Dissertation on Prevention of sharps injuries among healthcare workers in Hong Kong hospital

Title: Prevention of sharps injuries among healthcare workers in Hong Kong hospital

Abstract:

       Health care workers have a long-standing history of being at risk for acquiring bloodborne pathogens from occupational exposures. Since the 1980s, there has been an increased in the reported incidence of bloodborne infections among healthcare workers and a concomitant enhanced awareness of the occupational risks of bloodborne virus transmission. The aim of this dissertation is to review the risks associated with sharps injuries, including the risk of infection associated with different bloodborne viruses through literature review.

       The methodology of literature review was applied to carry a research for investigating various aspects of the related topic in depth. After critically reviewing ten research articles, identify major themes which causing sharps injuries among healthcare workers in hospital. Lack of knowledge on bloodborne pathogen infection disease is a major course for the phenomenon. Healthcare workers were lacking of training program on prevention of sharps injuries. These research articles indicated that healthcare workers neglect the importance of report on sharps injuries and using safety device with low rate.

      According to these finding in research articles, some recommendation was made by the author to prevent sharps injuries among healthcare workers in hospital.     

Education and training program, top-level support and selecting a safety device could reduce sharps injuries.

       Further researches should aim to examine the connection of the health beliefs, attitude and their failure to report to be found. Changing attitude and health beliefs should be supported by the top-level management. The new findings may be beneficial to patients, their families, healthcare workers and organization related to the issue.

 

Chapter One: Introduction

1.1 Introduction     

Since the early 1980s, following the discovery of HIV, there has been a rise in the incidence of bloodborne infections and an increased awareness of the occupational risks of bloodborne virus transmission. Healthcare workers are at risk of contracting hepatitis B, hepatitis C and HIV through injuries caused by contaminated needles and sharps. In the healthcare setting, transmission most commonly occurs as a result of percutaneous exposure to a patient’s blood following a sharp or needlestick injury. In addition, transmission might occur through exposure of the mucous membranes of the eye or mouth, as will as through broken skin via cuts, abrasions, eczema and so on.

       Nurses are the staff most at risk of sustaining a sharps injury (EPINet 1999). They carry out the greatest amount of direct patient care and undertake the majority of procedures that involve sharp devices, such as injections, manipulation and removal of intravascular devices. They also undertake venepuncture in a wide variety of settings where a phlebotomy service is not provided or is only provided during office hours. The second most significant group of staff at risk is doctors (EPINet 1999). They undertake the majority of invasive procedures (with the exception of injections) including cannulation, venepuncture and surgery. Others healthcare workers and allied professionals are also at risk, as are patient. Anyone who might come into contact

with sharps needs to be aware of the risks involved, for example, porters disposing of sharps boxes and domestic staff making beds where cannulae might have accidentally slipped out of a patient’s arm. Syringes and sharps might not have been disposed of appropriately during emergency situations and all healthcare workers need to be vigilant when clearing away after such events.     

Healthcare worker exposes patients to an increased risk of infection. The risk is particularly high when care is provided in a hospital setting, where contact with healthcare staff and equipment occurs frequently and other patients may act as a source of infection. Risk management is an important part of the clinical governance and controls assurance frame work. It involves a systematic approach to identifying events that could have adverse consequences for either patients or staff, implementing measures to control them, and ensuring that appropriate structures and policies are in place. Needlestick injuries to staff are known to carry a significant risk of transmission of bloodborne viruses. Effective management of this risk requires a clearly stated policy on the safe disposal of used needles, training of staffs who handle them, the provision of sufficient disposal containers, and a system for reporting and monitoring injuries.

     Control of infection is an essential part not only of healthcare but also of everyday life. Infections acquired as a result of healthcare have a major impact on both the affected patient and the providers of healthcare. Viruses transmitted by blood and body fluid are of particular importance to healthcare workers who may be at risk of acquiring infection through contact with body fluid. The most important bloodborne viruses are hepatitis B, hepatitis C and HIV. The hepatitis and HIV viruses are not related but will be considered together because the infection control implications are similar. 

    HBV is transmitted by sexual intercourse and perinatally from mother to baby. It is also transmitted when infected body fluids are inoculated through the skin, on instruments such as needles, via damaged or cut skin, or through contact with mucous membranes. The rate of transmission following needlestick injury with HBeAg-positive blood may be as high as 30% (Royal College of Pathologists 1992). Infection control procedures are also important to protect staff from infection. In the past, infection control precautions have tended to be focused on special measures intended to prevent the transmission of infection from patients known to have infectious disease. The concept of using a range of infection control precautions routinely in the care of all patients, regardless of whether they are known to have an infection, was first recommended in the late 1980s ( centers for Disease Control 1987). This approach, called universal precautions, was developed in response to the emerging HIV epidemic which was highlighting the problem of identifying patients with infection.

