knowledge and practice of needle stick Dr. Gawad AlwabrYemen .pdf

70 © 2018 Indian Journal of Health Sciences and Biomedical Research KLEU | Published by Wolters Kluwer - Medknow
Knowledge and practice of needlestick
injury preventive measures among
nurses of Sana’a city hospitals in
Yemen
Gawad M. A. Alwabr
Abstract:
BACKGROUND: A needlestick injury is an accidental skin‑penetrating stab wound from a hollow‑bore
needle containing another person’s blood or body fluid, leading to infection of diseases transmitted by
blood such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus. The purpose
of this study is to assess the level of knowledge and practice of needlesticks injury prevention
measures and to estimate the incidence of exposure to needlestick injury among nurses working in
the governmental hospitals in Sana’a city, Yemen.
MATERIALS AND METHODS: A cross‑sectional study among a random sample of nurses (n = 259)
were conducted. A pretested structured self‑administered questionnaire was used for data collection.
Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0. (Armonk, NY: IBM Corp).
RESULTS: One hundred and fourteen (44%) respondents had poor knowledge of needlestick
injury preventive measures, 75 (29%) had a fair knowledge, and 70 (27%) had good knowledge.
The knowledge was significantly associated with hospital’s name (P < 0.017). One hundred
and ninety‑eight (76.5%) respondents had a poor practice of needlestick injury preventive
measures, (8.9%) had fair practice, and (14.7%) good practice. There was a statistically significant
association (P < 0.001) between the knowledge and practice. Among all the respondents, 48.6%
were vaccinated against hepatitis B.
CONCLUSION: The practices and knowledge of needlestick injury preventive measures were low
and occupational exposure to needlestick injury was a common occurrence in the study sample.
This needs intensive programs to educate nurses on various aspects of needlestick injury preventive
measures.
Keywords:
Hospitals Sana’a, Knowledge, needlestick injury, nurses, practice, Yemen
Introduction
Health‑care workers (HCWs) are at
risk of various occupational hazards
in the hospital, including exposure to
bloodborne infections.[1]
Injuries from sharp
instruments and splashes of blood and body
fluids place nurses at high risk for many
bloodborne infections including human
immunodeficiency virus (HIV), hepatitis B
virus (HBV), and hepatitis C virus (HCV).[2]
Needlestick injuries are wounds caused
by sharp tools such as blood collection
needles, hypodermic needles, intravenous
cannulas or needles used to connect parts
of iv delivery systems.[3]
Needlestick injuries
are an important and common occupational
injury among HCWs including nurses.[4,5]
Incident needlesticks or sharp injuries in
the hospital setups are the primary routes
of occupational exposure to bloodborne
pathogens.[6]
Due to continue increasing in
the incidence of deadly infections by viruses
Address for
correspondence:
Dr. Gawad M. A. Alwabr,
Department of Biomedical
Engineering, Sana’a
Community College,
Sana’a, Yemen.
E‑mail: alwabr2000@
yahoo.com
Department of Biomedical
Engineering, Sana’a
Community College,
Sana’a, Yemen
Original Article
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How to cite this article: Alwabr GM. Knowledge and
practice of needlestick injury preventive measures
among nurses of Sana’a city hospitals in Yemen.
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Alwabr: Knowledge and practice of needlestick injury preventive measures among nurses
Indian Journal of Health Sciences and Biomedical Research KLEU - Volume 11, Issue 1, January-April 2018 71
that cause bloodborne diseases, the medical community
began to make some efforts to prevent and limit exposure
among HCWs.[7]
The World Health Organization
estimates that about 2.5% of HIV cases and 40% of HBV
and HCV cases among HCWs worldwide are the results
of these exposures.[4,8]
Developing countries, which
account for the highest prevalence of HIV‑infected
patients in the world, also record the highest rate of
needlestick injuries.[9]
Percutaneousexposurestobloodandbodyfluidsthrough
contaminated sharp tools are an important occupational
hazard for morbidity and mortality from infections with
bloodborne pathogens among health‑care workers.[3,4,10]
About 40%‑65% of HBV and HCV infections in HCWs
in developing countries are attributable to percutaneous
occupational exposure.[11]
Workplace safety is a very important aspect of
occupational health practice (Hanafi et al., 2011).
