Journal of Occupational

 
Table 2: Factors causing needle stick and sharp injuries

 
Table 3: The correlation between needle stick injuries and demographic variables

 
Discussion
Needle stick and sharp injuries as well as exposure to the fluid discharge of patients can lead to the transmission of highly dangerous diseases, which is considered as a risk factor by occupational therapists. According to the results of this study, among the total of 176 staff participating in the study, 90 individuals (51.12%) experienced needle stick and sharp injuries, with this amount being less than that of the studies conducted by Azap in Turkey (9), Kermode in Australia (12), and Askarian in Shiraz (13). These differences could have been due to the type of healthcare workers, hospitals, and sample sizes. The aforementioned amount has been greater than that of the study conducted by Smith et al in Japan (14). A study conducted by Cho et al showed that 70% of nurses suffered needle stick and sharp injuries during the last year (15). Rais and Jamil reported in their study that 77% of the hospital staff experienced at least a needle stick injury (16). In the present study, all healthcare workers were evaluated in terms of NSIs, but in the aforementioned studies, only nurses were evaluated.
The total coverage rate of hepatitis B vaccination (three times as standard protocol) was 90.9% in this study. According to a study carried out by Kathy Byrd et al, 69.5% of the hospital staff injected hepatitis B vaccines in three phases, with this having been lower than the standard level (17). A study by Rosemary J. Burnett in South Africa reported that 67.9% of the staff received at least one dose of the hepatitis B vaccine. In the aforementioned study, only 19.9% of the staff were fully vaccinated (18). These differences could be attributed to different protocols used for the vaccination of healthcare staff at hospitals.
In this study, the highest degree of damage was reported to have been occurred to the staffin the operating room, which is consistent with the results of the study conducted by Serfafiska in Poland (19).  This could have been due to the nature of the procedure and the risks present in the operation room. The staff of the operating room have to press the needle into the patient’s body and remove it several times, with the duration of this procedure being longer than other injections; thus, the chance of injuries is higher. The results of the study by Cho et al showed that high emotional exhaustion as well as working at surgical and operating rooms were associated with an increase in the chance of needle stick injuries (15). The results of the study by Adib Haj Bagheri showed that the majority of needle stick and sharp injuries occurred to the operating room staff (20). According to the results of the study by Martin et al, 64.5% of the staff had the history of at least one injury during the past five years. The most affected people were reported to be nurses and women (21). A study by Nagao et al showed that 72.2% of the injured staff were nurses (22). In the same vein, the results of the study by Yushikawa showed that the incidence of injuries was 3.2 times higher in nurses than in other staff. Most injuries occurred in the operating room and patient rooms (23). The results of the present study are consistent with those of the above-mentioned studies, thereby implying that nurses are more at the risk of NSIs due to the nature of their works.
In the present study, most of the damage occurred after injections and before disposing of the contaminated equipment; likewise, the results of a study in Shiraz attributed the greater amount of damage to intravenous injections (24). In the study by Damet et al, the highest extent of damage was reported to have happened when removing the needle cover. In most studies, insufficient experience, rush, and fatigue have been mentioned as the causes of injuries (25). In Nsubuga’s study, the most prevalent risk factors for needle stick injuries included not attending training sessions, being a nurse, working at the surgery department, having less than 10 years of work experience, working for long hours, needle re-closure, and not using gloves (26). In the study of Rais, 40.3% of the injuries occurred while using needles, and 58.4% of the injuries occurred when removing syringes. In 72.7% of the cases, fingers were reported to have been damaged (16). This finding has been consistent with a meta-analysis conducted by Fereidouni et al (3), in which they confirmed that injections were the most common causes of occupational injuries in healthcare workers.
The most common cause of injuries in nurses was the re-closure of syringes (39.1%). In the study by KuruZuum et al (27) and Yushikawa et al, (23) disposable syringes and suture needles were the most common causes of injuries. The results of the study by Vos et al showed that needle tips were the damaging items in 53% of the cases, with the wrong disposal and re-closuring of the needles reported as the two common causes of injuries (28). The results of the study by Bi et al showed that hollow needles were responsible for 51.7% of injuries. In another study, 40.4% of the injuries were reported to happen when using tools, 27.1% of the injuries after use and before disposal, 11.3% of the injuries during the disposal process, and 8.9% of the injuries at the time of cleaning and collecting the tools (29). In the study by Nagao et al, 55.9% of the injuries occurred after the use of needles and before their disposal (22). The results of the present study are consistent with those of the above-mentioned studies, implying that re-capping is the most common activity that causes NSIs.
In the present study, medical staff were reported to have been responsible for 6.7% of injury cases. The most likely reason for this could be the low risk of infections and dissatisfaction with the lack of follow-ups, having been consistent with the results of the study by Askarian (13). A study by Laishram et al reported that 43% of the staff did not report their injuries (30). In the study by Castigliola on nurses, it was reported that imagine the source of the injury being safe was the major reason for the failure to report needle stick injuries (31). In the study by Gershon et al, 45.8% of the injuries were not reported (32). In the study by Elmiyeh et al, not understanding the transmission risk of infectious diseases was reported as the major reason for not reporting injuries (33). The reason for the low rate of reporting injuries by the healthcare staff in the present study is different with that of other studies, which could be attributed to the possible lack of a clear process for reporting NSIs by healthcare staff.
The results of this study showed that carelessness, rush, fatigue, and high workloads were the most common causes of injuries. The results of the study by Cho et al showed that fatigue and workloads were associated with an increase in the chance of needle stick injuries (15). According to the study by Elmiyeh et al, heavy workloads and being too busy were the major causes of needle stick injuries (33).
According to the present study, there was a significant correlation between the type of occupation and the history of needle stick injuries. In the present study, the most common individuals associated with needle stick injuries were nurses and operating room technicians. The results of a systematic review study by Fereidouni et al showed that nurses were the most common healthcare staff associated with needle stick injuries (2). This could be due to the nature of nursing and the direct care of patients. 
 
Conclusion
To sum it up, the results of this study showed that more than half of the participants (51.12%) suffered from needle stick and sharp injuries. Furthermore, carelessness, hurry, and fatigue were the most common causes of injuries (66.7%). The risk of getting injured by sharp devices seems to be serious at hospitals. Therefore, it is recommended to use skin and mucous protectors as well as gloves when working with sharp tools to reduce the transmission risk of pathogens from patients to medical staff. Defining and explaining instructions for following relevant stages after injuries and erecting them on the walls of different departments, holding different training classes, increasing the number of employees in different departments based on global standards to avoid an increase in workloads and fatigue, and avoiding the reduction of one’s focus when working with sharp devices and needles could be very helpful in reducing damage to different parts of the body. Health policymakers and planners could use the results of this study for the prevention of NSIs. This study had two potential limitations; firstly, it was conducted at two training hospitals; secondly, the self-made questionnaire was distributed among participants. 
 
Acknowledgement
This article was extracted from an approved research project, with the Grant Number of 95204, by Fasa University of Medical Sciences, Fasa City, Iran. We would like to thank the research deputy of Fasa University of Medical Sciences for offering support to this project. The authors would also like to thank Shiraz University of Medical Sciences (Shiraz, Iran), the Center for Clinical Research Development at Nemazee Hospital, and Dr. NasrinShokrpour for offering valuable editorial assistance.
 
Conflict of interest: None declared.