      HIV infection is transmitted through sexual contact and exposure to blood and other body fluids from infected persons. It can also be transmitted parentally from mother to neonate. Although only blood, semen, vaginal secretions, and possibly, breast milk have been implicated in the transmission of HIV by epidemiologic evidence, the virus has been isolated from many other body fluids such as saliva, tears, and urine. Therefore, all body fluids are presumed to be potentially infective when discussing precautions which should be taken when caring for persons who are HIV-infected. In order to discuss precautions taken in the workplace, blood and body fluid contact will be referred to since sexual contact is not relevant in this setting (Flaskerud 1989).

      It is important for all nurses and other health care workers to consider the potential of any patient to be infected with HIV or other blood-borne pathogens when

providing patient care. Therefore, appropriate and sensible infection control precautions should be taken at all times. Wilson and Jenner (2001) stated that frequent contact with body fluids place many healthcare workers at particular risk of acquiring bloodborne viruses who may be infected in the following ways:

i) Inoculation of infected blood or body fluid through the skin on contaminated sharp instruments

ii) Contamination of mucous membranes such as the eyes or mouth with infected blood or body fluid

iii) Contamination of broken skin with infected blood or body fluid.

    In line with the Control of Substances Hazardous to Health Regulations (1994) the risk of exposure to hazardous biological agents such as bloodborne viruses should be assessed, and methods of minimizing the risk identified, for any activity involving contact with blood or body fluids. Healthcare workers can avoid exposure by using safety equipment, clothing when exposure to body fluid is anticipated. The main risk is from contaminated sharp instruments. Injury with a contaminated sharp instrument is the most likely route of transmission to healthcare workers and every hospital should have a policy outlining the procedures to be followed in the event of a needlestick injury.

      Transmission of bloodborne viruses from an infected healthcare worker to a patient may occur during procedures in which injury to the healthcare worker could result in blood contaminating the patient’s open tissue, for example when hands are in contact with sharp instruments, bone or teeth. Sharp instruments frequently cause injury to healthcare workers and are a major cause of transmission of bloodborne viruses (PHLS AIDS & STD Centre 1999). They are reported to account for 16% of occupational injuries in hospitals, but since many go unreported this figure is likely to be a considerable underestimate (National Audit Office 1999).

      The risk of transmission following a single sharp (percutaneous) injury depends on the type of bloodborne virus involved. The risk is one in three when the instrument is contaminated with hepatitis B virus from a patient who is e antigen positive; approximately one in 30 when the instrument is contaminated by hepatitis C; and one in 300 when contaminated by HIV. Wilson & Jenner (2001) stated that a number of studies have investigated the cause of percutaneous injuries in healthcare workers. Injuries are commonly associated with the disassembly of devices such as vacuum blood-taking systems or intravenous cannulas; recapping of needles; transfer of used sharps to point disposal; sharps not discarded after use or overfilled sharps containers.

       In the US, the Needlestick Safety and Prevention Act (HR 5178) was passed in November 2000. This legislation requires healthcare employers to provide safety-engineered sharp devices and needleless systems to employees to reduce the risk of occupational exposure to bloodborne viruses. The legislation comes after years of lobbying and advocacy across the US by dedicated healthcare workers, unions, researchers and the medical device industry (Pratt et al 2001).

According to Hong Kong Hospital Authority Occupational Safety and Health Management (1997), it is committed to safe-guard the safety and health of our staff from identified occupational hazards by continuously improving our working environment for it to be conductive for effective work to be carried out. Following the recommendation of a comprehensive review on industrial safety in 1995, the Hong Kong government has adopted a new policy on occupational safety and health. It promotes the establishment among employers and employees, a management-lead, pro-active and self-regulating system to identify and control hazards at the workplace.

As a responsible organization, the Hospital Authority is committed to developing a safety and healthy working environment for their staff and to fully comply with all relevant regulations. To this end, a safety policy has been developed and signed by the Chief Executive. Also, an occupational safety and Health Implementation Steering committee has been formed to foster the establishment of an effective Occupational Safety and Health Program in each hospital. Therefore, Hospital Safety Committee is formed to examine and study the accident/ incident statistical trend, analyze to produce reports and make recommendations for corrective action. According to notes from 10^th to 12^th Occupational Safety and Health (OSH) subcommittee meeting held on 28 July 2005, 20 Oct 2005 and 19 Jan 2006 in Princess Margaret Hospital , the top three types of injury of duty were sprain & strain, needle stick injury, and contusion & bruise. Therefore, among all injuries of duty reporting cases, the sharps and needle stick injury always counts the second incidence rate after sprain and strain injuries. Therefore, as a operating room nurse need to be aware of the risks of needlestrick injury, what to do to prevent such and injury and what to do if it happens. Holodnick and Barkauskas (2000) describe that exposure to bloodborne pathogens through percutaneous injuries is an occupational risk for health care workers, especially those in the operating room. They also describe an educational intervention to increase awareness of risk, provide suggestions for injury reduction, and increased use of personal protective equipment, and increased awareness of disease exposure risk among operating room personnel.

