Knowledge and expressed practices regarding needle stick injury among housekeeping staff: A descriptive survey

Vandna Pandey; Nancy Kurien; Sandhya Kumari; Sangeeta Meena; Santosh Borana; Saroj

doi:10.4103/EHP.EHP_20_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 5 | Issue : 3 | Page : 114-119

Knowledge and expressed practices regarding needle stick injury among housekeeping staff: A descriptive survey

Vandna Pandey, Nancy Kurien, Sandhya Kumari, Sangeeta Meena, Santosh Borana, Saroj
College of Nursing AIIMS, Jodhpur, Rajasthan, India

Date of Submission	09-Aug-2022
Date of Acceptance	02-Sep-2022
Date of Web Publication	11-Nov-2022

Correspondence Address:
Dr. Vandna Pandey
College of Nursing, AIIMS, Jodhpur, Rajasthan
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/EHP.EHP_20_22

Abstract

Background: Needle stick injury (NSI) is an accidental skin penetrating wound from a hollow bore needle. It is one of the most common occupational hazards for health care workers. Aims: The study aimed to assess the level of knowledge and expressed practices regarding needle stick injuries among housekeeping staff. Setting and Design: The research design was a descriptive survey, and research was conducted on housekeeping staff employed at a tertiary care hospital. Materials and Methods: 225 housekeeping staff were selected using non-probability convenience sampling. A self-structured questionnaire and checklist were used to assess their knowledge and practices regarding needle stick injuries. SPSS was used for the analysis of data through descriptive and inferential statistics. Results: In the present study, out of 225 subjects, 11.11% of respondents had poor, 37.33% had average, 36.88% had good, and 14.66% had excellent knowledge regarding NSI. Knowledge was significantly associated with education and year of working experience. In total, 4% of the respondents had poor, 34.66% had average, 35.11% had good, and 26.22% had excellent expressed practices regarding NSI. Expressed practices were significantly associated with education and prior exposure to NSI. A moderate positive correlation was present between knowledge and expressed practices. Conclusion: The study concluded that knowledge and practices about needle stick injury were average among housekeeping staff. The areas of concern identified were: risks associated with NSIs, no use of personal protective equipment (rubber gloves), and recapping of needles. These gaps in knowledge and expressed practices can be addressed by educating them.

Keywords: Expressed practices, healthcare workers, housekeeping staff, knowledge, needle stick injury

How to cite this article:
Pandey V, Kurien N, Kumari S, Meena S, Borana S, Saroj. Knowledge and expressed practices regarding needle stick injury among housekeeping staff: A descriptive survey. Educ Health Prof 2022;5:114-9

How to cite this URL:
Pandey V, Kurien N, Kumari S, Meena S, Borana S, Saroj. Knowledge and expressed practices regarding needle stick injury among housekeeping staff: A descriptive survey. Educ Health Prof [serial online] 2022 [cited 2023 Mar 31];5:114-9. Available from: https://www.ehpjournal.com/text.asp?2022/5/3/114/360985

Introduction

Needle stick injuries (NSIs) are wounds caused by needles that accidentally puncture the skin. It occurs when health care workers use, disassemble, transfer the specimen, clean up, recap, or discard used needles.^[1] Contributing factors for NSIs can be recapping of the needle, accidental prick during clean-up, passing or handling of various devices, and failure of proper disposal of the needle in puncture-proof containers.^[2]

Percutaneous exposure takes place when a break in the skin is caused by a needle stick contaminated with blood or bodily fluids, and mucocutaneous exposure happens when bodily fluids encounter open wounds, or non-intact skin such as found in atopic dermatitis, or mucous membranes such as the mouth or eyes. Health care workers (HCWs) are at an increased risk of accidental needle sticks and sharp injuries (NSSIs) and exposure to bloodborne pathogens such as hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) am HCWs.^[3],[4]

Multiple risk factors have been proposed in different studies for NSI incidents like young age, recapping of needles, improper use of personal protective equipment (like failure to use suitable-sized gloves), working in surgical or intensive care units, bad work experience, inappropriate disposal of needles, and intravenous cannulation. Occupational exposure to NSIs is reported to be much higher in the developing world, and it is anticipated that about 75% of the NSIs in developing countries were not reported.^[4]

Healthcare is teamwork in which each member has a unique role, including doctors, nurses, nursing aids, social workers, laboratory technicians, and housekeeping staff. The primary function of housekeeping staff in hospitals is general cleaning and proper handling of biomedical wastes. A carefully planned program of disposal of wastes will safeguard not only personnel and patients but also the community. The housekeeping staff is responsible for ensuring an infection-free and safe environment.^[5]

World Health Organization (WHO) estimated that NSIs cause 16,000 and 66,000 cases of HCV and HBV respectively and HIV report 1,000 cases annually among HCWs. Moreover, percutaneous exposure accounts for approximately 37.0% of HBV, 39.0% of HCV, and 4.4% of HIV cases among HCWs.^[6]

