PREVALENCE AND RISK FACTORS FOR PERCUTANEOUS INJURIES, BLOOD AND BODY FLUIDS EXPOSURES AMONG NURSES IN THE TAMALE METROPOLIS

ABSTRACT
Exposure to percutaneous injuries and blood/body fluids are serious occupational hazards that contribute to the transmission of a variety of blood borne pathogens. The study was conducted to determine the prevalence and risk factors associated with percutaneous injuries and exposure to patients’ blood and other body fluids among nurses in the Tamale metropolis. A cross-sectional design was adopted for the study. A total population of 572 was targeted with a sample size of 224 nurses obtained for the study. However, analysis was done with a sample size of 215 based on a 96% response rate. The researcher used descriptive and inferential statistics to analyse the data. Results from the study indicate that the prevalence of percutaneous injuries (PIs) and blood/body fluid exposures (BBFEs) in the two hospitals was high (61%). Sex, highest level of education, work experience, availability of Personal Protective Equipment (PPEs) and having a procedure/protocol for reporting, following standard operational protocols, wearing PPEs, working in haste, engaging in improper disposal and reporting accidental exposures all showed statistically significant association (p≤ .05). In conclusion, the prevalence of PIs and BBFEs among nurses in the two hospitals was high. Also some, personal factors, organizational factors and behavioural factors influenced the occurrence of these exposures among the nurses. Heads of the health facilities in the Tamale Metropolis should therefore sensitize their nurses to understand the risks associated with these injuries and exposures to encourage them to comply with the standard precautions.


CHAPTER ONE
INTRODUCTION
Any healthcare worker handling sharp objects or devices such as scalpels, sutures, hypodermic needles, blood collection devices, or phlebotomy devices is at risk of occupational exposure to blood borne pathogens. However, the risk varies across disciplines, with nurses seen to be the most at risk due to the nature of their work (Desalegn, Beyene, & Yamada, 2012). Studies have shown that even though all healthcare workers [HCWs] whose work demand contact with patients are at risk of exposure to sharp injuries and patients’ blood and other body fluids, nurses report majority of these injuries and exposures. This is because nurses are more likely to handle sharp devices and also have more contact periods with patients than other healthcare professionals (Mbaisi, 2013).

Some of these injuries and exposures may result from time pressures leading to nurses working in haste, misunderstandings among health team members, fatigue, inadequate staffing, lack of awareness, reduced attention during procedures, and lack of cooperation from patients (Cicconi, Claypool, & Stevens, 2010). Exposure to blood borne pathogens has been identified as one of the most serious occupational health risks encountered by nurses in the healthcare profession worldwide (Leow,Groen, Bae, Adisa, Kingham, & Kushner, 2012 ; Wicker, Jung, Allwinn, Gottschalk, & Rabenau, 2008).

Background to the Study
Globally, more than 35 million healthcare workers face the risk of percutaneous injuries with contaminated sharp objects every year (Wicker et al., 2008). The Centers for Disease Control and Prevention [CDC] estimated that, 385,000 sharp injuries occurred yearly among hospital workers in the United States (CDC, 2008). It is also estimated that 100,000 of these injuries occur annually in the United Kingdom and 500,000 annually in Germany (Rampal, Rampal, Rosidah, Whye-Sook, & Azhar, 2010).

Percutaneous injuries [PIs] are well known occupational hazards among healthcare workers. They are significant sources of infections with blood borne pathogens among healthcare workers including nurses (Aderaw, 2013). The major source of blood borne infections among hospital workers is through injuries either from needles or other sharp instruments (World Health Organization [WHO], 2011). Percutaneous injury is defined by the CDC (2011) as “a penetrating stab wound from a needle, scalpel, or other sharp object that may result in exposure to blood or other body fluids”.

In the healthcare setting, sharp objects such as needles and ampoules are the most common items causing PIs, and their handling is one of the most performed daily activities. Handling sharp objects therefore represent a major risk for Healthcare Workers (HCWs) and more particularly for nurses (Elseviers, Arias-Guillén, Gorke, & Arens, 2014). Also, a percutaneous exposure occurs when the skin is cut or penetrated by a needle or other sharp object that may be contaminated with blood or other body fluid (CDC, 2009).

Blood and body fluids on the other hand are described as fluid contained in the fluid compartments of the body, they include: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures and body fluids visibly contaminated with blood (Cherie, Allen & Kevin 2010).

Exposure to Percutaneous injuries and blood/body fluids are serious occupational hazards in the transmission of a variety of blood borne pathogens such as; Hepatitis B virus [HBV], Hepatitis C virus [HCV], and Human Immunodeficiency Virus [HIV] among HCWs. The number of these workers annually exposed to sharps injuries contaminated with HBV, HCV, and HIV has been reported to be 2.1 million, 926,000, and 327,000, respectively (Wicker et al., 2008). Blood borne pathogen exposures can result from PIs or through contact of blood and body fluids [BBFEs] with mucous membranes or non-intact skin. These exposures pose a risk of transmission of HIV, HBV, HCV and other pathogens to healthcare workers (Kessler, McGuinn, Spec, Christensen, Baragi, & Hershow, 2011). Studies in Nigeria have shown that occupational injuries and illnesses among healthcare workers are ranked among the highest of any industry though this situation could be reversed or eliminated (Amosun, Degun, Atulomah, Olanrewaju, & Aderibigbe, 2011).

