Knowledge, Attitude and Practice of Nursing Personnel regarding safe handling of sharps

 

Azabu, Charachunlungliu Newmai, Comely Gassah, DY Phowlhrin Anal, Imlijungla Walling, L. Hemso Khiamniungan*

Assistant Professor, Medical-Surgical Nursing, College of Nursing, Christian Institute of Health Sciences and Research (CIHSR), Dimapur, Nagaland.

 

ABSTRACT:

Introduction: Handling different kinds of sharps on a daily basis as part of routine nursing activities puts the Nursing Personnel at a very high risk of sustaining injuries and thereby exposing them to various blood borne infections. This study aims to determine the Knowledge, Attitude and Practice of Nursing Personnel regarding safe handling of sharps. Methods: A cross-sectional study using Convenience Sampling Technique was conducted and 45 Nursing Personnel participated in the study. The setting was in selected wards of Christian Institute of Health Sciences and Research, Dimapur, Nagaland. Self-administered questionnaires, Likert scale and Observational checklist were used to assess the Knowledge, Attitude and Practice respectively. Results: Majority of the participants (38%) were in the age group of 26-30 years, trained in private institutions (67%) with majority (44%) having less than 3 years of working experience. Assessment of Knowledge regarding safe handling of sharps revealed that 5% had excellent knowledge, 53% had very good knowledge, 13% had good knowledge, 22% had fair knowledge and 7% had poor knowledge. Attitude on safe handling of sharps revealed that 98% had positive attitude, 2% had neutral attitude and none had negative attitude. Assessment of Practice regarding safe handling of sharps revealed that none of the Nursing Personnel had adequate level of practice, while 62% demonstrated moderate level of practice and 38% had inadequate level of practice. There was no statistically significant association found between Knowledge, Attitude and Practice with their selected demographic variables. Discussion: Majority of the Nursing Personnel having ‘very good’ knowledge regarding safe handling of sharps evinces a system of regular and extensive in-service classes focusing on safe injection practices and Universal precautions. Positive attitude of the Nursing Personnel creates an avenue for advancement of knowledge and improvement in practice through training and education. Higher knowledge level of Nursing Personnel regarding safe handling of sharps did not translate into good practice as none of the participants had adequate level of practice. Therefore, more emphasis should be given to evaluate and address issues which may be hampering the practicability of applying knowledge and learnings into actual practice.

 

 

 

INTRODUCTION:

Contaminated sharps is defined as any contaminated objects that can penetrate the skin including, but not limited to, needles, scalpels, broken glasses, broken capillary tubes, and exposed end of dental wires. (1910.1030 - Bloodborne Pathogens. Occupational Safety and Health Administration)¹

 

Nursing personnel are exposed to sharps of different kinds as part of their routine clinical activities and hence are more prone to injuries from such contaminated sharps and are at increased risk of acquiring blood borne infections such as HBV, HCV and HIV. The annual estimated proportions of health-care workers (HCW) exposed to blood-borne pathogens globally were 2.6% for HCV, 5.9% for HBV, and 0.5% for HIV, corresponding to about 16,000 HCV infections and 66,000 HBV infections in HCW worldwide (WHO  Needlestick Injuries)²

 

According to Muralidhar et al., (2010)³, about 80% of the nurses had experienced needle stick injuries. Askarian et al., (2012)⁴ also reported that 28% of the nurses failed to use personal protective equipment while handling sharps. Nursing Personnel are a valuable asset in a healthcare organization and it is of paramount importance to look into the health and wellbeing of nurses. Given the alarming rate of sharp related injuries among Nursing Personnel which greatly jeopardize their physical, emotional and psychological health, it is crucial to thoroughly evaluate their Knowledge, Attitude and Practice regarding safe handling of sharps which will provide the much-needed baseline data for developing and revising safety measures.

 

OBJECTIVES OF THE STUDY:

1.     To assess the Knowledge, Attitude and Practice of Nursing Personnel regarding safe handling of sharps

 

2.     To determine the association of Knowledge, Attitude and Practice of Nursing Personnel regarding safe handling of sharps with their selected demographic variables.

