two

hundred and forty-three sharp injuries and 22 incidents of blood or body fluid exposure

were encountered in the cumulated 50 months of our study. The incidence of Sis was the

highest among nurses (55%) of all the HCWs, akin to the global data. An injury rate of

nearly 20% among housekeeping staff seems to be specific to the Indian data. Patient's

room followed by Operation Theater appeared to be common locations of injury in our

study. The source of the injury was identified in majority (64%) of the injuries. A major

part of the group was not the primary users of the sharp (38%). Disposable needles

caused nearly half of the injuries. Suture needles contributed to a reasonable number of

injuries in one of the hospitals.

According to previous studies the investigator finds out that there is a still lot to

do prevention of needle stick injury in hospitals.

Operation theatre staffs are among the health care workers who are affected the

most by needle stick injury. Hence the investigator is interested in accessing the

knowledge of operation theatre staff on prevention of needle stick injury.


The investigator believes that a good education and system in place, we can reduce the

occurrence of needle stick injury in the operation theatre by more than 80%.

6.2 Review of literature

Review of literature is a systematic search of published work to gain information

about a research topic. Conducting review of literature is challenging and enlightening

experience. Through the literature reviews, researcher generates a picture of what is

known about a particular situation and the knowledge gap that exists between the

problem statement and the research subject problems and lays a foundation for the

research plan.

The literature review was based on an extensive survey of journals, books and

international nursing indicates. A review of research and non research literature relevant

to the study was undertaken which helps to investigation to develop deep insight with the

problem and gain information on what has been done in the past.

A study concerning exposures to blood and bodily fluids in health care workers,

findings revealed that on average 93.7 per 1000 health care employees were exposed

annually. The majority of these exposures were found to occur in nursing personnel, with

35% of total exposures occurring via needle sticks (Goob, Yamada, Newman, &

Cashman, 1999). Gershon and Flanagan (2000) reported that the number of needle stick

injuries in the United States exceeds 500,000 per year, with 1 in 100 involving known

HIV infected needles. This same study identified that the majority of needle sticks

happened in female nurses between the ages of 23 -65. Most of those exposed reported

that this was not their first exposure.


One interesting study conducted by Alam (2002) stated that between 21% and

30% of the workers surveyed were unaware that HIV and Hepatitis C could be

transmitted by needle sticks, and that as many as 70% admitted to having a previous

history of needle sticks.

A seven-year study of the incidence of needle sticks among medical students concluded

that workload and education of safe practice should be taken into consideration (Osborn,

Papadakis, & Gerberding, 1999)

Another study explored how different levels of education and work environment

influenced needle stick exposures in a medical student population, concluding that there

is more risk between the fourth and fifth year of medical training (Deisenhammer, Radon,

& Nowak, 2001). McCarthy and Britton (2000) reported that 27% of the nursing students

they studied experienced exposure to blood borne pathogens through needle sticks. They

suggested that a high risk for non sterile occupational injuries existed because these

students were doing invasive procedures with minimal experience

One study, focused solely on nursing students, determined that uncapping needles

resulted in the highest incidence of injury. The researchers suggested that additional

emphasis should be placed on reporting injuries (Smith, & Leggat, 2005). Knowledge

deficit regarding reporting practices seemed to be a major reason that students do not

report an injury.

One study found that students did not report needle stick injuries due to lack of

knowledge of how to report the injuries (Cervini &Bell, 2005). In another study, Mendias

and Ross (2001) identified that having a clear policy pertaining to reporting and post-

exposure chemoprophylaxis was imperative.


The study of four Indian hospitals on incidence of exposure of healthcare workers

to blood and body fluid: A multicentric prospective analysis. Four Indian hospitals

(hospital A, B, C and D) from major cities of India participated in this multicentric study.

Data ranging from 6 to 26 months were collected from these hospitals using Exposure

Prevention Information network. Two hundred and forty-three sharp injuries and 22

incidents of blood or body fluid exposure were encountered in the cumulated 50 months

of our study. The incidence of sharp injuries was the highest among nurses (55%) of all

the HCWs, akin to the global data. An injury rate of nearly 20% among housekeeping

staff seems to be specific to the Indian data. Patient's room followed by Operation

Theater appeared to be common locations of injury in our study. The source of the injury

was identified in majority (64%) of the injuries. A major part of the group was not the

primary users of the sharp (38%). Disposable needles caused nearly half of the injuries.

