healthcare worker needle prick injury

Knowledge, Attitude and Practices

Questionnaires on Needlestick Injury

among Health Care Workers

at East Avenue Medical

Center

Rizelle F. Jimenez, MDFloravil M. Mabras, MD

Presentors

Danilo M. Castro, MD, MHA, FPSMID, FPCPAdviser

All healthcare workers are at risk of occupational

transmission of blood-borne pathogens because of

frequent exposure to blood.

The risk of exposure to blood-borne pathogen is primarily due to

NEEDLESTICK INJURY.

The HBV infection is a

well-recognized occupational risk.

HEPATITIS B VIRUS (HBV)

HEPATITIS B VIRUS

• Hepatitis B immune globulin (HBIG) and/or hepatitis B vaccine

HEPATITIS C VIRUS (HCV)

HCV is not transmitted efficiently through

occupational exposures to blood.

HEPATITIS C VIRUS

No vaccination recommended.

HUMAN IMMUNODEFFICIENCY VIRUS

CDC reported 57 confirmed and 137 suspected cases of occupational HIV

transmission

HUMAN IMMUNODEFFICIENCY

VIRUS

4-week regimen drugs Zidovudine & Lamivudine Lamivudine & Stavudine Didanosine & Stavudine

within hours after the exposure

NSI in the United States:Epidemiologic, Economic, and Quality of Life Issues

Incidence of NSI is significantly higher than reported

Substantial economic cost Occupational and behavioral changes

Lee JM, Botteman MF, Xanthakos N, Nicklasson L. AAOHN J. 2005 Mar;53(3):117-33.

Tanberg, Stewart et al (1991)o Perception of risk, occupation, years in

occupation and concern about paperwork were the most powerful predictors of low reporting rate of NSI.

Rampal, Zakaria et al (2010)o 99.1% vs 30.9% o gaps between knowledge and practice

2011 Needlestick Injury at EAMC

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2001 - 2011 Needlestick Injury at EAMC

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GENERAL OBJECTIVES

To assess knowledge, attitude and

practices on transmissions and post-

exposure prophylaxis of HBV, HCV

and HIV through NSI among

healthcare workers.

EAMC

SPECIFIC OBJECTIVES

1. To validate the knowledge, attitude and practices questionnaires on needle-stick injury.

2. To assess the knowledge of healthcare workers on the following topics: HBV, HCV, HIV: risk of sero-conversion after

NSI HBV, HCV, HIV: PEP medications and timing

of administration of the medications after NSI

EAMC

Cont. SPECIFIC OBJECTIVES3. To assess the attitude of healthcare workers on the

following: o Protocol at EAMC regarding NSIo HBV, HCV, HIV: risk of seroconversion after NSIo PEP after NSI

To assess the practices of healthcare workers on NSI :o Frequency and percentage of healthcare workers

who had NSI

EAMC

METHODOLOGY

METHODOLOGY

A. Study Subjects

1.TARGET POPULATION

2. Duration3. Inclusion Criteria4. Exclusion Criteria5. Sample Size /

Sampling Design

B. Description Of Study Procedure

Healthcare workers at East Avenue Medical

Center namely: 1. Nurses2. Medical Residents3. Medical

Technologists

METHODOLOGY

A. Study Subjects1. Target Population

2.DURATION3. Inclusion Criteria4. Exclusion Criteria5. Sample Size /

Sampling Design


July to November 2012

METHODOLOGY

A. Study Subjects1. Target Population2. Duration

3.INCLUSION CRITERIA

4. Exclusion Criteria5. Sample Size /

Sampling Design


1.Nurses

2.Medical Technologists

3.Medical Residents

METHODOLOGY

A. Study Subjects1. Target Population2. Duration3. Inclusion Criteria

4.EXCLUSION CRITERIA

5. Sample Size / Sampling Design


• HCW who were given the questionnaire but failed to return it.

• HCW who were contractual workers and volunteers at our institution.