 

RESEARCH HYPOTHESIS:

1.     There is a significant relationship between the Knowledge, Attitude and Practice of Nursing Personnel regarding safe handling of sharps

2.     There is a significant association between Knowledge, Attitude and Practice of Nursing Personnel with their selected demographic variables

 

MATERIALS AND METHODS:

The study was conducted in 5 wards of Christian Institute of Health Sciences and Research (CIHSR) using a descriptive design. A Convenience Sampling technique was employed to select the 45 Nursing Personnel who participated in the study. The sample size was calculated based on the pilot study findings. The approval for the study was granted by the Research Committee of the College of Nursing.

 

The instruments used for data collection comprised of two sections:

 

Section 1:

Demographic variables of Nursing Personnel namely; Age, Institution trained, Total nursing experience.

 

Section 2:

Part A: Structured questionnaire to assess Knowledge of Nursing Personnel.

Part B: Likert scale to assess Attitude of Nursing Personnel

Part C: Observational checklist to assess the Practice of Nursing Personnel

 

Each tool consisted of 20 items. Content validity was done with the help of 3 nursing experts and the derived CVI was 0.98, 0.96 and 0.95 respectively. Informed written consent was obtained from the participants after assuring anonymity and confidentiality. The Practice of the Nursing Personnel was assessed using the Observational checklist prior to determining their Knowledge and Attitude regarding safe handling of sharps. It took an average of 1 hour to complete all assessments per participant. The data was analyzed using descriptive and inferential statistics.

 

RESULTS WITH DISCUSSION:

 

Table 1: Distribution of demographic variables of Nursing Personnel (n=45)

Demographic variables	Frequency (n)	Percentage (%)
1.     Age
a.     21-25  years	15	33.3
b.     26-30  years	17	37.8
c.     More than 30 years	13	28.9
2.     Institution Trained
a.     Government	03	06.7
b.     Private	30	66.7
c.     Semi-Government	12	26.7
3.     Total working experience
a.     Less than 3 years	20	44.4
b.     3-9 years	18	40.4
c.     More than 9 years	07	15.6

 

 

Table 1 highlights that out of 45 Nursing Personnel, 17(37.8%) were in the age group of 26-30 years, 30 of them (66.7%) were trained from private institution, 20 (44.4%) had less than 2 years of total working experience.

 

Objective 1: To assess the Knowledge, Attitude and Practice of Nursing Personnel regarding Safe handling of sharps

 

 

Figure 1: Knowledge of Nursing Personnel regarding safe handling of sharps

 

Figure 1 shows that majority of the Nursing Personnel (53%) had ‘very good’ knowledge regarding safe handling of sharps. The present study findings were consistent with the study conducted by Sheeba et.al. (2016)⁵ which reported 57% of the Nursing Personnel had moderately adequate knowledge regarding safe handling of sharps. Similar trend was found in the studies conducted by Siddique et al. (2008)⁶ and Vaz et al. (2010)⁷. Also study conducted by Amandeep, K., Pardeep, K. (2018)⁸ among staff nurses of selected hospitals of Ludhiana found that 52% had average knowledge, 34% had good knowledge, 4% had very good knowledge, 10% had poor knowledge regarding Biomedical waste management.

 

In the present study, majority of the Nursing Personnel having good knowledge level attributes to the presence of regular in-service education. Supplementation of the conventional lecture method of teaching with activity based or simulation based learning may further enhance the knowledge level.

 

Figure 2: Attitude of Nursing Personnel regarding safe handling of sharps

 

 

Figure 2 shows that almost all (98%) of the Nursing Personnel had a positive attitude towards the importance of safe handling of contaminated sharps.