Suture needles contributed to a reasonable number of injuries in one of the hospitals.

A study conducted among operation theatre room staff on the efficacy of hands-

free technique in reducing sharp injuries. Wright and colleagues reviewed 249 glove tears

and 70 sharp injuries and reported that only 6%of the injuries occurred during passage of

instruments. The study suggested that even if hands-free technique reduced sharp injuries

during instrument passage between scrub nurse and surgeons, this benefit would only

avoid a small percentage of the total of Sharp injuries during operations.

A randomized prospective study demonstrated a reduction of incidences of glove

perforation with the use of hands-free technique compared with control during 156

caesarian sections. In contrast with a recent study 3,765 operation reported that when

hands-free techniques was judge by the scrub nurse to have been ≥ 75% of the time
during the operation, there was 59% reduction in the incidence in operation with a blood

loss of ≥ 100ml.

A study to assess the knowledge, attitude and practices amongst health care workers on

needle stick injuries in Departments of Holy Family Hospital, Rawalpindi from October

to December 2007. A 20-item questionnaire was provided to three hundred health care

workers including doctors, nurses and paramedical staff from various to assess

knowledge, attitude and practices regarding needle stick injuries. Results were calculated

on the basis of frequency and percentages using. Results showed 282 subjects (94%) had

history of needle stick injuries. Healthcare personnel working in surgery department

(43.3%) were most frequently affected and the commonest place was Emergency room

(42.2%). Hasty work (37.9%) and recapping needles (19.5%) were commonest causes

respectively. Only 49% were in the habit of using gloves for phlebotomy procedures.

21.6% were aware of Universal Precaution Guidelines. 16.7% were aware about their

immune status after being pricked while 82.7% were vaccinated against hepatitis B.

6.3 STATEMENT OF THE PROBLEM

“A study to assess the knowledge of operation theatre staff on prevention of

needle stick injury in selected hospital in Bangalore”.

6.4 OBJECTIVES OF THE STUDY

1. To assess the knowledge of operation staffs regarding prevention of needle stick

injury.
2. To assess the effectiveness of structured teaching program regarding prevention of

needle stick injury among operation theatre staffs.

3. To find out the association between knowledge of operation theatre staff regarding

prevention of needle stick injury and demographic variables.

6.5 HYPOTHESIS

H1: There will be significant increase in knowledge level regarding prevention of needle

stick injury after structured teaching program among operation theatre staffs.

H2: There will be significant the association between knowledge of operation theatre

staffs regarding needle stick injury and selected demographic variables.

6.6 OPERATIONAL DEFINITIONS

1) Knowledge: Refers to correct responses given by nursing students regarding dementia

as measured by knowledge questionnaire.

2) Operation theatre staffs: Refers to nursing staff working in operation theatre selected

hospitals in Bangalore.

3) Needle stick injury: Refers to injury which occurs during the work process from

sharp instruments.

6.7 ASSUMPTIONS

1. The knowledge gain by the operation theatre staffs after the planned teaching program

will be retained and utilized for the prevention of needle stick injury.

2. Acquisition of knowledge regarding prevention of needle stick injury will enable the

operation theatre staffs to adopt a safe practice.


3. Planned teaching program will identify the knowledge and attitude among

demographic variables.

6.8 DELIMITATION

1. The data collection period is limited to 6 weeks

6.9. VARIABLES

6.9.1 Independent variable: of this study is knowledge of operation theatre staffs

regarding needle stick injury.

6.9.2 Demographic variables: of this study are Age, Sex, Religion, previous exposure

to teaching on needle stick injury and Source of information on needle stick injury.

7. MATERIALS AND METHODS

The study is designed to assess the effectiveness of structured teaching program

regarding prevention of needle stick injury among operation theatre staff

7.1. SOURCE OF DATA

Data will be collected from operation theatre staffs of selected hospitals in Bangalore.

7.1.1. RESEARCH DESIGN

Research design adopted for the present study quasi experimental research design.

7.1.2. RESEARCH APPROACH


The research approach used in this study is evaluative approach.

7.1.3. SETTING OF THE STUDY

Selected hospital in Bangalore

7.1.4. POPULATION

Operation theatre staffs.

7.1.5. SAMPLE SIZE

The proposed sample size of the study is 50 operation theatre staffs.

7.1.6. SAMPLING TECHNIQUE

Sampling technique using in this study is simple random Sampling Technique.