Hence, all HCWs should routinely use proper barrier
precautions to prevent skin and mucous membrane
exposure during contact with any patient’s blood or body
fluids that require universal precautions.[12]
The present study was conducted to assess the level of
knowledge and practice of needlestick injury prevention
measures, and to estimate the incidence of exposure
to needlestick injury among nurses working in the
governmental hospitals of Sana’a city, Yemen. This study
will provide essential baseline data to the government
health sector for developing preventive strategies of
needlestick injury.
Materials and Methods
A cross‑sectional study was conducted from
AugusttoOctober2015,amongthenursesingovernmental
hospitals of Sana’a city, Yemen. The study population
included nurses working in the hospitals of (Al‑Thawra,
Republic, Al‑Sabein, Police, and 48th
). All participants
were informed about the design and purpose of the study
and have given their approval with written informed
consent before enrollment into the study. The anonymity
of the participants was maintained throughout the study.
Convenience sampling technique was used. In total, from
the 300 questionnaires distributed, 259 were returned
fully completed, giving a response rate 86.3%.
A pilot study was conducted with a random sample of
20 participants to ensure the feasibility and applicability
of the questionnaire. The pilot study confirmed the
feasibility of the main study. Subsequently, minor
changes were done in the questionnaire for effective
communication among the participants. Those who
participated in the pilot study were excluded from the
study. Face and content validity of the questionnaire was
assessed by three experts in the field of public health.
The reliability of the questionnaire was assessed using
Cronbach’s alpha (0.84). Ethical approval was obtained
from the ethical committee of Ministry of Public Health
and Population, Yemen.
Data were collected using a structured self‑administered
questionnaire containing closed‑ended questions,
which had been designed after an extensive literature
search, to assess the nurses’ knowledge and practices
of preventive measures of needlestick injury, blood and
body fluids exposure. The questionnaire was divided
into four parts. The first part included sociodemographic
characteristics such as age, gender, qualification, years of
experience, and place of work, the second part contained
18 questions seeking to find out the level of knowledge
of the needlestick injury prevention measures, blood and
body fluids exposure diseases with possible responses
of “yes,” and “no” answers. The third part contained 9
questions seeking to find out the level of practice of the
needlestick injury preventive measures, and blood and
precaution measures of body fluids exposure included
the use of gloves, use of protective eyewear, sharp
practices, waste disposal, and patient care equipment.
The fourth part contained 11 questions seeking to the
number of needlestick injury during the past 6 months
and the causes and circumstances surrounding the latest
injury. We also asked whether the nurses had reported
the injury.
The knowledge of the needlestick injury prevention
measures, blood and body fluids exposure diseases
was graded using a scoring system, a score of “one” for
a correct answer and “zero” for an incorrect or “do not
know” answer. This scoring system has been used in an
earlier study.[12]
The practice of the needlestick injury
preventive measures, blood and body fluids exposure
diseases was graded using a scoring system; a practice
that was deemed right when undertaken always. A score
of “one” for a correct answer “always” and “zero” for
an incorrect “never” or “sometimes.” Scores of each
respondent were calculated by adding the scores of
all items of the knowledge and practice. The score
was converted to percentage and level. Scores for each
respondent were summed up and graded as poor <50%,
below average = 50%–59%, average = 60%–69%,
good = 70%–79%, and very good = 80%–100% of the total
scores for knowledge and practice.
Statistical Package for the social sciences(SPSS) version20
was used to analyze the data. The data were sorted,
coded, and computerized, and the descriptive statistics,
including frequency distributions and percentages,
were calculated. Means and standard deviations were
used for the normally distributed quantitative data.

72 Indian Journal of Health Sciences and Biomedical Research KLEU - Volume 11, Issue 1, January-April 2018
Chi‑square test and the P value were used to determine
the relationship between two qualitative variables or
to detect significant differences between two or more
proportions. Statistical significance was set at P < 0.05
for this study.
Results
A total of 259 nurses participated in the study. Among
them, 146 (56.4%) were male and 118 (43.6%) were
female, most of them 178 (68.7%) were in the age
group (<30 years). More than half of the participant,
163 (62.9%), has Diploma degree. One hundred
and nineteen (45.9%) of the participants had been
experienced >5 years, and 156 (60.2) of them had a
training course related to needlestick injury prevention
measures [Table 1].