 

The awareness of the hazards and health implications of sharp related injuries may have influenced the attitude of the Nursing Personnel in this study. The positive attitude indicates a favorable avenue for advancement of knowledge and practice through education and training. Honda et al., (2011)⁹ also reported similar findings in their study where more than half of the respondents had positive attitude regarding safe sharp management. Another study conducted by Gursangeet, S, and Amandeep, K. (2016)¹⁰ also reported that 95.8% of the nursing students had positive attitude regarding biomedical waste management. The study findings of Mondal, R., and Satyanarayana, P. (2018)¹¹ also found that nursing staff had the highest attitude score (85%) as compared to doctors and administrators in a Tertiary care hospital at Andhra Pradesh.

 

Figure 3: Practice of Nursing Personnel regarding safe handling of sharps

 

Figure 3 shows that none of the Nursing Personnel had adequate level of practice, 62% had moderate level and 38% had inadequate level of practice despite majority of the Nursing Personnel having very good knowledge.

 

A study conducted by Gowtham et al., (2019)¹² on health team members of selected primary health Care centers in Bangalore South reported similar findings where 67% of the respondents had moderate level of practice regarding biomedical waste management.  An interventional study conducted by Nagarajappa. D., (2014)¹³ with the aim to assess the effectiveness of biomedical waste management module in the practice of 45 primary health centers in Bangalore Rural district also reported very poor practice in the pretest.

 

Table 2: High risk practices of the Nursing Personnel

High risk practices	Frequency (n)	Percentage (%)
a.       Recapping of needles	45	100
b.      Recapping using two hand scoop method	36	80
c.       Handling sharps without proper PPE	43	96
d.      Failure to carry sharp bin to the patient’s bedside	34	76
e.       Failure to dispose sharps immediately after use	32	70

 

Studies by Nsubuga., and Jaakkola. (2005)¹⁴., Ebrahimi, H., and Khosravi, A. (2007)¹⁵.,Manzoor et al., (2010)¹⁶., Gupta et al., (2019)¹⁷ also revealed similar high risk practices by nurses such as recapping of needles, non availability of safe injection containers and leaving behind unattended needles. These findings project the inability of the Nursing Personnel to implement knowledge and learning to practice. Lack of adequate and user-friendly resources for management of sharps may explain such high risk practices among the Nursing Personnel. However, a study conducted by Pramod, K., and Indrajit, W. (2017)¹⁸ in Community Health Institutions in a district of Haryana reported prompt disinfection and disposal of sharps at the point of generation.

 

 

Objective 2: To determine the association of Knowledge, Attitude and Practice of Nursing Personnel regarding safe handling of sharps with their selected demographic variables.

Table 3 shows that there is no association between Knowledge of Nursing Personnel regarding Safe handling of sharps with their selected demographic variables

 

Studies regarding knowledge on biomedical waste management done by Rohit et al., (2019)¹⁹ among 40 staff nurses in selected hospitals in Udaipur and Francis. L., (2018)²⁰ in Christian Mission Hospitals, Madurai among 30 nurses reported similar study findings. However, the present study findings were contradicted by the study conducted by Fethin. G., (2020)²¹ wherein ‘age’ and ‘course of the study’ of the student nurses were significantly associated with the pre-test knowledge regarding needle stick injuries.

 

Table 4 shows that there is no association between Attitude of Nursing Personnel regarding safe handling of sharps with their selected demographic variables.

 

 

Table 3: Association between Knowledge of Nursing Personnel with their selected demographic variables.

Demographic variables	Knowledge of Nursing Personnel					Total	p value
	Excellent  n (%)	Very Good  n (%)	Good n (%)	Fair n (%)	Poor n (%)
1.     Age
21-25 years	0(0.0)	09(20.0)	2(4.4)	3(6.6)	1(2.2)	15(33.3)	0.69
26-30 years	2(4.4)	10(22.2)	2(4.4)	2(4.4)	1(2.2)	17(37.7)
More than 30 years	0(0.0)	05(11.1)	2(4.4)	5(11.1)	1(2.2)	13(28.2)
2.     Institution trained
Government	0(0.0)	02(4.4)	1(2.2)	0(0.0)	0(0.0)	03(6.6)	0.93
Private	1(2.2)	16(35.5)	4(8.8)	7(15.5)	2(4.4)	30(66.6)
Semi-government	1(2.2)	06(13.3)	1(2.2)	3(6.6)	1(2.2)	12(26.6)
3.     Total working experience
Less than 3 years	0(0.0)	12(26.6)	4(8.8)	3(6.6)	1(2.2)	20(44.4)	0.617
3-9 years	2(4.4)	9(20.0)	1(2.2)	5(11.1)	1(2.2)	18(40.0)
More than 9 years	0(0.0)	3(6.6)	1(2.2)	2(4.4)	1(2.2)	07(15.5)