7.1.7 SAMPLING CRITERIA

7.1.7. 1 Inclusion criteria

1. Who are willing to participate in this study?

2. Who are present during the period of data collection?

7.1.7.2 Exclusion criteria

1. Those who are on long leave

7.2. METHOD OF DATA COLLECTION

7.2.1. Tool for data collection

Structured questionnaire

7.2.2. Method of data Collection

Method used is self administered pretest and post test


7.2.3. Procedure for data collection

The data will be collected with the prescribed period from selected hospitals in

Bangalore.

 Permission will be obtained from higher authorities.

 Written consent will be taken from the respondents.

 Purpose of the study will b explained to the respondents.

 Knowledge of operation theatre staff on needle stick injury will be assessed by

using self administered questionnaire

 Planned teaching program on needle stick injury will be conducted.

 On the 8th day post-test will be conducted.

7.2.4. DATA ANALYSIS METHOD

7.2.4.1 Descriptive statistics: Frequency, mean, mean percentage, and standard

deviation of described demographic variables.

7.2.4.2 Inferential statistics:

 Paired t’ test to assess the effectiveness of planned teaching program on needle

stick injury

 Chi square test will be used to find out association between selected variables.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED

ON THE PATIENT OR OTHER HUMAN BEINGS OR ANIMALS?

Yes

7.4. HAS ETHICAL CLEARENCE OBTAINED?

YES, ethical clearance certificate is enclosed.


8. LIST OF REFERENCES

1. Rao PH. Report: Hospital waste management--awareness and practices: a study of

three states in India. Waste Management Res 2008; 26:297-303.

2. Jahan S. Epidemiology of needle sticks injuries among health care workers in a

secondary care hospital in Saudi Arabia. Ann Saudi Med 2005; 25:233-8.

3. Watterson L. Sharp thinking. Nursing Stand 2005; 20:20-2.

4. Trim JC. A review of needle-protective devices to prevent sharps injuries. Br J

Nursing 2004; 13:146-53.

5. Mehta A, Rodrigues C, Ghag S, Bavi P, Shenai S, Dastur F. Needle stick injuries

in a tertiary care centre in Mumbai, India. J Hosp Infect 2005; 60:368-73.

6. Kerwat K, Goedecke M, Wulf H. Needle stick injuries. Anasthesiol Intensivmed

Notfallmed Schmerzther 2009; 44:344-5.

7. Smith D R, Mihashi M, Adachi Y. Epidemiology of Needle sticks and sharps

injuries among nurses in a Japanese teaching hospital. J Hosp Infect 2006; 64(1):

44-49.

8. Overview: Risks and prevention of sharp injuries in healthcare personnel.

Workbook for Designing Implementing, and Evaluating a Sharps Injury


Prevention Program. Center of disease control. 2004 [cited January 12, 2008];

Available from: www.cdc.gov.

9. Alam M. Knowledge, attitude and practices among health care workers on needle

stick injuries. Annals of Saudi Medicine 2002; 22: 5-6.

10. Gershon R R, Karkashian C, Felknor S. Universal precautions: an update. Heart

Lung 1994; 23(4):352-358.

11. Needle sticks injuries. Diseases, disorders and injuries [cited January 15, 2008];

Available from:

http://www.ccohs.ca/oshanswers/diseases/needlestick_injuries.html.

12. Gurubachariya D L, Mathura K C, Karki D B.Knowledge, attitude and practices

among healthcare workers on needle-stick injuries. Kathmandu Univ Med J

(KUMJ). 2003; 1(2): 91-94.

13. Calver J. Occupational Health Services. Am J Infect Control. 1997; 25: 363-365.

14. Rajasekaran M, Savignanam G, Thirumalaikolundu-subramainan P. Injection

practices in Southern part of India. Public Health 2003; 117: 208-213.


9 Signature of candidate

10 Remarks of the guide The topic selected for the study is relevant

11 Name and designation (in block MRS.G VANJEENATHAMMAL


letters PROFESSOR
HEAD OF DEPARTMENT
MEDICAL SURGICAL NURSING,
COLUMBIA COLLEGE OF NURSING,
#84/1, 5TH MAIN ROAD, OMBR LAYOUT,
BANASWADI, BANGALORE-43
11.1 Guide MRS.G VANJEENATHAMMAL
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature ----
----
12 12.1 Head of the Department MRS.G VANJEENATHAMMAL

12.2 Signature
13 13.1 Remarks of the Chairman or Relevant
Principal

13.2 Signature