Table 2 indicates that the participating knowledge was
good, very good, average, below average, and weak(29%,
27%, 24.5%, 11.4%, and 8.1%), respectively, whereas the
participating practice was weak, below average, very
good, average, and good (51.4%, 15.4%, 14.7%, 9.7%, and
8.9%), respectively.
Table 3 shows a comparison of knowledge and practice
scores in relation to the participants’ sociodemographic
characteristics. The knowledge scores were significantly
associatedwiththegenderandhospital’sname(P=0.004).
No significant statistical differences were found
between the knowledge scores toward age (P = 0.593),
education (P = 0.525), work experience (P = 0.625), and
the training course (P = 0.371). While no significant
statistical differences were found between the practice
scores toward all the participants’ sociodemographic
characteristics (P > 0.05).
Approximately 37.5% of the respondents reported
having suffered from needlestick injuries in the
previous 6 months. Among them, up to 40.2%
of them had it once, whereas nearly 23.7% have
suffered the injury twice and 36.1% have suffered the
injury >2 times. A total of 97 respondents (95.9%) did
not report the injury to the employee health service.
Over have of nurses (51.4%) had not vaccinated
for hepatitis B. According to the action taken after
sustaining the injury, about 74% of the respondents
reported that they did not take any action, 10.1% had
contacted their professional colleagues, 7.9% had
contacted the infection control principal, and 7.9%
had contacted a medical emergency room. Nearly
35.9% of the participants did not wear the safety devices
to prevent needlestick injuries. Most of them (75.3%)
considered unavailability the safety devices in the
hospital to be the reason for did not wear it, whereas
11.8% considered inappropriate environment such as
Table 1: Sociodemographic characteristics (n=259)
Parameters Characteristics n (%)
Gender Male 146 (56.4)
Female 113 (43.6)
Total 259 (100)
Age (years) <30 178 (68.7)
>30 81 (31.3)
Total 259 (100)
Education Diploma 163 (62.9)
Bachelor 88 (34.0)
Master 8 (3.1)
Total 259 (100)
Experience (years) <2 61 (23.6)
3-5 79 (30.5)
>5 119 (45.9)
Total 259 (100)
Hospital’s name Republic 70 (27.0)
Al‑Sabein 58 (22.4)
Al‑Thawra 43 (16.6)
48th
46 (17.8)
Police 42 (16.2)
Total 259 (100)
Training course Yes 156 (60.2)
No 103 (39.8)
Total 259 (100.0)
Table 2: The respondents level of knowledge and
practice about needlestick injury preventive measures
(n=259)
Levels Knowledge, n (%) Practice, n (%)
Weak (<50%) 21 (8.1) 133 (51.4)
Below average (50%-59%) 30 (11.4) 40 (15.4)
Average (60%-69%) 63 (24.5) 25 (9.7)
Good (70%-79%) 75 (29) 23 (8.9)
Very good (80%-100%) 70 (27) 38 (14.7)
Total 259 (100.0) 259 (100.0)
Mean 3.55 2.20
SD 1.225 1.501
SD: Standard deviation
overcrowding to be the cause, 7.5% neglect, and 5.4%
forget to wear the safety devices [Table 4].
Discussion
The present study assessed knowledge and practice of
nurses about needlestick injury preventive measures
and addressed certain aspects of needlestick injury in
government hospitals of Sana’a city. In this study, the
majority of the nurses (76.5%) had poor practice, and 44%
hadpoorknowledgetowardneedlestickinjurypreventive
measures. The low level of practice and knowledge
attributedtotheinsufficientinformationofknowledge,the
lack of policies, training, and continuing education about
needlestickinjurypreventionmeasures.Also,attributedto
the unavailability of safety devices in the hospitals. This
findingagreedwiththeresultsobtainedfromtheprevious

studies. A previous study conducted in Bengaluru, India,
among dental professionals revealed that 42% had poor
knowledge and 58% of dental professionals had good
knowledge about the Universal Precaution Guidelines.
