Safe injection procedures, injection practices, and needlestick injuries among health care workers in operating rooms

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 10 January 2017

Figures & data

Table 1 Procedures for safe injection, as observed in the studied operating rooms.

Safe injection procedures	Operating rooms (n = 34)
	Yes		No
	No.	%	No.	%
1. Disposable injection equipment
- Absence of any loose disposable injection equipment outside of packaging or in a waste container including
• Loose disposable needles and syringes	29	85.3	5	14.7
• Loose disposable phlebotomy equipment	34	100.0	0	0
• Loose disposable intravenous infusion equipment	33	97.1	1	2.9
- Non reuse of disposable injection equipment	34	100.0	0	0
- Presence of job aids posters that promote safe administration of injections	0	0	34	100.0
Absolute score
Min–Max	2.0–4.0
Mean ± SD	3.8 ± 0.4
Percent score
Min–Max	40.0–80.0
Mean ± SD	76.4 ± 9.1
2. Hand hygiene
- Presence of running water	34	100.0	0	0
- Presence of soap	0	0	34	100.0
- Presence of alcohol-based hand rub	34	100.0	0	0
- Presence of job aids posters that promote appropriate hand hygiene	34	100.0	0	0
Absolute score
Min–Max	3.0–3.0
Mean ± SD	3.0 ± 0.0
Percent score
Min–Max	75.0–75.0
Mean ± SD	75.0 ± 0.0

Table 2 Waste management measures as observed in the studied operating rooms.

Waste management measures	Operating rooms (n = 34)
	Yes		No
	No.	%	No.	%
1. Waste containers
- Presence of separate waste containers for sharps, infectious and non-infectious waste	34	100.0	0	0
- Infectious waste^a is always present inside an appropriate container	17	50.0	17	50.0
- Absence of overflowing or pierced sharps containers	31	91.2	3	8.8
- Absence of used sharps in an open container^b	34	100.0	0	0
- Presence of one or more sharps container “in stock”	34	100.0	0	0
- Presence of job aids posters that promote safe disposal of used injection equipment	0	0	34	100.0
Absolute score
Min–Max	3.0–5.0
Mean ± SD	4.4 ± 0.6
Percent score
Min–Max	50.0–83.3
Mean ± SD	±10.1
2. Final waste disposal
- Complete closure of all sharps containers awaiting for final destruction	34	100.0	0	0
- Safe storage of full sharps containers	34	100.0	0	0
- Absence of any used sharps on floors	34	100.0	0	0
Absolute score
Min–Max	3.0–3.0
Mean ± SD	3.0 ± 0.0
Percent score
Min–Max	100.0–100.0
Mean ± SD	100.0 ± 0.0
Total absolute score
Min–Max	11.0–15.0
Mean ± SD	14.2 ± 0.8
Total percent score
Min–Max	61.1–83.3
Mean ± SD	79.0 ± 4.9

a Infectious waste should be placed in a container that is specific for non-sharps infectious waste example bloody swabs or dressings.

b A standard safety box that does not have the top cardboard flaps folded over and inserted into the top of the box is an open container. Any other container with a wide opening at the top (wide enough to insert fingers and touch used sharps) also is an open container.

Table 3 Safe injection practices in all observed injections performed in the studied operating rooms.

Safe injection practices	Injection observed (n = 62)
	Done		Not done
	No.	%	No.	%
Preparation of injection procedure
- Preparation of injection on a visibly clean, dedicated table or tray	62	100.0	0	0.0
- Washing hands before preparing an injection with soap and running water	0	0.0	62	100.0
- Cleaning hands before preparing an injection by using alcohol-based hand rub	26	41.9	36	58.1
- Using a new pair of gloves	26	41.9	36	58.1
- Taking disposable syringe from a sterile unopened packet	62	100.0	0	0.0
Injection administration
- Using a clean barrier to protect fingers when breaking the top of glass ampoule (n = 48)	8	16.6	40	83.3
- Cleaning the patient’s skin before the injection with an antiseptic	33	53.2	29	46.8
- Avoiding palpation of the venipuncture site after skin preparation with an antiseptic (n = 19)	8	42.1	11	57.9
- Appropriate securing the patient and the intended puncture site	62	100.0	0	0.0
- Cleaning the rubber stopper on the glass bottle top with an alcohol pad before inserting the spike	0	0.0	62	100.0
- Termination of the procedure and applying pressure to prevent hematoma expansion (n = 10)	10	100.0	0	0.0
Waste management activities
- Avoiding recapping of used needle with two hands	62	100.0	0	0.0
- Cleaning the work area with disinfectant after the procedure if there is BBF contamination (n = 2)	2	100.0	0	0.0
- Cleaning hands by washing with soap and clean water or using alcohol-based hand rub after the procedure	12	19.4	50	80.6
- Immediate disposal of sharps and infectious waste in an appropriate container	62	100.0	0	0.0
Total absolute score
Min–Max	5.0–11.0
Mean ± SD	7.0 ± 1.5
Total percent score
Min–Max	31.2–68.7
Mean ± SD	43.8 ± 9.6

Table 4 Distribution of the studied HCWs according to their sociodemographic and occupational characteristics.