• Nursing aides and janitors

METHODOLOGY

A. Study Subjects1. Target Population2. Duration3. Inclusion Criteria4. Exclusion Criteria

5.SAMPLE SIZE / SAMPLING DESIGN


HEALTHCARE WORKERS TOTAL Pilot Testing Research

1. Nurses 516 72 225

2. MedicalTechnologist 7 1 7

3. Medical Residents 177 25 129

3.1. Anesthesia 14 2 10

3.2. Dermatology 11 2 8

3.3. Emergency Medicine 9 1 7

3.4. General Surgery 16 2 12

3.5. Internal Medicine 28 4 20

3.6. Ophthalmology 14 2 10

3.7. Orthopedics 5 1 4

3.8. Otolaryngology 18 3 13

3.9.Obstetrics – Gynecology

17 2 12

3.10. Pathology 8 1 6

3.11. Pediatrics 19 3 14

3.12. Radiology 11 2 8

3.13. Urology 7 1 5

TOTAL 700 98 361

METHODOLOGY

A. Study Subjects1. Target Population2. Duration3. Inclusion Criteria4. Exclusion Criteria5. Sample Size /

Sampling Design

B. DESCRIPTION OF STUDY PROCEDURE

Questionnaire development

Pilot Testing

adjudication process of questionnaire

Reliability Testing

Administer the KAP questionnaire

QUESTIONNAIRE

Dear Sir/Madam:

Good day!

We, Rizelle F. Jimenez, MD and Floravil Mabras, MD, third year medical residents of the Department of Internal Medicine, are conducting a survey on the “Validation of Knowledge, Attitude and Practices Questionnaires on Needle-Stick Injury among Healthcare workers at East Avenue Medical Center.”

All of your responses are confidential. Once they are collected, there will be no way to connect your name with the questionnaire you completed. Your responses will be combined with others in order to analyse the data.

If you need help in completing this survey or have any questions, please ask us.

When you have completed the survey, please return it to us or drop at the Medical Office, 5th floor.

Thank you in advance for providing this information. Please feel free to write your comments. We will greatly appreciate it. Sincerely yours, RIZELLE F. JIMENEZ, MD FLORAVIL M. MABRAS, MDDepartment of Internal Medicine Department of Internal Medicine East Avenue Medical Center East Avenue Medical Center

Cover Letter

Continuation of part II

DEFINITION

KNOWLEDGE PART Score Percentage

Knowledgeable 15 to 19 75 to 100 %

Not Knowledgeable 0 to 14 0 to 74%

Continuation of part III

DEFINITION

ATTITUDE PART Score

Positive 68 to 85

Negative 17 to 67

DATA ANALYSIS FREQUENCY TABLE

frequency distribution table Shapiro-Wilks test Cronbach’s α (alpha) and Kappa statistic Factor Analysis will be used to assess where

the items fall into which construct. The greater the variance attributable to the

constructs will be the higher the validity of the instrument.

R version 2.12.2 and Epi Info versions 6 and 3.5.1 will be used for the data processing and data analysis.

DATA ANALYSIS FREQUENCY TABLE

R version 2.12.2 and Epi Info versions 6 and 3.5.1 will be used for the data processing and data analysis.

RESULTS

700 HCW

Pilot TestingData

Gathering

98 HCW361 HCW

7 HCW Failed to return the

questionnaire

KAP Questionnaire

Table 1: Demographic Profile & Medical Background of the Healthcare Workers (N=354)

Age Freq %

20-24 97 29.22

25-29 138 41.57

30-34 67 20.18

35-39 18 5.42

40-44 5 1.51

45-49 7 2.11

Total 332

• average age: 27.79 y/o

• SD: 4.94 years

• Median age: 27 y/o

• Oldest age: 49 y/o

• Youngest age: 21 y/o

Cont. Table 1: Demographic Profile & Medical Background of the Healthcare Workers (N=354)