[13]
However, it is incompatible with the results obtained
fromthepreviousstudies.AstudyconductedinSoutheast
Nigeria in Tertiary Health Institutions revealed that 92%
of the nurses had good knowledge, although 75% of them
had good practice for universal precautions measures.[14]
A study conducted in Pakistan at Holy Family Hospital
revealed that 73.3% of the nurses had good knowledge
about a definition of needlestick injuries and the diseases
caused by them.[7]
Another study conducted in Pakistan at
a Tertiary Care Hospital revealed that 86% of the nurses
had good knowledge about needlestick injury preventive
measures.[15]
In this study, the results reflect that there is a significant
relationship between nurses’ gender and their knowledge
and an insignificant relationship with nurses’ gender
and their practice toward needlestick injury prevention
measures. This result might relate to a difference of
interesting to raise knowledge about needlestick injury
preventive measures with nurses’ gender. This result
disagreed with the results obtained from a previous study
done in Iraq indicated that there is no relation between
nurses’ gender and their knowledge of needlestick injury
preventive measures.[16]
Table 3: Association between sociodemographic characteristics and the respondent’s knowledge and practice
about needlestick injury preventive measures (n=259)
Sociodemographic characteristics Knowledge level Practice
n Mean SD F Significant n Mean SD F Significant
Gender
Male 146 3.69 0.980 14.10 0.004 146 2.14 1.540 0.227 0.489
Female 113 3.28 1.306 113 2.27 1.453
Age group (years)
<30 178 3.54 1.131 0.076 0.593 178 2.20 1.515 0.036 0.948
>30 81 3.46 1.194 81 2.21 1.481
Education
Diploma 163 3.46 1.248 0.646 0.525 163 2.15 1.500 0.281 0.755
Bachelor 88 3.63 0.926 88 2.30 1.487
Master 8 3.38 1.302 8 2.25 1.832
Experience (years)
<2 61 3.51 1.120 0.471 0.625 61 2.15 1.447 1.380 0.254
3-5 79 3.42 1.069 79 2.43 1.654
>5 119 3.58 1.218 119 2.08 1.415
Hospital’s name
Republic 70 3.17 1.274 3.918 0.004 70 2.13 1.541 2.360 0.054
Al‑Sabein 58 3.81 1.162 58 2.34 1.584
Al‑Thawra 43 3.26 1.093 43 1.91 1.231
48th
46 3.70 0.866 46 2.70 1.672
Police 42 3.74 1.083 42 1.88 1.253
Training course
Yes 156 3.46 1.132 0.297 0.371 156 2.29 1.558 4.607 0.248
No 103 3.59 1.175 103 2.07 1.409
SD: Standard deviation
This study result showed an insignificant relationship
with nurses’ age and their knowledge and practice
toward needlestick injury preventive measures; this result
might relate to inadequate training for the nurses about
needlestickinjurypreventivemeasures.Thisresultagreed
with the results obtained from a previous study done in
Iraq indicated that there is no relation between nurses’
age and their knowledge of needlestick injury preventive
measures.[16]
Relative to educational levels, this study results showed
an insignificant relationship between nurses’ educational
level and their knowledge and practice of needlestick
injury preventive measures. This result incompatible
with the previous study conducted in Iraq indicated
that there is a significant association between nurses’
educational level and their knowledge of needlestick
injury preventive measures.[16]
Concerningtothenurses’workexperience,thisstudyresult
showed an insignificant relationship between the nurses’
work experience and their knowledge and practice of
needlestickinjurypreventivemeasures;thismightrelateto
inadequatetrainingforthenursesaboutneedlestickinjury
preventivemeasuresduringthepreviousyearsofworking.