The gravity of workplace risks is seen in the International Labour Organization [ILO] estimates that, among the world’s 2.7 billion workers, at least 2 million deaths per year were due to occupational infections and injuries. The ILO also noted that nearly 4 per cent of GDP could be lost due to work-related diseases and injuries (ILO, 2003). These constitute deaths related to only infectious injuries and diseases. O’Malley et al. (2007) in 2006 conducted an economic analysis of the management costs of occupational exposure to blood and body fluids, including post-exposure prophylaxis in the United States of America. The study revealed that the overall cost ranged from US$ 71 to US$5000.

Apart from the economic factors, these exposures also cause psychological trauma to HCWs. The challenges are further complicated if potential chronic disability is developed leading to loss of employment, denial of compensation claims and even liver disease requiring liver transplant (Moazzam, Salem, & Griffith, 2010). NIOSH (2008) considers exposure to needle stick injuries and infectious diseases as factors leading to occupational stress among most healthcare workers. They are also known to be responsible for psychological distress, burn-out, absenteeism, reduced patient satisfaction and treatment errors among health care workers.

Despite the consequence and negative effects of these exposures among nurses and other HCWs, several reports from both developed and developing countries still show a continued high prevalence of needle stick injuries, sharp injuries and splashes of patients’ blood and body fluids (Seyed & Kaveh, 2009). Some studies further indicated that about three-quarters (40-70%) of these injuries are mostly unreported in developing countries (Habib, Ahmed, & Aziz, 2011).

Sharp injuries are the most common type of percutaneous injury sustained by nurses (Subratty & Moussa, 2007). In a study of US hospitals, the results revealed that nurses accounted for almost half of all reported needle stick injuries (Chen & Jenkins, 2007). This is because nurses are directly at risk of transmission of blood borne pathogens through their handling of contaminated body fluids (Lee, 2009 ; Wicker et al., 2008). In Ethiopia, Alemayehu, Worku and Assefa (2016) indicated that among nurses, midwives and medical doctors, nurses were the most exposed to sharp injuries (28.8%) whiles medical doctors were the most exposed to BBFEs (42%). Similarly, in Saudi Arabia, a 5 year surveillance study also found that most reported injuries involved the nursing staff, followed by doctors, then downstream staff (El-Hazmi & Al-Majid, 2008). A cross-sectional study among nurses in Turkey, Iran and Uganda reported a prevalence rate of 30.1%, 75.6% and 3.94% respectively of sharp injuries in the previous year.

At the local level, a study conducted among nurses at the emergency unit of the Komfo Anokye Teaching Hospital in Ghana indicated that, sharp injuries were very prevalent, with about one-third of respondents reporting four (4) or more injuries in the past 12 months (Lori, McCullagh, Krueger, & Oteng, 2016). This high rate of repeated exposures may put these nurses at a high risk for acquiring serious infection which may result in chronic infectious diseases like HIV, hepatitis B and hepatitis C. If a tertiary facility with all the proper surveillance systems that ensures the safety of their workers could record such high rate of repeated exposures to sharp injuries. It therefore shows that at the lower level care facilities the situation could be worse considering the fact that surveillance systems in most cases are either weak or absent.

Certain work practices such as administering injections, taking blood samples, recapping and disposing used needles, handling trash, and during the transfer of body fluids from a syringe to a specimen container have all been identified as some major activities causing PIs and splash exposures (Lakbala, Ebadiazar, & Kamali, 2012). Despite these levels of exposures, reports still indicate that non-reporting of injuries and exposures are highly prevalent (Irmak, 2012 ; Nasiri, Vahedi, Siamian, Mortazavi, & Jafari, 2010 ; Nsubuga & Jaakkola, 2005).

In developing countries, studies have revealed that occupational infections are mostly less often documented because of the lack of routine surveillance of sharp injuries and blood and body fluid exposures (Phillips, Simwale, Chung, Parker, Perry, & Jagger, 2012). The situation in Ghana is not different as data on occupational exposure to PIs and BBFEs in most health facilities are scarce despite the risk these injuries and exposures pose to nurses and other HCWs.

Statement of the Problem 
Even though there is a national guideline on infection prevention and occupational health and safety practices in Ghana, little is known about the prevalence and risks factors associated with PIs and BBFEs.

Furthermore, studies have shown that occupational injuries occur highest among nurses (Amosun, Degun, Atulomah, Olanrewaju, & Aderibigbe, 2011; Chen & Jenkins, 2007). However, there is little information as to the cadre of nurses mostly affected, this is because majority of the studies mostly focused on all HCWs and just a few actually looked at the different cadre of nurses.

As a result of the lack of data, authorities are mostly unable to estimate the impact of these exposures in other to inform policy. The research was necessitated out of the need to obtain information on the prevalence of these exposures and assess their associated risk factors among nurses in the Tamale Metropolis, Ghana.

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Item Type: Ghanaian Postgraduate Material  |  Attribute: 101 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH110 ($20)  |  Delivery: Within 30Mins.
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