Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study

BMC Infectious Diseases Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study Afia Zafar 1 Faiza Habib 1 Roshan Hadwani 0 Muslima Ejaz 1 Khurshid Khowaja 0 Rozina Khowaja 0 Seema Irfan 1 0 Divisions of Nursing, Aga Khan University Hospital , Karachi , Pakistan 1 Department of Pathology and Microbiology, Aga Khan University Hospital , Karachi , Pakistan Background: Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan. Methods: At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors. Results: During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5%) followed by registered nurses (n = 283; 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002-04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/ 100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and patients visits in clinics (p = 0.01). Conclusion: We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project. - Background Healthcare workers (HCWs) are at direct risk of exposure to blood and other body fluids during the course of their job. Consequently, they are at risk of infection of blood borne viruses including hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) [1]. Occupational exposure to blood can result from percutaneous (needle stick or other sharps injury) and mucocutaneous injury (splash of blood or other body fluids into the eyes, nose or mouth), or blood contact with nonintact skin [2]. Needle stick injury (NSI) is the most common form of occupational exposure to blood which results in transmission of blood borne infections. Numerous modifiable and non-modifiable factors place HCWs at risk of NSIs. The most common reasons are twohanded recapping, and the unsafe collection and disposal of sharps waste. Personnel in areas such as operating, delivery and emergency rooms and laboratories have higher risk of exposure [3]. Cleaners, waste collectors and other employees involved in handling blood-contaminated items are also at risk. Globally in the year 2000 approximately 16,000 HCV, 66,000 HBV, and 1,000 HIV infections occurred in HCWs due to percutaneous injuries [4]. HCV, HBV, and HIV in HCWs attributable to percutaneous occupational exposure were 39%, 37%, and 4.4% respectively [5]. Centers for Disease Control and Prevention (CDC) estimates that approximately 385,000 needles and sharps-related injuries occur every year to HCWs in the United States [6]. Biohazard exposures are often accepted as being a part of the job although majority of these exposures are preventable. In the United States, NSIs decreased from an estimated one million exposures per year in 1996 to 385,000 per year in 2000. This decline resulted from continuous surveillance and implementation of preventive measures. In contrast, in resource limited countries like Pakistan, biohazard exposures and their consequent health impacts are rarely monitored. However higher rates of hepatitis B and C infections have been reported from Pakistan [7,8]. These produce an immense burden on an already compromised health system; hence accurate information regarding the magnitude of NSI in our population is crucial to be able to undertake prevention efforts that would have an overall impact on the quality of health care. Thus, we are reporting for the first time in Pakistan surveillance data of NSIs in HCWs at a tertiary care hospital. Different studies have reported a decline in NSI rate after implementation of multifactorial approaches including safety engineered devices and reusable sharps containment system [9]. Being a developing country, financial constrains do not allow us to utilize these sophistic (...truncated)