In relation to the hospital name, this study results showed
a significant relationship between the hospital name and

Table 4: Responses of nurses to elements related to
exposure to needlestick injury and circumstances of
the exposure (n=259)
Characteristics n (%)
Exposure to needlestick injury
Yes 97 (37.5)
No 162 (62.5)
Total 259 (100.0)
The frequency of needlestick injury in the previous
6 months
Once 39 (40.2)
Twice 23 (23.7)
Three and more 35 (36.1)
Total 97 (100.0)
Reported the incident of needlestick injury
Yes 4 (4.1)
No 93 (95.9)
Total 97 (100.0)
Vaccinated for hepatitis B
Yes 126 (48.6)
No 133 (51.4)
Total 259 (100.0)
The action was taken after sustaining the injury
Contact the infection control principal 18 (7.9)
Contact a medical emergency room 18 (7.9)
Contact their professional colleagues 23 (10.1)
Did not take any action 168 (74)
Total 277 (100.0)
Wearing the safety devices
Yes 166 (64.1)
No 93 (35.9)
Total 259 (100.0)
Causes of didn’t wear the safety devices
Not available 70 (75.3)
Neglect 7 (7.5)
Forget to wear 5 (5.4)
Congestion of patients (overcrowding) 11 (11.8)
Total 93 (100.0)
their nurses’ knowledge and an insignificant relationship
between the hospital name and their nurses’ practice
towardneedlestickinjurypreventivemeasures;thismight
due to the facts that, some hospitals might implement
training courses relative to needlestick injury preventive
measures more than others. However, there is a lack
of interest in applying procedures of needlestick injury
preventive measures in all the studied hospitals.
Concerning to the nurses’ training course, this study
result showed an insignificant relationship between
the nurses’ training course and their knowledge and
practice of needlestick injury preventive measures, this
might relate to insufficient and inadequate training for
the nurses about needlestick injury preventive measures.
This study result showed that 37.5% of nurses had
exposure to needlestick injury in their work duration the
previous 6 months. Among them, up to 40.2% of them
had it once, while nearly 23.7% have suffered the injury
twice and 36.1% have suffered the injury >2 times. This
may be attributed to lack of sufficient knowledge and
practice of needlestick injury preventive measures. This
result agreed with the results obtained from the previous
studies. A study conducted in Mongolia at public
tertiary hospitals in an urban community; the incidence
of needlestick injury during the previous 3 months was
38.4%.[10]
Another study conducted in Mumbai, India, in
a Teaching Hospital indicated that 39.6% of nurses had
a history of needlestick injuries.[17]
In this study, the prevalence of needlestick injury is
considerably higher than those obtained from the
previous studies. A study conducted in Bengaluru,
India, among dental professionals indicated that
27.5% of nurses had needlestick injury in the past
12 months (Pavithran et al., 2015). A study conducted in
Pakistan at a Tertiary Care Hospital indicated that 29%
of nurses of nurses had a needlestick injury in the past.
About 54% had suffered at least one needlestick injury,
20% at least two, and 13% more.[15]
A study conducted in
Malaysia indicated that 31.6% of nurses had needlestick
injury in the two studied hospitals.[18]
Several other studies had shown a high occurrence of
needlestick injury among nurses. A study conducted
in Hodeidah governorate, Yemen in addition, 83.8% of
the HCWs providing injections in the hospitals reported
that they had been pricked by a used needle during
work.[19]
A study conducted in Pakistan in Tertiary Care
Hospitals reported that 64% of the nurses were exposed
to at least one needlestick injury during their career.[20]
A
study conducted in Egypt, in University of Alexandria
hospitals indicated that (67.9%) of nurses had suffered
at least one needlestick injury in the last 12 months.[21]
A study conducted in India in a Tertiary Care Hospital
it was found that 80% of nurses were exposed to
needlestick injury in their careers.[3]
A study conducted
in Pretoria, South Africa at Witbank Hospital indicated
that (46.7%) of the nurses were exposed to needlestick
injury, one injury 44.61%, two to three injuries 45.5%
and >3 injuries 9.8%.[22]
A study conducted in Pakistan at
Holy Family Hospital indicated that 94% of nurses had
a history of needlestick injuries.[7]
A study conducted
in Iran among 269 dental and medical students during
their clinical training at Kerman University of medical
sciences indicated that 74.3% of them had needle‑stick
injury.[23]
A study conducted in tropical northern
Australia, in large, modern tertiary teaching hospital
reported that 63.5% of staff had needlestick injury in the
3 years period, 2001–2003.[24]
A study conducted in Saudi
Arabia at Armed Forces Hospital, Sharorah reported that
74% of the nurses had needlestick injury, the frequency
of needlestick injury per year 67% one to two times,
29% three to four times, 4% five to six times.[25]

According to the action taken after sustaining the
injury, the current study showed that 74% of the
respondents reported that they did not take any action,
10.1% had contacted their professional colleagues,
7.9% had contacted the infection control principal,
and 7.9% had contacted a medical emergency room.