(P value - Fisher’s exact test value at level of significance 0.05)

 

Table 4: Association between Attitude of Nursing Personnel with their selected demographic variables.

Demographic variables	Attitude of Nursing Personnel			Total	p value
	Positive	Neutral	Negative
1.    Age
21-25 years	15(33.3)	0(0.0)	0(0.0)	15(33.3)	0.28
26-30 years	17(37.7)	0(0.0)	0(0.0)	17(37.7)
More than 30 years	12(26.6)	1(2.2)	0(0.0)	13(28.8)
2.    Institution trained
Government	03(6.6)	0(0.0)	0(0.0)	03(6.6)	0.33
Private	30(66.6)	0(0.0)	0(0.0)	30(66.6)
Semi-government	11(24.4)	1(2.2)	0(0.0)	12(26.6)
3.    Total working experience
Less than 3 years	20(44.4)	0(0.0)	0(0.0)	20(44.4)	0.156
3-9 years	18(40.0)	0(0.0)	0(0.0)	18(40.0)
More than 9 years	06(13.3)	1(2.2)	0(0.0)	07(15.5)

(P value-Fisher’s exact test value at level of significance 0.05)

 

Table 5: Association between Practice of Nursing Personnel with their selected demographic variables.

Demographic variables	Practice of Nursing Personnel			Total	p value
	Adequate n (%)	Moderate n (%)	Inadequate n (%)
1.     Age
21-25 years	0(0.0)	07(15.5)	08(17.7)	15(33.3)	0.27
26-30 years	0(0.0)	11(24.4)	06(13.3)	17(37.7)
More than 30 years	0(0.0)	10(22.2)	03(6.6)	13(28.8)
2.     Institution trained
Government	0(0.0)	02(4.4)	01(02.2)	03(6.6)	0.882
Private	0(0.0)	18(40.0)	12(26.6)	30(66.6)
Semi-government	0(0.0)	08(17.7)	04(08.8)	12(26.6)
3.     Total working experience
Less than 3 years	0(0.0)	11(24.4)	09(20.0)	20(44.4)	0.707
3-9 years	0(0.0)	12(26.6)	06(13.3)	18(40.0)
More than 9 years	0(0.0)	5(11.1)	02(04.4)	07(15.5)

(P value-Fisher’s exact test value at level of significance 0.05)

 

Table 5 shows that there is no association between Practice of Nursing Personnel regarding safe handling of sharps with their selected demographic variables

 

The present study did not show any significant association between Knowledge, Attitude and Practice of Nursing Personnel with their selected demographic variables. Mudedla et al., (2014)²² also reported similar study findings. However, the study findings contradicted the findings of Kebede and Gerensea,( 2018)²³   which reported significant relationship between practice and the years of experience. Another study conducted by Sheela et al., (2016)²⁴ also reported significant association between Practice regarding needle stick injury and exposure to educational programme affirming the importance of education to improve safe practice and prevent injuries.

Hence, the present study findings did not support the research hypotheses.

 

IMPLICATIONS FOR NURSING:

Nursing Practice and administration:

The findings of this study will bring to light objectively the Knowledge, Attitude and Practice regarding safe handling of sharps

·       Inculcate the need to focus on safer techniques of handling sharps

·       Nursing Personnel will be able to assess and recognize the factors which may be associated with poor practice

·       In-service classes must incorporate newer techniques such as simulation based learning on safe handling of sharps and other related topics

·       Formation of protocols regarding safe handling of sharps

·       Spot-checks or monitoring of practices related to handling of sharps

·       Mandatory health checkup for all Nursing Personnel.