Sociodemographic and occupational characteristics	HCWs (n = 318)
	No.	%
Gender
- Male	218	68.6
- Female	100	31.4
Age (Years)
- Min–Max	20.0–65.0
- Mean ± SD	35.7 ± 10.6
- 20–<30 years	141	44.3
- 30–<40 years	75	23.6
- 40–<50 years	51	16.0
- 50–<60 years	44	13.8
- 60–<70 years	7	2.2
Level of education
- Read and write	10	3.1
- Basic education	20	6.3
- Diploma at Institute of Nursing	77	24.2
- MBBCh	101	31.8
- Master	56	17.6
- MD	54	17.0
Profession
- Surgical staff	170	53.5
- Anesthesia staff	41	12.9
- Nursing staff	73	23.0
- Other HCWs (Technicians, housekeepers and sterilization staff)	34	10.7
Duration of employment (years)
- Min–Max	0.50–47.00
- Mean ± SD	11.5 ± 11.4
- 6 m–<10 years	184	57.9
- 10–<20 years	54	17.0
- 20–<30 years	40	12.6
- 30–<40 years	36	11.3
- 40–<50 years	4	1.3
Hepatitis B vaccination
- Vaccinated with ⩾3 doses	169	53.1
- Not vaccinated or incomplete doses	149	46.9

Table 5 Characteristics of the last NSSI experienced by the injured HCWs.

Characteristics of the last NSSI	Injured HCWs (n = 195)
	No.	%
Source patient was identifiable
- No	13	6.7
- Yes and tested	56	28.7
- Yes but not tested	126	64.6
Injured HCW was the original user of the sharp item
- No	66	33.8
- Yes	129	66.2
Sharp item was contaminated
- Contaminated	156	80.0
- Uncontaminated	39	20.0
Sharp item that caused the injury
- Suture needle	102	52.3
- Disposable syringe	32	16.4
- Scalpel	25	12.8
- Ampule	14	7.2
- I.V. catheter	7	3.6
- Electrocautery	5	2.6
- Scissors	3	1.5
- Others (Towel clip, prolene suture, spinal/epidural needle, drain, transfusion set)	7	3.5
Timing of injury
- Before use of item	34	17.4
- During use of item	133	68.2
- After use of item	28	14.3
Site of the injury
- Rt hand Palm	5	2.6
- Rt hand Dorsum	4	2.1
- Rt Thumb	26	13.3
- Rt Fingers	34	17.4
- Lt hand Palm	12	6.2
- Lt hand Dorsum	5	2.6
- Lt Thumb	28	14.4
- Lt Fingers	77	39.5
- Rt Front lower leg	1	0.5
- Rt foot	3	1.5
Depth of the injury
- Superficial (little or no bleeding)	108	55.4
- Moderate (skin punctured, some bleeding)	70	35.9
- Deep (deep stick/cut, or profuse bleeding)	17	8.7
Gloves used at time of the injury
- Single pair gloves	91	46.7
- Double pair gloves	63	32.3
- No gloves	37	19.0
- N/A^a	4	2.1
Hand predominance of injured HCW
- Right handed	188	96.4
- Left handed	7	3.6
Source of the injury
- Suturing	99	50.8
- Improper handling of instruments	34	17.4
- IV injection or cannulation	14	7.2
- Improper disposal of sharp waste	17	8.7
- Opening of ampoule or disposable syringe before use	14	7.2
- Recapping a needle	11	5.6
- Electrocautery	5	2.6
- Bad lighting in emergency operating rooms	1	0.5

a The injury was not in the hands.

Table 6 Post-exposure management following the last NSSI exposure experienced by the exposed HCWs in the last 6 months (n = 195).

Post-exposure management	Done		Not done
	No.	%	No.	%
First aid measures
- Washing the affected area, allowing bleeding, using a disinfectant	85	43.6	110	56.4
Reporting exposure
- Immediately following the exposure to infection control or occupational health unit	4	2.05	191	97.9
Source patient testing following NSSIs
- HBV	54	27.7	141	72.3
- HCV	56	28.7	139	71.3
- HIV	21	10.8	174	89.2
Exposed HCWs testing
- HBV	69	35.4	126	64.6
- HCV	73	37.4	122	62.6
- HIV	40	20.5	155	79.5
Administration of PEP
- HBIG, HBV vaccine, PEP medication HCV	6	3.07	189	96.9
Follow-up care
- HBV (n = 69)	19	27.5	50	72.5
- HCV (n = 73)	20	27.4	53	72.6
- HIV (n = 40)	11	27.5	29	72.5