Based on the study conducted in a tertiary care center in North India, the most common clinical activity to cause NSIs were inserting I/V cannula (30%), handling garbage bags (21%), dusting through blood sugar needle (13%), handling suture needles (12%), by subcutaneous injection (11%), recapping (9%) and withdrawal of blood (4%).^[7] A sharp management plan and staff training can ensure safety from NSIs. According to NIOSH (CDC), a standing order procedure is suggested to prevent such injuries in all healthcare institutions.^[8]

In low and middle-income countries, the risk of occupational blood-borne infection is high because of crowded hospitals, limited knowledge regarding risks, limited utilization of post-exposure prophylaxis, inadequate PPE, less adherence to Universal Precautions, and low coverage of Hepatitis B vaccination among healthcare workers.^[9] Poor disposal practices of needles and individual under-reporting of NSIs due to factors like lack of knowledge and absence of standard operating protocol is also the reason for the prevalence of NSIs.^[10] Although housekeeping staff have no direct contact with patients and do not use sharp items to perform their jobs, they are frequently exposed to NSIs because they are responsible for the disposal of needle containers.^[11]

According to a cross-sectional study by R.V.Sardesai et al. in a tertiary care center, the number of class IV workers was the highest among those who reported NSI.^[12] Based on the study conducted in a government teaching hospital, Mandya, Karnataka, with a sample size of 509 among HCWs. Only 27.6% HCWs reported cases of NSIs.^[13]

Subject and Methods

For the present study, a quantitative approach was considered the most appropriate approach to assess the knowledge and expressed practice regarding NSIs among housekeeping staff employed at tertiary care hospitals. A descriptive survey design was utilized.

Study variables were knowledge and expressed practices among housekeeping staff, demographic variables such as age, gender, education, years of work experience, Hepatitis B vaccination status, marital status, and prior exposure to needle stick injury.

The population for the study was housekeeping staff employed at tertiary care hospitals. A non-probability convenience sample was attained.

The number of participants to be recruited in the study is calculated based on the prevalence formula:^[14] n = (Z)2 (p) (q)/d2. According to the formula, the recommended sample size was 202, thus a total of 225 were obtained to make up for any possible attrition.

Inclusion criteria for the sample selection were housekeeping staff who were willing to participate and were present at the time of data collection. The study’s tools included a demographic data sheet, a self-structured knowledge questionnaire, and a practice checklist. Demographic data sheets included the aforementioned variables. A self-structured knowledge questionnaire was used to assess the level of knowledge. It consisted of 10 multiple choice questions and scores could range from 0 -10. The correct answer to each question was marked ‘1’, and the wrong or unattempted answers were marked ‘0’. A practice checklist was used to assess expressed practices. It consisted of 10 questions and scores ranged from 0–10. The expected response of each question was marked ‘1’, and unexpected or no response was marked ‘0’.

The reliability of the self-structured knowledge questionnaire and self-structured checklist was determined by the Kuder Richardson (KR-20) coefficient, and was 0.80 and 0.76, respectively. Moreover, to ensure the content validity of the tools, it was given to seven experts from the medical nursing specialty. Suggestions of the experts were incorporated, and the tools were modified accordingly.

Scoring of the self-structured knowledge questionnaire as well as the self-structured practice checklist were (9–10 - excellent), (7- 8 - good), (4 -6 - average), and (< 4 – poor). Ethical approval for the study was provided by the ethical committee of the institution (AIIMS/IES/2022/3889). The data collection process was explained and informed written consent was obtained from each subject participating in the study. Confidentiality regarding the data was assured to get cooperation throughout the data collection procedure.

The collected data were coded and summarized using a Microsoft Excel sheet, and all the entries were cross-checked to avoid any errors. Data analysis was performed using descriptive and inferential statistics using the SPSS-22 (Statistical Packages for Social Sciences). Frequency, percentage, mean and standard deviation were used to describe the demographic variables, knowledge, and expressed practice regarding NSIs. A Fisher test was used to examine the association of knowledge and expressed practice regarding NSIs and selected demographic variables. Dissemination of pamphlets for education and information regarding NSIs was performed among housekeeping staff. The information contained in this pamphlet included an introduction to NSIs, do’s and don’ts to prevent NSIs, prevention from NSIs, and management of NSIs.

Results

Description of demographic variables of housekeeping staff

Regarding the demographic details of the housekeeping staff under study, about 66% of the housekeeping staff were 18–39 years old. Most staff members were female (58.22%), and 41.77% were male. Nearly one-third (32.88%) of the staff had no formal education. Most staff (59.1%) had 1–5 years of experience. Around 47% of the staff had not taken a single dose of the Hep B vaccine whereas, 26.22% of the staff were fully vaccinated. The majority (90.66%) of the staff was married. The majority of the staff 205 (91.11%) were exposed to NSI, 7.11% were exposed once, and the remaining 1.77% were exposed twice or more. [Table 1]

Table 1: Frequency and percentage distribution of participants in terms of demographic variables. N=225

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Findings related to knowledge regarding needle stick injury among housekeeping

The mean level of knowledge of the housekeeping staff was 6.33 (SD = 1.99). In total, 14.66% had excellent knowledge, 36.88% had good knowledge and 37.33% had average knowledge about NSI. Only 11.11%of housekeeping staff had a score of less than 4, indicating poor knowledge.