·       Creation of modules for Nursing Personnel on safe handling of sharps for awarding credit points for promotions/increments

 

Nursing Education:

·       Classes on safe handling of sharps and adherence to standard precaution guidelines should be emphasized more during the training period

·       Creation of modules for nursing students on safe handling of sharps

 

Nursing Research:

·       Study on Knowledge, Attitude and Practice of Nursing Personnel regarding safe handling of sharps and the incidence of needle stick injuries

 

CONCLUSION:

The present study revealed that there is a gap between Knowledge and Practice. Newer training methods can be implemented to sensitize the Nursing Personnel on the need to improve practice on safe handling of sharps. Additionally, hospital should look into multi-dimensional strategies to prevent sharp-related injuries and provide safe working conditions which will ultimately contribute to quality care.

 

REFERENCES:

1.     1910.1030—Bloodborne pathogens. Occupational Safety and Health Administration. Available from https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030

2.     WHO Needlestick injuries. WHO; World Health Organization. Available from https://www.who.int/occupational_health/topics/needinjuries/en/

3.     Muralidhar, S., Singh, P. K., Jain, R. K., Malhotra, M., and Bala, M. Needle stick injuries among health care workers in a tertiary care hospital of India. Indian J Med Res. 2010 Mar; 131:405-10 .

4.     Askarian, M., Malekmakan, L., Memish, Z. A., and Assadian, O. Prevalence of needle stick injuries among dental, nursing and midwifery students in Shiraz, Iran. GMS Krankenhaushygiene Interdisziplinar. 2012;7(1).doi: 10.3205/dgkh000189.Epub 2012 Apr 4. Available from https://doi.org/10.3205/dgkh000189

5.     Sheeba Rani P, Anbu S Kumar. Knowledge, attitude and practice regarding safe handling of sharps. Indian Journal of continuing nursing education. 2016 (17), 75-77

6.     Siddique, K., Anil, S., Shoaib Tauqir, S. F., Anwar, I., and Zafar, A. Knowledge Attitude and Practices Regarding Needle Stick Injuries amongst Healthcare Providers. Pak J Surg. 2008, 24.

7.     Vaz, K., McGrowder, D., Crawford, T., Alexander-Lindo, R., and Irving, R. Prevalence of injuries and reporting of accidents among health care workers at the university hospital of the west indies. International Journal of Occupational Medicine and Environmental Health. 2010; 23(2). Available from  https://doi.org/10.2478/v10001-010-0016-5

8.     Amandeep Kaur, Pardeep Kaur. A Study to Assess the Effectiveness of Self Instructional Module on Biomedical Waste Management among the Staff Nurses of the selected Hospitals of Ludhiana, Punjab.Int. J. of Advances in Nur. Management. 2018; 6(1): 62-66. doi: 10.5958/2454-2652.2018.00014.8

9.     Honda, M., Chompikul, J., Rattanapan, C., Wood, G., and Klungboonkrong, S. Sharps Injuries among Nurses in a Thai Regional Hospital: Prevalence and Risk Factors. 2011;2(4), 9.

10.  Gursangeet Sidhu, Amandeep Kaur. Knowledge and Attitude of Students regarding Bio Medical Waste Management. Asian J. Nur. Edu. and Research 2016; 6(1): 123-126. doi: 10.5958/2349-2996.2016.00024.0

11.  Mondal Ramkrishna, Satyanarayana P. Knowledge, Attitude and Practice (KAP) Study Regarding Bio-Medical Waste Management Am ong Staff in a Tertiary Care Hospital at Andhra Pradesh. Asian Journal of Management. 2018; 9(1):267-271. doi: 10.5958/2321-5763.2018.00040.9

