Sharp injuries and their determinants among health care workers at first-level care facilities in Sindh Province, Pakistan

Abstract

Summaryobjectives To assess the rate and determinants of sharp injuries during the previous 6 months among health care workers at first-level care facilities in two districts of Pakistan.methods Cross-sectional survey at public, general practitioners and non-licensed private practitioners selected through stratified random sampling. At each facility, we interviewed a prescriber and a dispenser ⁄ injection provider about knowledge of bloodborne pathogens transmission and preventive practices, risk perception, and use of precautions and sharp injuries received during the previous 6 months. Multivariable Poisson regression was used to assess the factors associated with the number of sharp injuries.results Fifty-four percentage of the 233 workers had at least one injury during the previous 6 months. The overall rate of sharp injuries per person per year was 3.7; among non-physician prescribers (9%), it was 4.3; among dispensers (69%), it was 3.7, and among physicians (18%), it was 2.1. In the multivariable model, work experience, risk perception and type of health care worker were significantly associated with receiving sharp injuries during the previous 6 months. In the model including dispensers only, a higher knowledge score was associated with fewer sharp injuries, while perceived severity of disease and lack of professional qualification were associated with more.

Health belief model to predict sharps injuries among health care workers at first level care facilities in rural Pakistan

“…BBPs' transmission Knowledge, being in the job for a longer time and perceiving fewer barriers to safe practice predicts use of UPs in turn resulting in less number of SIs. Similar findings have been reported from previous studies conducted in similar settings from Pakistan and India [Kermode et al, 2005a,b;Janjua et al, 2010b]. Increasing knowledge about BBPs transmission and precautionary measures, and decreasing barriers through easy availability of safety equipment, sharp disposal containers, and providing training on UPs may help the workforce at FLCFs to protect themselves by adopting essential UPs and reducing risk of SIs.…”

“…We found that when UPs score was included in the model, none of the constructs of HBM were significant while in a model without UPs score two constructs of HBMbarriers to safe practice and perceived severity of disease as a result of SIs, were significant. This further clarified the earlier findings from Pakistan and India and confirms that UPs is an intermediate between SIs and different behavioral predictors including some of the constructs of HBM [Kermode et al, 2005a;Janjua et al, 2010b]. In other words, these constructs work through the use of UPs in reducing SIs.…”

“…While, studies conducted at primary care practices in Wales-UK, Brazil, and immunization clinics in Dominican Republic reported lower rate of SIs 0.025, 0.12, and 0.13 per HCW/year, respectively [Atenstaedt et al, 2007;Moro et al, 2007;Garcia and Facchini, 2009]. Number of explanations could be considered for the lower rate in this study compared to the study conducted in Sindh-Pakistan [Janjua et al, 2010b]. Sindh province has one of the highest injections use at FLCFs (13 injections/person/year) compared to other regions in Pakistan that might have contributed to higher SIs compared to current study [Janjua et al, 2005].…”

“…The rate of SI in this study was 1.9/HCW/year which was less than that reported in previous study among HCWs from FLCFs from Sindh province of Pakistan (3.7/HCW/year) [Janjua et al, 2010b]. Distribution of SIs by type of HCW was similar between current study and the previous study from Sindh; higher rate among non-licensed prescribers than licensed prescribers.…”

Injection practices among practitioners in private medical clinics of Karachi, Pakistan

“…The logistic regression model in this study found that greater work experience, > 14 years of schooling, having ≤ 20 patients per day, administering < 30 injections per day and not recapping needles or reusing syringes were significantly associated with lower risk of sharps injury. The inverse relationship between work experience and sharps injury is consistent with previous studies conducted at primary care facilities in Pakistan [23,24] and India [8]. The exact reason for the lower risk of sharps injury with increased work experience is unknown; however, the most likely explanation for this association could be attainment of greater skill in carrying out procedures such as injection administration, suturing and cannulation over time.…”