Findings related to expressed practices regarding needle stick injury among housekeeping staff

The mean level of expressed practices of the housekeeping staff was 7.05 (SD = 1.96). A total of 26.22% of participants had excellent expressed practices, 35.11% had good, 34.66% had average, and 4% had poor expressed practices regarding NSI.

Findings related to association of knowledge with demographic variables

The association of level of knowledge with demographic variables using Fisher’s exact test revealed a significant association of level of knowledge with education and years of working experience of the housekeeping staff at p<0.05. [Table 2]

Table 2: Association of the level of knowledge among housekeeping staff with demographic variables. N = 225

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Findings related to the association of expressed practices with demographic variables

The association of the level of expressed practices with demographic variables using Fisher’s exact test revealed a significant association of the level of expressed practices with education and prior exposure to NSI of the housekeeping staff at p<0.05. [Table 3]

Table 3: Association of the level of expressed practices among housekeeping staff under study with demographic variables. N = 225

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Correlation between knowledge and expressed practices regarding needle stick injury among housekeeping staff employed

The correlation between knowledge and expressed practices were analyzed with Karl Pearson’s Correlation Coefficient. The result showed that there is a moderate positive correlation between knowledge and expressed practices at r = 0.41.

Discussion

NSIs are common and significant occupational hazards among housekeeping staff which can potentially cause blood-borne infections such as HIV and Hep B. Hence it is important to understand the knowledge and expressed practices followed by housekeeping staff to increase awareness and reduce the incidence of NSI.^[15] The findings of the study have been discussed regarding the objectives and assumptions of the study.

The present study was conducted to assess the level of knowledge and expressed practices among housekeeping staff. A total of 225 housekeeping staff were enrolled in the study by convenience sampling.

A total of 32.88% of the participants had no formal education. Most (87.99%) of the subjects were educated until secondary, and very few had any higher education. This is consistent with the study conducted by D’silva MM, Mathew M, Jose NT, et al. in which the majority were educated between 8th - 10th standard (44%)^[16] and the study conducted by Erdem Y, Talas MS. in which (54%) are graduates of primary school or were illiterate.^[17] There are different methods to prevent infections due to sharp injuries, comprising staff education and proper wearing of PPE. Vaccination could be one of the methods to protect workers from infection, but vaccination is only available for HBV and Tetanus.^[15] In the present study, out of the total participants, only 26.22% of the housekeeping staff were fully vaccinated against HBV.

This finding was similar to a study conducted by Talaat M et al. in which, overall, 15.8% of HCWs reported receiving three doses of the hepatitis B vaccine, out of which the lowest was among housekeeping staff (3.5%).^[18] A similar study, conducted by D’silva MM, Mathew M, Jose NT, et al., shows that among the subjects, around 80% were immunized with three doses of Hepatitis B vaccination.^[16]

In the present study, around 9% of the housekeeping staff had been exposed to NSI, out of which 7.11% have been exposed twice, and 1.77% have been exposed more than twice, consistent with the study conducted by Erdem Y, Talas MS. in which 29.1% have been injured with various blunt and penetrating objects while working in the hospital.^[17]

In the present study, around 9% of the housekeeping staff had been exposed to NSI, out of which 7.11% have been exposed twice, and 1.77% have been exposed more than twice, consistent with a study conducted by Erdem Y, Talas MS in which 29.1% have been injured with various blunt and penetrating objects while working in hospital.^[15]

The present study revealed that most participants had good and average knowledge of 36.88% and 37.33%, respectively, and very few (11.11) had excellent knowledge of needle stick injury. About 11% had poor knowledge. It is consistent with the study conducted by D’silva MM, Mathew M, Jose NT, et al., in which the majority (75%) of the participants had good knowledge, very few (13%) had very good knowledge, and about 12% had poor knowledge on needle stick injury.^[16]

Recommendations

Based on the findings of the study, it is recommended that the study be replicated on a larger sample of housekeeping staff, and the NSI prevention and management training sessions be conducted for the housekeeping staff.

Conclusion

The present study points out the importance of knowledge and its implementation in preventing NSIs. The study revealed a moderate positive correlation between knowledge and expressed practices. A significant association between participants’ education and knowledge and expressed practices was found, which reconfirms the vitality of education and dissemination of information. Strategies to mitigate the incidence of NSI can be done by displaying information boards on the do’s and don’t relating to NSIs, creating an easy NSI reporting platform, and monitoring postexposure treatment.

Acknowledgement

We express our sincere gratitude to study participants for being part of this study and sharing their valuable time and information. We are thankful to AIIMS Jodhpur administration and authorities for providing much needed support and guidance.

Financial support and sponsorship

This research did not receive any grant from the public, private, or any other funding agencies.

Conflicts of interest

The author (s) declared no potential conflict of interests regarding research, authorship, or publication of this research article.

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