Sex Freq %

Male 157 45.38

Female 189 54.62

Total 346


Profession Freq %

Medical Resident 1st year 45 12.89

Medical Resident 2nd year 45 12.89

Medical Resident 3rd year 26 7.45

Medical Resident 4th year 2 0.57

Medical Resident 5th year 2 0.57

Staff Nurse 223 63.90

Medical Technologist 6 1.72

Total 349


Educational Attainment Freq %

MD 129 36.03

Med tech 6 1.68

Nursing 219 61.86

Total 354


Duration as Health

WorkerFreq %

<5 years 295 84.53

6 - 10 years 47 13.47

11 - 20 years 5 1.43

> 20 years 2 0.57

Total 349

Year of Employment Freq %

Before 2000 6 1.80

2000 1 0.30

2003 7 2.10

2004 3 0.90

2005 7 2.10

2006 10 3.00

2007 3 0.90

2008 10 3.00

2009 32 9.61

2010 48 14.41

2011 134 40.24

2012 72 21.62

Total 333


NSI Injuries in the Past 6 Months Freq %

Yes 139 39.83

No 205 58.74

Total 344

Number of Injuries in the Past 6 Months Freq %

None 205 58.74

1 to 2 86 24.29

3 to 5 37 10.45

> 6 10 2.82

Can't Remember 11 3.11

No answer 5 1.41

Total 354


Vaccination against HBV Freq %

Yes 319 91.40

No 30 8.60

Total 349

With Antibodies against HBV Freq %

Yes 48 13.6

No 222 62.89

Don't Know 83 23.51

Total 353 100


Needle Stick Injury Training Freq %

Yes 105 30.43

No 240 69.57

Total 345

NSI Protocol Freq %

Yes 237 67.91

No 109 31.23

Total 346

Table II. Knowledge on transmissions and post exposure prophylaxis among health care workers (N=354)

YES NO TOTAL MISSING

Freq % Freq % Freq Freq %

A. Hep B Surface Antigen 304 85.88 50 14.12 354 7 1.94

B. Hep B Envelope Antigen 246 69.49 108 30.51 354 7 1.94

C. Hep C Virus 201 56.78 153 43.22 354 7 1.94

D. HIV 294 83.05 60 16.95 354 7 1.94

E. No Idea 16 4.53 337 95.47 353 8 2.22

Number of People Correct 163 46.05 191 53.95 354 7 1.94

Q1: You sustained a NSI while disposing of a syringe used to a patient suspected to be immunocompromised. What profile of the patient would you like to know?

Cont. Table II. Knowledge on transmissions and post exposure prophylaxis among health care workers

(N=354)



A. Hep B Vaccine 175 49.44 179 50.56 354 7 1.94

B. Hep B Immunoglobin 274 77.40 80 22.60 354 7 1.94

C. No vaccine or medication available

31 8.76 323 91.24 354 7 1.94


Q2: You got the report that your patient was positive of Hepatitis B Surface Antigen and Hepatitis B Envelope Antigen, what compromises post-exposure prophylaxis?


(N=354)



A. Hep C Vaccine 110 31.07 244 68.93 354 7 1.94

B. Hep C immunoglobin 212 60.06 141 39.94 353 8 2.22

C. No vaccine or medication available

99 27.97 255 72.03 354 7 1.94


Q3: Patient was positive for Hepatitis C virus, what compromises post-exposure prophylaxis?


(N=354)



A. Zidovudine 159 44.92 195 55.08 354 7 1.94

B. Lamivudine 131 37.01 223 62.99 354 7 1.94

C. Didanosine 62 17.71 288 82.29 350 11 3.05

D. Stavudine 58 16.38 296 83.62 354 7 1.94

E. No vaccine or medication available

89 25.14 265 74.86 354 7 1.94


Q4: What compromises post-exposure prophylaxis for HIV?


(N=354)



A. within 24 hrs 216 61.02 138 38.98 354 7 1.94

B. 2 to 7 days 89 25.14 265 74.86 354 7 1.94

C. Later than 7 days 18 5.08 336 94.92 354 7 1.94

D. No idea 58 16.38 296 83.62 354 7 1.94

Q5: How soon post-exposure prophylaxis should be given?

Cont Table II. Knowledge on transmissions and post exposure prophylaxis among health care workers

(N=354)



A. Deep wounds 263 74.29 91 25.71 354 7 1.94

B. Visible blood on instrument 220 62.15 134 37.85 354 7 1.94

C. NSI using hollow bore needles containing blood

307 86.72 47 13.28 354 7 1.94

D. Parental route of contaminated blood

261 73.94 92 26.06 353 8 2.22

E. Blood from patient with a high virus level

284 80.23 70 19.77 354 7 1.94

F. No Idea 8 2.26 346 97.74 354 7 1.94


Q6: The risk of transmission of infection depends on type of contact of the contaminated material. The following factors are associated with a higher risk:

