Occupational infection and needle stick injury among clinical laboratory workers in Al-Madinah city, Saudi Arabia

Clinical laboratory workers are subjected daily to occupational hazards that include infections from biological samples and contaminated equipment [1]. For example, literature showed that workers at clinical laboratory are at increased risk of acquiring viral infections such as hepatitis viruses (HBV and HCV), human immunodeficiency viruses (HIV), Middle East Respiratory Syndrome (MERS-CoV), and others [2, 3]. In addition, bacterial occupational infection has been shown to be high among clinical laboratory workers and other health care providers [4‐6]. For example, in a study that was conducted in the United Kingdom, clinical laboratory workers were at about seven times higher risk of acquiring tuberculosis infection in reference to the general population [7].

One of the major sources of infection among health care professionals is needlestick injuries [8, 9]. According to the literature, needlestick injury is responsible for the majority of hepatitis and HIV infections among health care professionals. In addition, the majority of these infections occur in developing countries [10]. Analysis of needlestick injuries showed that injuries could happen during all steps of needle use procedures [8]. However recapping of the needle, work load and lack of training, and not following safety precautions are among major risk factors [11‐13]. Requiring workers to follow procedures and practices related to infection control, injury prevention and the use of protective equipment can significantly reduce infections and needlestick injury [14, 15].

The aim of the current study is to investigate self-reported frequency of occupational infection and needlestick injury among the clinical laboratory workers in Al- Madinah. In addition, factors that are associated with these incidences were also examined.

AL-Madinah city, the second holiest site in Islam after Mecca, receives more than 10 million pilgrims each year, who come from all the world. The city provides health services to pilgrims and residents through 10 major hospitals and several medical centers. The considerable diversity of patients and heavy load highlight the importance of adopting good practices and safety protection measures to limit the spread of diseases in the city. Therefore, this study was designed to examine the self-reported occurrence of needlestick injuries, safety practices (i.e. recapping), and occupational infection among laboratory workers in Al-Madinah. The results of the current study can be used for interventions that target the enhancement of biosafety measures among Al-Madinah clinical laboratory workers.

A total of 234 medical laboratory workers was recruited to participate in the study. The majority (Table 1) of participants were young (57.7%, age range: 18–30), males (62.8%), married (55.6%), belong to governmental clinics (56.4%), bachelor degree holder (71.4%), have a specialty in clinical laboratory sciences (74.4%), works as technicians (60.3%) and received training on laboratory safety (65%). About 40% have less than 3 years of experience, whereas 27.4% have between 4 and 6 years of experience (Table 1). The sample is well distributed according different branches of laboratory sciences that include clinical chemistry (30.3%), hematology (42.3%), histology (11.5%) and microbiology/immunology (15.8%). All participants were vaccinated against HBV as this a requirement by health law in Saudi Arabia before employment in medical laboratories.

The results showed that about 24% of the sample had experienced a needlestick injury. The results showed that the needlestick injury was associated with private clinics (P < 0.05) and lack of training on biosafety (Table 2). The participants were asked about capping needle directly after use. Approximately, 49% reported that they always do that, whereas 15% reported doing that most of the times (Table 3). Recapping needle after use, was associated with governmental clinics (P < 0.01), technician/residency staff (P < 0.01) and lack of training (P < 0.05, Table 3). Table 4 shows the incidence of occupational infection among participants. The incidence was about 33% and it was associated with college degrees (P < 0.05) and training on biosafety (P < 0.05, Table 4).

Figure 1 shows the awareness of participants about disinfection procedures and infection routes. The results showed that the majority of participants reported excellent to very good awareness levels (> 80%).

In this study, the incidence of occupational infection and needlestick injury among clinical laboratory workers in Al-Madinah city was investigated.

With respect to the self-reported frequency of needlestick injury, approximately 24% of the sample had such experience during their career period. This rate is comparable to what was reported in some previous studies [16‐18]. For example, an incidence rate of 22.4% sharp injuries over a period of 12 months was reported in a cross-sectional study that was conducted in Dominican Republic [16]. In an Egyptian cross-sectional interview-based study, about 36% of participants reported exposure to at least 1 needlestick injury during the past 3 months [18]. However, higher frequencies (63–73%) were reported in cross-sectional survey-based studies that were conducted in Bosnia [19] and Afghanistan [20] and include the whole career period. Needlestick injuries reported in this study could be due to what was reported by the participants that they always (49%) recap needle after use, whereas 15% reported doing that most of the times. Recapping needle after use was associated technician/residency staff and lack of training. In a Poland study, 64% of respondents occasionally recap needles after injections [21]. In Morocco, 51% reported recapping needles after use [22]. In a review that was conducted by De Carli and colleagues [8], issues related to management of sharp disposals, needle recapping, and the transfer of sampled blood from syringes into tubes account for the majority of needlestick injuries. Thus, behavior of medical staff plays an important in sharp injuries [23]. Needlestick and sharp injuries can be prevented by applying educational and biosafety training programs and needle protective devices [24, 25]. The finding of the present study that needlestick injuries were strongly associated with the lack of training on biosafety and private clinics confirmed the importance of education in reducing sharp injuries in medical laboratories. Finally, the results showed that needledstick injuries were less frequent in governmental clinics and recapping was performed more frequently. Thus, additional factors seem to contribute to needlestick injury, such as workloads and adherence to safety guidelines that are expected to differ in governmental and private clinics. More studies are required to determine the exact factors that contribute to the observed high frequency of needlestick injury among Al-Madinah clinical laboratory workers.

The results showed that approximately 33% of participants experienced occupational infection during their career period. Previous studies have shown increased risk of clinical laboratory workers to diverse types of infection from their work places [26] that include blood borne pathogens (HBV, HCV, HIV), respiratory illnesses (MERS-CoV, influenza viruses, Tuberculosis) [27] and skin infections [28]. In a cross-sectional survey study that was conducted in clinics from 10 Moroccan cities, 58.9% of the subjects underwent at least one occupational blood exposure [22]. The results showed an association between occupational infection and college degree holders and training on biosafety.

The results showed that > 80% of the sample reported very-good to excellent knowledge regarding infection routes and disinfection procedures. Thus, other factors apart from education are likely to play a role in determining incorrect behaviors such as the adherence to infection control guidelines. However, the association between needlestick injury and occupational infection with lack of training on biosafety highlights the importance of training in reducing such biohazards. Previous studies have pointed to the effectiveness of the adherence to infection control guidelines, use of injury prevention devices and biosafety educational programs in the prevention of occupational infection and injury [29, 30].

In this cross-sectional study, we asked the participants if they have ever experienced needlestick injury or occupational infection. To have a better assessment of the current situation, conduction of a longitudinal study is strongly recommended where the incidence of such biohazards can be accurately measured. Inclusion of more questions in the assessment such as how often the participants perform phlebotomy and whether they use needlestick prevention devices are strongly recommended. Other limitations include the validity of key measures such as recall bias and social desirability related to recapping practices, selection bias and the data were not adjusted for confounder factors.

In conclusion, the frequency occupational infection and needlestick injury among clinical laboratory workers in Al-Madinah was relatively high as self-reported by participants. Strict implementation of biohazard guidelines in the health care settings and the use of needlestick prevention devices are recommended to reduce the risk of occupational health infections.