Elsevier

Annals of Epidemiology

Volume 17, Issue 12, December 2007, Pages 988-992
Annals of Epidemiology

Needlestick Injuries Among Nurses of Fars Province, Iran

https://doi.org/10.1016/j.annepidem.2007.07.106Get rights and content

Purpose

A prevalence survey was performed to estimate the magnitude and predictors for needlestick injury (NSI) in nurses of Fars province hospitals.

Methods

Questionnaires were distributed in 52 hospitals to a stratified random sample of 2118 (46.3%) nurses between April and September 2005 to collect self-reported NSI in the past 12- months.

Results

Of the 1555 nurses who returned a completed questionnaire, 49.6% (95% confidence interval [95 CI] 47.1%–52.1%) recalled at least one sharps injury, of which 52.6% were classified as NSI. Just over one fourth (26.3%; 95 CI 24.1%–28.6%, 409/1555) of respondents sustained at least one NSI, 75.6% (95 CI 71.1%–79.6%) recalled having sustained between 1 and 4 injuries in the past 12-months, of which 72.2% involved a hollow-bore needle and 95.1% of injuries involved fingers. Predictors of NSI included being a registered nurse (odds ratio [OR] 1.6, 95% CI 1.1–2.3) or midwife (OR 2.4, 95% CI 1.4–3.9) compared with nurse managers, being employed in a hospital located in other cities smaller than Shiraz (OR 1.4, 95% CI 1.1–1.8). Nurses who reported a previous contaminated NSI were less likely to sustain a further injury (OR 0.3, 95% CI 0.2–0.4).

Conclusion

The prevalence of NSI in Iranian nurses is high, with the majority of injured staff having sustained up to 4 NSIs in a 12-month period. Nearly all NSIs were high-risk injuries involving a hollow-bore needle. Providing nursing staff with safety-engineered devices, including retractable syringes when hollow-bore needles are to be used, will be an important step toward reducing our NSI epidemic.

Introduction

The World Health Organization has identified that 16 billion healthcare injections administered annually in its developing and transitional member states that injections are unnecessary (1). Unless this level of hypodermic needle use is reduced, needlestick and sharp injuries (NSIs) will not only remain a potentially life-threatening occupational injuries for healthcare workers (HCWs), but NSI will increase in frequency. Presently, countries in which the healthcare system has low or varying resources have a prevalence of NSI in HCWs ranging from high to epidemic; 27% to 31% of HCWs in Nigeria (2) reported sustaining an NSI, 35.6% of HCWs in Egypt (3), 63.0% in north India (4), 87.3% to 93.2% in Taiwan (5), and 82.0% in China (6). Student nurses are not protected from NSI, with endemic rates reported in north India (3) at 48.1%, 61.9% in Taiwan (7), and 71.1% in Iran (8).

The probability of a hollow-bore needle being contaminated with a life-threatening infection is high in these countries because of their endemic levels of bloodborne pathogens. The model developed by Kane et al. (9) applied conservatively to world census data identified that unsafe injection practices could result in 8 million to 16 million persons acquiring hepatitis B virus (HBV), 2.3 million to 4.7 million hepatitis C virus (HCV), and 80,000 to 160,000 human immunodeficiency virus (HIV) infections. In Taiwan the proportion of patients with active HBV infection was 16.7%, up to 12.7% of patients have HCV infection, and up to 0.8% HIV infection (4). Projections have been made for seroconversions in Egyptian HCWs who sustain an NSI, with 24,004 estimated new HCV infections and 8,717 new HBV infections (5). Estimated seroconversions of HCWs in western Turkey from an NSI is 1.4% for HBV and 7.9% for HCV (10).

We report the first estimates of the magnitude and predictors of NSI in nurses from the Fars province of Iran.

Section snippets

Setting

A cross-sectional survey of nursing staff was conducted in university hospitals in Fars province, which serve as referral centers for about one fourth of all patients in Iran. The Fars province is one of 30 provinces, located in the south of Iran; it has 52 hospitals (17 private and 35 governmental) under the supervision of the Shiraz University of Medical Science. All but two hospitals in the Fars province, both located in the cities of Jahrom and Fasa, were included in the study because

Results

The majority, 77% (95% confidence interval [95 CI] 74.8%–79.0%) of nurses were female whose ages ranged from 18 to 63 years, with a mean age of 31.0 years (± 8.5 years) (Table 1). Female nurses were significantly younger (31.5 ± 7.81 years,, p < 0.001) than male nurses (37.8 ± 9.6 years). Postgraduate period and years of service both ranged from less than 12 months to 40 years (mean: 9.5 years from postgraduate period, 7.0 years for years of service). Male nurses had a significantly longer

Discussion

In the 12 months preceding the study, just over one fourth, 26.3%, of our nursing staff had sustained at least one NSI, of whom 75% had sustained up to 4. We restricted our analysis to a maximum of 4 injuries in the previous 12-month period in an attempt to improve the reliability of recall. In doing so, our NSI rate is a conservative estimate and will be artificially lower than the level documented for Nigeria (2), 31%, Turkey (10), 62%, India (3), 72%, China, 82%, and Taiwan (4), 93.2%,

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