Cont Table II. Knowledge on transmissions and post exposure prophylaxis among health care workers

(N=354)

Knowledgeable

(>=15)

Not Knowledgeable

(<15)Total

MD 23 (17.83%) 106 (82.17%) 129

Med tech 2 (33.33%) 4 (66.67%) 6

Nursing 13 (6.05%) 202 (93.95%) 215

Missing 4

Total 38 (10.73%) 312 (88.14%) 354

Mean Score 10.466SD of Score 3.335

Table III. Attitude on transmissions and post exposure prophylaxis among health care workers (N=354)

Questions on Attitude

Likert Scale Frequencies

Total

Positive Missing

SD D N A SA Freq % Freq %

Question 1: Safety Training on needle stick injury is part of staff development orientation and programs

13 0 13 70 255 351 325 92.59 10 2.77

Question 2: All needle stick injuries should be reported.

13 1 9 75 254 352 329 93.47 9 2.49

Question 3: I will report my injury because I need to undergo work-up for the following to determine if I should receive post-exposure prophylaxis.

A. Hepatitis B Virus 12 0 10 68 261 351 329 93.73 10 2.77

B. Hepatitis C Virus 13 0 12 73 254 352 327 92.90 9 2.49

C. HIV 13 0 5 55 279 352 334 94.89 9 2.49

Cont. Table III. Attitude on transmissions and post exposure prophylaxis among health care workers

(N=354)

Questions on AttitudeLikert Scale Frequencies

Total

Positive MissingSD D N A SA Freq % Freq %

Question 4: I will report my injury because I know that the source of blood was from a confirmed or suspected with the following



C. HIV 13 0 9 46 282 350 328 93.71 11 3.05

Question 5: I will report my injury because I am afraid that I will be infected with the following:



C. HIV 15 0 10 35 291 351 326 92.88 10 2.77

Cont. Table III. Attitude on transmissions and post exposure prophylaxis among health care workers

(N=354)

Questions on Attitude

Likert Scale Frequencies

Total

Positive MissingSD D N A SA Freq % Freq %

Question 6: I will report my injury because I am not sure if the needle stick injury was high risk for transmission of the following:



C. HIV 11 3 7 64 263 348 327 93.97 13 3.60

Question 7: I will report my injury because I had no previous vaccination against Hepatitis B Virus

28 23 53 59 185 348 244 70.11 13 3.60

Question 8: I will report my injury because I know the reporting procedure

23 14 50 90 173 350 263 75.14 11 3.05

Question 9: I will report my injury because I will not be blamed or get in trouble for having the exposure.

21 19 66 78 166 350 244 69.71 11 3.05

Table IV. Practices on transmissions and post exposure prophylaxis among health care workers (N=98)

A. I will report needle stick injury to:Yes No Total Missing


1. Supervisor 233 65.82 121 34.18 354 7 1.94

2. Emergency Room Physician 80 22.60 274 77.40 354 7 1.94

3. Out-patient Department Physician 42 11.86 312 88.14 354 7 1.94

4. Infection Control Committee Head/Staff 301 85.03 53 14.97 354 7 1.94

5. None 0 0.00 361 100.00 361 0 0.00

6. Others 14

a. Charge Nurse 2

b. Senior Nurse 2

c. Head Nurse 2

d. Senior ROD 1

e. Senior/Charge Nurse 4

f. Did not Specify 3

Cont. Table IV. Practices on transmissions and post exposure prophylaxis among health care workers

(N=98)

B. I will ask for post-exposure

prophylaxis:

Yes No Total Missing


1. within 24 hours 299 84.46 55 15.54 354 7 1.94

2. 2-3 days 49 13.84 305 86.16 354 7 1.94

3. 4-7 days 16 4.52 338 95.48 354 7 1.94

4. Later Than 7 day 17 4.80 337 95.20 354 7 1.94

5. None 1 0.28 353 99.72 354 7 1.94

6. Others (did not specify) 1 0.28 353 99.72 354 7 1.94

Cont. Table IV. Practices on transmissions and post exposure prophylaxis among health care workers

(N=98)