It has been noticed that the participants of the present
study had a negative attitude toward reporting to the
concerned authorities regarding needlestick injury if in
case one occurs. This may be due to the poor knowledge
about the bloodborne diseases that could be spread
through these injuries. The current study results agreed
with the previous study conducted in Saudi Arabia at
Armed Forces Hospital, Sharorah, indicated that 92% did
not report the incident of needlestick injury.[25]
However,thedatafromthecurrentstudywereincontrast
with the results of previous studies. A study conducted
in Pakistan at a Tertiary Care Hospital reported that the
measures taken after needlestick injury are: 80% knew
about patient and disease, 93% allowed injury to bleed,
87% washed injury with soap and water, 73% notified
infection control office within 24 h.[15]
A study conducted
in Bengaluru, India, among dental professionals reported
that 81% of them would first contact a medical emergency
room in case of an accidental needlestick injury,
9% would contact the oral surgery department, 6.5%
would contact their professional colleagues, 2% would
contact the principal, and 1.5% would not contact anyone
in case of needlestick injury.[13]
Another study conducted
in Hyderabad and Karachi, Pakistan for investigations
of dentists reported that 40.4% of them would report to
the concerned authorities and 59.6% would not report
to anyone regarding needlestick injury.[26]
A study
conducted in Hodeidah governorate, Yemen, reported
that 20% of the injection providers in the health‑care
facilities took no action when accidentally injured by
a used needle, whereas the vast majority disinfected
the site of injury with alcohol.[19]
A study conducted in
Pakistan at Holy Family Hospital indicated that 87.9% of
HCWs reported immediate responses after needlestick
injury included drawing out blood, 89.4% washing the
pricked site with running water, 76.6% application of
antiseptic solution, and 79.4% pressing the pricked site.[7]
The World Health Organization recommended that the
site of injury should be allowed to bleed briefly and then
should immediately be washed thoroughly with running
water and antiseptic solution.[27]
In the present study, 48.6% of the participants were
vaccinatedagainstHBV.Thisfindingishighincomparison
to some studies from developing countries. A study
conducted in India in a Tertiary Care Hospital indicated
that 11.7% of HCWs had Hepatitis B vaccination.[3]
Other
study conducted in Pakistan in Tertiary Care Hospitals
indicated that 34% of study participants were vaccinated
against hepatitis B infection.[20]
However, it is very low in
comparison to other studies from developing countries.
A study conducted in Pakistan at a Tertiary Care Hospital
indicated that 82% of nurses had vaccinated.[15]
Another
study conducted in Pakistan at Holy Family Hospital
indicated that 82.7% of HCWs had a vaccination against
hepatitis B.[7]
A study conducted in Saudi Arabia at
Armed Forces Hospital, Sharorah indicated that 84% of
nurses had hepatitis B vaccination.[25]
The present study also showed that 35.9% of the
participants did not wear the safety devices to prevent
needlestick injuries. Most of them (75.3%) considered
unavailability the safety devices in the hospital to be the
reason for did not wear it, whereas 11.8% considered
inappropriate environment such as overcrowding to
be the cause, 7.5% neglect and 5.4% forget to wear the
safety devices. This result differs with previous studies.
A study conducted in Pakistan in Tertiary Care Hospitals
indicated that 40% of study participants did not wear the
safety devices to prevent needlestick injuries.[20]
A study
conducted in Mongolia at public tertiary hospitals in an
urban community indicated that 66.2% of the nurses
did not wear the safety devices.[10]
A study conducted
in Southeast Nigeria in Tertiary Health Institutions
indicated that 43.9% of the nurses did not wear the safety
devices.[14]
Conclusion
This study showed a high prevalence of needlestick
injury, poor practices, and knowledge of nurses on
needlestick injury preventive measures, low vaccination
coverage, and inadequate preventive facilities. Hence,
needlestick injury continues to be a serious occupational
hazard among nurses. Preventive strategies, provision of
preventive facilities, and intensive programs to educate
nurses about preventive measures of needlestick injury
should be ensured by dissection makers of the studied
hospitals. Furthermore, the new avenues in a prevention
of needlestick injury (such as a use of a syringe with a
sliding sleeve, a syringe with hinged cap, and scalpel
with retractable blade) must be considered.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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