Incidence of Occupational Exposure in a resource limited setting health care

Background: The data regarding the incidence of sharp injury (SI) from India is limited. Health care worker safety is of paramount importance and requires assessment of risks & solutions to reduce preventable risk factors.

Objective: To describe the incidence of needle stick injury (NSI) & blood and body fluid exposure (BBE) in a resource limited setting

Methods: Epinet software (from University of Virginia) was installed to analyze the data from Jan 2007 to Dec 2009. The statistical analysis was carried out using SPSS software.

Results: A total of 268 NSI and 18 blood and BBEs were reported during the study period.The majority of SI occurred to nursing (n= 183, 68%), followed by technicians & students (n=36; 13%), housekeeping (n=30, 11 %), doctors (n=12; 5%) and others (n=7, 3%). These injuries most commonly occurred in in-patient rooms (n=112, 42%), ICUs (n=54, 20%), operating room (n=47,18%), out-patient (n=21, 8%), ER (n=11, 4%) and others (n=21, 8%). Majority of SI occurred during IV insertion (n=96, 35%), recapping (n=41, 15%), during disposal after use (n=25, 9%), during surgery (n=17, 6%), waste collection (n=17, 6%) and others (n=59, 22%). In the majority (n=200, 74%) of the events the source of NSI was identifiable, of which HBV (n=41, 15%), HCV (n=21, 8%), HIV (n=5, 2%). In 35% cases, source of NSI was unidentifiable. Immunization for hepatitis B among HCW was 80%. One HCW had acquired HCV and was successfully treated with interferon and ribovarin. Needles on disposable syringes were the commonest device causing injury followed by IV catheter stylet (9.05%) and suture needle (5.76%). 62% of the total SI were known to be contaminated and 11% were known to be uncontaminated. The presence of safety design was analyzed and 77% of the injuries occurred due to unprotected instruments. The other locations where HCWs commonly got exposed to BBF were operating rooms, or recovery rooms, (15.23%), outside patient rooms (10.3%) and intensive care units (10.3%).

Conclusions: Intervention to reduce the SI among HCW needs to be planned viz. puncture proof containers at the bed side, and the use of safety devices during IV insertion and phlebotomy. Training for proper waste segregation, collection and disposal among all HCW is also essential.