Introduction
Doctors, nurses, and medical and
nursing students are among the health care workers (HCW) who are occupationally
exposed to blood and other body fluids (e.g. saliva, vomit, mucus, etc.) which
might increase their risk of acquiring blood-borne pathogens especially human
immunodeficiency virus (HIV), hepatitis C (HCV), hepatitis B (HBV), and
psychological stresses. There are different studies which have
investigated these types of exposures in the various settings [1-5].
Amonghealth care workers, evidences suggest that different health discipline
students are also at a high risk of being occupationally exposed to needlestick injuries (NSI)
and body fluids [6].There are also a number of studies
that have determined such occupational exposures among these high risk groups
especially nursing [7-9] and medical [10-13] students. It should be noted that almost all the previous studies had measured
needlestick injuries or body fluids exposure (BBE) in the prior year of their
study, also, there is no reported study which has investigated these important issues
among doctors and
medical students in Rafsanjan University of Medical Sciences (RUMS). RUMS has been established nearly three decades ago in a city
called Rafsanjan in the Southeast of Iran (Figure 1). This school has three
affiliated hospitals (i.e. Ali-Eben-Abitaleb, Moradi and Niknafs) in which
medical students spent their internship period.
Figure 1: Study
location in Iran
The
aim of the present study was to determine the lifetime occupational exposure to needlestick and body
fluids among doctors and medical students in RUMS.
Materials and methods
This
descriptive study was
carried out in the year 2009 within three affiliated hospitals of RUMS. A group of one hundred
respondents including 25% of the random sample of total doctors (n=25) and 100%
of medical students (n=75) were asked to complete a self-administered
questionnaire regarding their lifetime occupational exposure to needlestick
injuries and fluids. The questionnaire consisted of three sections: 1) demographic
characteristics of the participants including age, gender, work history and job
(i.e. doctors or medical students), 2) their Hepatitis B vaccination history
and 3) the details of their lifetime occupational exposure to needlestick or/and
body fluids. Participants were also asked whether they usually recapped the
used needles or not, and whether they had reported their exposure to the
appropriate authorities.
The validity of the questionnaire was
supported by reviewing the existing questionnaires. Furthermore, for assessing
the reliability of the questionnaire a pilot study was also carried out. The
questionnaires were handed out in all the departments and the participants were
asked to complete them only if they were willing to. The completed
questionnaires were gathered the next day and the data were entered into SPSS
(version 16) and were analysed using Fisher's Exact and Student t-tests, as
well as Chi-square test.
Results
Ninety five completed questionnaires
were returned giving the response rate as 95%. The results highlighted that the mean age of doctors and students under study
were 33.95±9.55 and 25.20±1.65 years, respectively. The mean of working months
for doctors and students under study were 92.29±103.49 and 7.52±6.06,
respectively. Demographical characteristics along with NSI and BFE
of doctors and
students under study are depicted in Table 1. As the table shows, 15 (%15.8) of
doctors and 42 (%44.2) of students had NSI (P=0.098) and13 (%14) of doctors and
32(34.4) of students had BFE
(P=0.044).
As a result, 57 (60%) of all the
respondents had at least one lifetime occupational exposure to needlestick
injuries and 45 (48.4%) had at least one lifetime occupational exposure to body
fluids. As this table and other tables in this section depict the
completed questionnaires
had also some missing items. The highest number of needlestick injuries
occurred within the emergency department (n=29, 51%), during nightshift (n=29,
51%) and with suture needle (n=37, 65%) and only 30 (31.5%) of the exposed
cases had reported their exposure to the appropriate authorities.
Furthermore,
91 (96%) of the participants had received their Hepatitis B vaccinations and 43
(45%) of the participants reported that they always recapped used needles. Among
other variables under study i.e. age, gender, job, work history and recap
practicing, only two have shown the significant association with the exposure
to needlestick injuries and
body fluids. First, recap practicing has significantly increased the exposure
to needlestick injuries
(P = 0.001) (Table 2).
Table
2. The association between practising recap with exposure to needlestick injuries among respondents
|
|
Recap
|
|
|
Needlestick
injuries
|
Yes
|
No
|
Total
|
|
Number (%)
|
Number (%)
|
Number (%)
|
|
Yes
|
39 (90.7)
|
16 (57.1)
|
55 (77.5)
|
|
No
|
4 (9.3)
|
12 (42.9)
|
16 (22.5)
|
|
Total
|
43 (100)
|
28 (100)
|
71* (100)
|
Chi-Square = 3.399, df = 1, P = 0.001
* The complete data on joint distribution of two variables were
available for 71 out of 95 cases.
The
second variable was respondent's gender as being male also significantly
increased the exposure to body fluids (P = 0.005) (Table 3).