12.  Gowtham Dev, Thressiamma P. M. Sunil M B. A Study to assess the knowledge and Practices regarding Biomedical Waste Management among health team members of selected Primary Health Centres, Bangalore South. Int. J. Nur. Edu. and Research. 2019; 7(4):501-511. doi: 10.5958/2454-2660.2019.00112.1

13.  Nagarajappa D.. Assess the Effectiveness of Need Based Biomedical Waste Management Module on its Practice by the Primary Health Centres in Bangalore Rural District, Karnataka. Int. J. Nur. Edu. and Research 2(1): Jan.-March, 2014; Page 36-42

14.  Nsubuga, F. M., and Jaakkola, M. S. Needle stick injuries among nurses in sub-Saharan Africa. Tropical Medicine and International Health. 2005; 10(8), 773–781. https://doi.org/10.1111/j.1365-3156.2005.01453.

15.   Ebrahimi, H, and Khosravi, A. Needlestick injuries among nurses.Journal of Research in Health Sciences.     2007:7(2), 56-62

16.  Manzoor, I., Daud, S., Hashmi, N. R., Sardar, H., Babar, M. S., Rahman, A., and Malik, M. Needle stick injuries in nurses at a tertiary health care facility. J Ayub Med Coll Abbottabad,.2010; 5.

17.  Gupta, D., Saxena, S., Agrawal, V. K., Singh, M., and Mishra, S.  Study of knowledge, attitude and practice of needle stick injury among nurses in a tertiary care hospital. International Journal Of Community Medicine And Public Health. 2019; 6(2), 865. Available from https://doi.org/10.18203/2394-6040.ijcmph20190221

18.  Pramod Kumar, Indarjit Walia. A Feasibility Survey to Develop check list on the Practices Regarding Biomedical Waste Management in Community Health Institutions in a District of Haryana, India. Asian J. Nur. Edu. and Research.2017; 7(3): 295-298. doi: 10.5958/2349-2996.2017.00061.1

19.  Rohit Yadav, Dashrath Menaria, Monika Bhatia, Rajendra Meghwal, Roopchand Meena, Asha Chacko. A Comparative Study to assess the level of knowledge regarding Biomedical Waste Management among staff Nurses in selected hospital of Udaipur. Int. J. Nur. Edu. and Research. 2019; 7(4): 554-558. doi: 10.5958/2454-2660.2019.00123.6

20.  Francis. L . A Descriptive Study to evaluate the level of Knowledge regarding Biomedical Waste Management among Nurses in Christian Mission Hospitals at Madurai. Asian J. Nursing Education and Research. 2018; 8(3):335-338. doi: 10.5958/2349-2996.2018.00067.8

21.  Fethin George. Effectiveness of Structured Teaching Programme on Knowledge regarding Prevention and Management of Needle Stick Injury among selected student Nurses. Asian J. Nursing Education and Research. 2020; 10(1):76-78. doi: 10.5958/2349-2996.2020.00017.8

22.  Mudedla, S., Reddy, K., Sowribala, M., and Tej, Wl. A study on knowledge and awareness of standard precautions among health care workers at Nizam′s institute of medical sciences Hyderabad. The Journal of National Accreditation Board for Hospitals and Healthcare Providers. 2014; 1(2), 34. Available from  https://doi.org/10.4103/2348-6139.151296

23.  Kebede, A., and Gerensea, H. (2018). Prevalence of needle stick injury and its associated factors among nurses working in public hospitals of Dessie town, Northeast Ethiopia, 2016. BMC Research Notes. 2018; 11(1), 413. Available from https://doi.org/10.1186/s13104-018-3529-9

24.  Sheela Willimas, Lissa J, Saraswathi KN. A study to assess the knowledge and practice of staff nurses regarding needle stick injury in selected hospital at Mysuru with a view to develop an informational pamphlet. Int. J. Adv. Nur. Management. 2016; 4(3): 295-298. doi: 10.5958/2454-2660.2016.00053.3

 

 

 

Received on 18.08.2020          Modified on 08.10.2020

Accepted on 11.12.2020      ©A&V Publications All right reserved