Occupational Hazard: A Report on Needle-Stick Injuries in Arusha, Tanzania By Reem Mahmood

Transcription

1 Occupational Hazard: A Report on Needle-Stick Injuries in Arusha, Tanzania By Reem Mahmood Introduction In the developing world, needle-stick injuries are common. A needle-stick injury is defined as a puncture of the skin by a needle injection 1. They occur due to over use of injections where oral medications would have sufficed, and unsafe practices when giving these injections. According to the World Health Organisation (WHO), around 70% of injections given in developing countries are unnecessary. 1 The consequences of unsafe practice could be catastrophic in areas like Arusha, Tanzania, where the prevalence of HIV is 1.4 per Many healthcare professionals in developing countries are aware of the risk of transmission of HIV through needle-stick injuries, however are unaware that other blood-borne diseases can also be transmitted, including hepatitis B and C. 3 Unsafe practice in developing countries can be attributed to limited resources, a lack of training and, an absence of standardised procedures. 4 Healthcare professionals are putting themselves and others at risk, however it is difficult to ascertain the impact of needle-stick injuries in the work place due to the under reporting of incidents. 3 Therefore, it is important to gain insight into the practices occurring in developing countries in order to understand why needle-stick injuries are so common and how to prevent them. Aims This report investigates needle-stick injuries affecting healthcare professionals at West Meru Hospital in Arusha, a northern region of Tanzania. The aim of this report is to highlight changes that can be made in order to reduce the number of needle-stick injuries that occur. The report will investigate the existing precautions taken to avoid an incident and what steps are taken after it occurs. It will also include data on the number of needle-stick injuries occurring. The results will allow recommendations to be made in order to improve the safety and care of healthcare professionals. Method A literature search was carried out in order to gain background knowledge on needle-stick injuries both in the UK and abroad. A 5 week placement was undertaken at West Meru Hospital. During that time it was possible to observe injection giving technique and needle safety on the wards. Staff members were interviewed in order to learn about their experiences of needle-stick injuries in the hospital. Data was collected using a register which lists staff members on post-exposure prophylaxis (PEP). Figure 1. Meru District Hospital in Arusha, Tanzania Results In the large northern region of Arusha the population is just under 1,700, Meru Hospital is a district government hospital which serves around 315,000 people with 10 wards and only 120 doctors, nurses and clinical officers, collectively.

2 The exact number of needle-stick injuries occurring within the hospital is a difficult figure to determine. After speaking to healthcare professionals it is clear that needle-stick injuries are a common occurrence, however, they are very rarely reported. Lack of reporting is due to many reasons, including: Ignorance many healthcare professionals are not aware that incidents should be reported or to whom they should be reported. Lack of reporting protocol there was no protocol in place which informs staff who they should report to after an injury. There is a register documenting the staff receiving PEP, however there is no register of all staff members that have had a needle-stick injury. Perceived lack of need to report - most doctors do not feel it is necessary to report an incident unless there is I have had many needle-stick injuries a risk of HIV. Many will perform a HIV test on the but if the patient does not have HIV patient and on themselves, and if both are negative then I do not get worried. then it is assumed that PEP is not needed. Therefore, Dr Mvungi, Meru District Hospital the incident it not reported and no follow-up is carried out. Most staff members do not consider the risk of contracting hepatitis B and C from a needle-stick injury. Stigma there is a lack of confidentiality if the incident is reported therefore there is fear of stigma from other members of staff. There is a register which documents members of staff that have received PEP. This could be for various reasons including after rape, a human bite, or a needle-stick injury from a patient living with HIV. The register showed that the number of healthcare workers receiving PEP in the past 12 months was 43, but only 3 (around 7%) of these were after a needle-stick injury. The majority of those receiving PEP were victims of rape. However, the number of people receiving PEP does not accurately portray the number of people who have had a needle-stick injury at work. Number of Healthcare Workers Receiving PEP in the Past 12 Months Needle-stick injury Human Bite Rape Figure 2. Bar Chart to Show the Number of Healthcare Workers Receiving PEP in the Past 12 Months Whilst on the wards, it was clear to see why so many needle-stick injuries occur. There is evidently unsafe practice in the use and disposal of needles. There were safety boxes available on the wards; however they were not always used appropriately. The following were just some of the practices seen over a 5 week period on the wards:

3 Overflowing safety boxes Needles on the floor around the safety box Used needles left on trolleys Needles being resheathed Unsheathed needles being passed from doctor to nurse Needles being reused Sharps being disposed of in a clinical waste bin Figure 3. An overflowing safety box and needle on the floor found on the Maternity Ward Figure 4. Needle found left in a vial on the Male Ward Posters were present around the wards and clinics which promoted safe practice and protocols. There were posters demonstrating Ayliffe Technique and, on some wards, there were posters which gave instructions on what to do after a needle-stick injury. However, despite these guidelines, many members of staff were unaware of what they should do after a needle-stick injury. After speaking to doctors and nurses there was debate about whether they should let the wound bleed, wash with just water, or wash with soap and water. Overall, the time spent at West Meru Hospital showed that needle-stick injuries are a common occurrence even though the exact number is not known. There is unsafe use and disposal of needles in addition to a lack of awareness of the management of needle-stick injuries. Therefore, recommendations can be made to reduce the number of needle-stick injuries and to improve the wellbeing of healthcare professionals. Recommendations Based on the results of the report, the following recommendations were made and implemented at Meru District Hospital: 1. Reporting Needle-stick Injuries It was important to develop a protocol for reporting needle-stick injuries in the hospital. The protocol states that any staff member that has a needle-stick injury should report to the clinical director of the hospital, Dr Lawrence. A proforma was created so that the information needed about the incident could be collected easily. The proforma included the following questions: o Name of staff member

4 o Date and time of incident o What procedure was being performed? o How did the injury occur? o Was there exposure to any materials? (e.g. blood) o Was the patient HIV positive? o Is PEP required? o Did the patient have any other blood-borne diseases? (e.g. hepatitis B or C) o When is follow-up due? The data collected will then be compiled into a register. This register will remain completely confidential and will only be shown if in the best interests of the staff. 2. Preventing and Managing Needle-stick Injuries New posters were created in order to clearly and concisely demonstrate how to safely use needles and how to manage a needle-stick injury. These were printed and put up on all wards and clinics of the hospital. The posters are shown below: Figure 5. Poster on prevention of needle-stick injuries Figure 6. Poster on management of needlestick injuries

5 3. Educating Staff Every Friday, the healthcare professionals of the hospital receive an hour of teaching as part of their continuing education. It was decided that one of these sessions will be dedicated to teaching staff about the safe use and disposal of needles. Also taught in this session will be the prevention of needle-stick injuries and the new protocol following an injury. This will be repeated annually to reinforce the training in existing staff and to make sure that any new staff also receives training. Further Research It would be very beneficial to go back to West Meru Hospital to see if the new recommendations are still being implemented. If the needle-stick injuries are being reported, it would be interesting to see how many actually occur, and then follow this up annually to see if the incidence decreases with increased needle-safety. References 1. Manyele SV ed. Do No Harm: Injection Safety in the Context of Infection Prevention and Control. Tanzania Ministry of Health and Social Welfare (accessed 3/10/2013) 2. Ramadhani A, Somi G, Josiah R, Matee M, Hokororo J et al. HIV/AIDS/STI Surveillance Report. Tanzania Ministry of Health and Social Welfare. Report (accessed 3/10/2013) 3. National Health Service. Needlestick Injury. (accessed 3/10/2013) 4. World Health Organisation. Occupational Health: Needlestick Injuries. (accessed 3/10/2013)