Table
3. The association between gender with exposure to body fluids among
respondents
|
|
Gender
|
|
|
Body fluids
|
Male
|
Female
|
Total
|
|
Number (%)
|
Number (%)
|
Number (%)
|
|
Yes
|
23 (67.6)
|
21 (37.5)
|
44 (48.9)
|
|
No
|
11 (32.4)
|
35 (62.5)
|
46 (51.1)
|
|
Total
|
34 (100)
|
56 (100)
|
90* (100)
|
Chi-Square = 7.695, df = 1, P = 0.005
* The complete data on joint distribution of
two variables were available for 90 out of 95 cases.
Discussion
The results of the present study
revealed that 60% of the respondents had at least one lifetime occupational exposure to needlestick,
which is close to the 67.9% that was
reported by Hanafi et al, in 2011 [1]. Nevertheless, our figure was substantially
higher than 34% that was reported by Salzer et al [10]; and 30.9% that was reported
by Tadesse and Tadesse [2]; 49% that was reported by Talas [9]; 31.4% that was reported
by Wicker et al. [4] and 27% that was reported by Adegboye et al. [5]. Similarly,
48.4%
of our respondents had at least one lifetime occupational exposure to body fluids, which seems to
be substantially higher than 23.1% that was reported by Kessler et al. [6]. It
should be noted again that almost all the previous studies measured needlestick
injuries in the previous year of their study, while in this study we measured
lifetime exposure.
This might partially explain why we
have determined a higher exposure than most of the other studies. Higher
exposure to needlestick and body fluids in our study might also be due to less working
experience of our respondents, especially among the medical students. Evidences
also suggest that our respondents have a high workload, therefore, it seems
that more studies are needed to determine the related factors. Based on these
findings, it is recommended that further studies also try to measure lifetime exposure
to determine a complete picture of these occupationally constant threats. Since
such adverse events are always remembered by the affected population because of
their possible considerable health consequences and psychological stress, we think
that recall bias is unlikely to occur in the studies that measure lifetime
exposure.
One of the other important findings
of our study is that 68.5% of the exposed cases did not report their exposure
to the appropriate authorities. This figure is much higher than 33.0%, the
proportion that was reported by Kessler et al study in 2011 [6], and 34% reported
by Salzer et al in 2011 [10]. The results of our study in accordance with the
results of other studies [6-10] have determined that usually exposed cases do
not report their exposure due to the following reasons: believing that their contact
is not important; being too busy; not knowing how to report and/or believing
that such reports might have an unfavorable effect on their job success. Therefore,
such inappropriate attitudes and behaviors should be changed by improving
medical curricula and/or conducting educational campaigns. We have also found
that recap practicing has significantly increased the risk
of exposure to needlestick. This finding has also been supported by previous studies [14-16].
In order to prevent this risky
behavior, improving medical curricula and/or conducting educational campaigns
are also needed. The aims of such programs are either to diminish such risky
behaviors altogether or to implement single-handed "scoop" method to
recap needles. Similarly, providing safety devices for the disposal of needles are
also recommended [17].
The other important finding of our
study is that the risk of exposure to needlesticks is higher in the emergency
departments and during nightshifts. This could be due to the fact that usually
emergency departments and nightshifts suffer from higher workload and inadequate
staffing. The results of the previous studies also highlighted that sufficient
staffing on every shift and extra caution throughout periods of high workload
are needed to avoid exposure to needlesticks [18-20]. Our results also
highlighted that 96% of our participants had been vaccinated against hepatitis
B, which seems to be higher than 67.7% that was reported by Talas in 2009 [9]. It
is therefore recommended that before beginning clinical practice in RUMS all
medical students and doctors receive full immunization against hepatitis B. Finally,
as in the Vaz et al study [3], we would like to recommend establishing a
monitoring system which would provide precise information on the scale and
trends of exposure to needlestick and body fluids in doctors, medical students,
and other health care workers of RUMS. Launching such monitoring systems would
also offer an environment for implementing the effective intervention.
Conclusion
Occupational exposures to needlestick
injuries and body fluids among doctors and medical students in RUMS have
occurred with a relatively high lifetime incidence. Improving medical curricula,
conducting educational campaigns, increasing recap needles behaviour,
implementation of safety devices and reducing the workload of the population
under study might have positive effects on decreasing the incidence and
prevalence of these constant threats.
Acknowledgments
This paper is based on Hamed Khadem
Rezaeian medical thesis, which was supervised by Drs Mohsen Rezaeian and
Mohammad Asadpour. The authors would like to thank all the doctors and medical
students who participated in this study.
Conflict of interest: Non declared
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