C. How do I dispose of used needles and

sharps

Yes No Total Missing


1. Place used sharps on puncture-

resistant containers335 94.63 19 5.37 354 7 1.94

2. Place used needles in the yellow-lined

garbage bins17 4.80 337 95.20 354 7 1.94

3. Place used needles into grabage bins 1 0.28 353 99.72 354 7 1.94

4. Place used needles into the plastic

intravenous fluid bottles22 6.21 332 93.79 354 7 1.94

5. Wrap used sharps in a paper 6 1.70 346 98.30 352 9 2.49

Bibliography

1. Centers for Disease Control and Prevention -- Morbidity and Mortality Weekly Report. (2001, June 29). Retrieved October - November 2011, from Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Postexposure Prophylaxis: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm

2. Centers for Disease Control and Prevention. (2011, May). Retrieved October - November 2011, from Surveillance of Occupationally Acquired HIV/AIDS in Healthcare Personnel, as of December 2010: http://www.cdc.gov/HAI/organisms/hiv/Surveillance-Occupationally-Acquired-HIV-AIDS.html

3. Alam, M. (2002). Knowledge, Attitude and Practices among Health Care Workers on Needle-Stick Injuries. Annals of Saudi Medicine, 22, 396-399.

4. Choi , E. J., Choi, S. H., & Sunwoo, S. (2007, July). Factors Affecting Resident Physician's Underreporting Behavior of Needle Stick Injuries in a Tertiary Teaching Hospital. Journal of the Korean Academy of Family Medicine, 28(7), 500-508.

5. Collins, C. H., & Kennedy, D. A. (1987). Microbiological hazards of occupational needlestick and other sharps’ injuries. Journal of Applied Bacteriology, 385-402.

6. Gurubacharya, D. L., Mathura, K. C., & Karki, D. B. (2003, Apr-Jun). Knowledge, attitude and practices among health care workers on needle-stick injuries. Kathmandu Univ Med J, 1(2), 91-94.

7. Habib, F., Khan, D. K., Abbas, S., Bhatti, F., & Zafar, A. (2011, May). Knowledge and beliefs among health care workers regarding hepatitis B infection and needle stick injuries at a tertiary care hospital, karachi. J Coll Physicians Surg Pak, 21(5), 317-318.

8. Kunkel, Dennis. (2003). Exposure to Blood: What Healthcare Personnel Need to Know. Centers for Disease Control and Prevention.

9. Muralidhar, S., Singh, P., Jain, R., Malhotra, M., & Bala, M. (2010, March). Needle stick injuries among health care workers in a tertiary care hospital of India. Indian Journal of Medical Research, 405-410.

Bibliography

10. Okaro, A. O., Eze, C. U., & Ohagwu, C. C. (2010). Awareness, Knowledge, Attitude and Practice of Blood and Body Fluid Precautions among Radiographers in Enugu, Nigeria. African Journal of Basic & Applied Sciences, 2(1-2), 11-17.

11. Panililio, A. L., Orelien, J. G., Srivastava, P. U., Jagger, J., Cohn, R. D., & Carco, D. M. (2004). Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infection Control and Hospital Epidemiology, 25(7), 556-62.

12. Pike, A. M. (1976). Laboratory-associated infections: summary and analysis of 3921 cases. Health Laboratory Science, 105-14.

13. Rampal, L., Zakaria, R., Sook, L., & Zain, A. (2010). Needle Stick and Sharps Injuries and Factors Associated Among Health Care Workers in a Malaysian Hospital. European Journal of Social Sciences, 13, 354-362.

14. Saleem, T., Khalid, U., Ishaque, S., & Zafar, A. (2010, February). Knowledge, attitudes and practices of medical students. Journal of Pak Med Assoc, 60, 151-156.

15. Shah, R., Mehta, H., Fancy, M., Nayak, S., & Donga, B. N. (2010). Knowledge, Attitude and Practices regarding Needle Stick Injury among Health Care Workers in Tertiary Care Hospital in Ahmed Abad, Gujarat. National Journal of Community Medicine, 1(2), 93-96.

16. Siddique, K., Mirza, S., Tauqir, S., Anwar, I., & Malik, A. (2008). Knowledge, Attitude and Practices regarding Needle Stic Injuries Amongst Heallthcare Providers. Pakistan Journal of Surgery, 24(4), 243 - 248.

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