 

1.2 Aims and objective

Therefore, the author wants to explore the causes, prevention and management of sharp injury for healthcare workers in hospital. This is very important to have a safety measure to reduce sharps injury because it always count as top three incident rate of injury on duty in my working hospital.        

 

Chapter two: Preliminary Literature Review

2.1 Introduction

      A literature review should offer a comprehensive and coherent introduction to the quantitative and qualitative evidence on a specified topic. Its aim is to offer the reader a response to a research question through an overview of the evidence, the key themes, debates and controversies, with a fully supported interpretation of the data. There is no attempt, nor would it be possible, to combine the results for statistical analysis; the aim is to focus on an analysis of the discussion and theoretical aspects of the research topic (Steward 2004).

       The literature review is integral to the success of academic research. A major benefit of the review is that it ensures the research ability of your topic before ‘proper’ research commences. Initial enthusiasm, combined with this common misconception, often results in broad, generalized and ambitious proposals. Therefore, it is the progressive narrowing of the topic, through the literature review, that makes most research a practical consideration. It also contributes to the development our intellectual capacity and practical skills, because it engenders a research attitude and will encourage you to think rigorously about your topic and what research you can do on it in the time you have available (Hart 1998). He also stated that literature review is the selection of available documents on the topic, which contain information, ideas, data and evidence written from a particular standpoint to fulfill certain aims or express certain views on the nature of the topic and how it is to be investigated, and effective evaluation of these documents in relation to the research being proposed.

According to Steward 2004, a good literature review should be showed as the follow:

l   Comprehensive, collating evidence from all relevant disciplines.

l   Fully referenced, offering reliable access routes to the evidence.

l   Selective, using appropriate inclusion and exclusion criteria to identify key evidence.

l   Relevant, focusing on data pertinent to the research question.

l   A synthesis of ideas and key themes.

l   Balanced, offering a comparative account of differing theories and practices.

l   Critical, evaluating the rigour of evidence or argument in the data.

l   Analytical, developing new understandings from the available evidence.

       Therefore, a literature review should provide readers with a clear understanding of the subject, the author and where to look if she wants to find out more. Reviews are seen as an academic requirement, but not as an exciting aspect of a report. They also need to understand the context in which the review has been undertaken and the protocols applied to access, select and evaluate the trustworthiness of this knowledge (Steward 2004).

       Sharps injuries are a predominant sharp-related hazard in many countries. An estimated 600,000 to 800,000 hospital sharps injuries occur in the USA each. Some hospitals in Canada reported up to one-third of nursing and laboratory staff experiencing such injuries. In Singapore, a study on sharps injury established 22.2 incidents per 1000 healthcare workers at a regional hospital for the year 1997 (Ng et al 2002).   

Sharps injuries in the operating theatre setting expose personnel to human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Hagstrom (2006) mention that a study published in 2001 which is found 54 documented cases of medical personnel in the United States and Canada who had contracted HIV as a result of needle stick injuries or other exposure. The rate of needle sticks and sharps injuries reported in the United States ranges from 380,000 to 500,000 per year.

      Therefore, the greatest numbers of percutaneous and other injuries that are reported affect surgeons and surgical residents. Although it generally is agreed that these injuries currently are more readily reported, it is believed that many needle sticks and sharps injuries remain unreported especially by physicians. The literature indicates that the majority of percutaneous needle sticks and sharps injuries in the operating theatre can be prevented by modifying behaviors and practices, staff involvement in developing and implementing safety programs, and ongoing feedback of sharps injury incidents to the operating nursing staff. Hagstrom (2006) also stated that effective safety programs and safety equipment decrease the risk of bloodborne pathogen transmission from patients to health care workers.

 2.2 Occupation transmission of bloodborne pathogens disease

       According to McCulloch (2000), Bloodborne infections are those where the blood contains infectious agents that can be transferred into the body of another person giving rise to infection (Advisory Committed on Dangerous Pathogens, 1995). Of particular concern are those diseases where infectious agents may be present in the blood but where the affected individual may be asymptomatic. Within healthcare setting there is a risk of both occupational and patient exposure to these agents. The most significant are human immunodeficiency virus (HIV) and the viruses causing hepatitis B and hepatitis C. From the time that reporting began in 1982 to the end of December 1997, a total of 15,074 cases of AIDS were reported in the United Kingdom. The hepatitis B virus is a major cause of acute and chronic hepatitis, cirrhosis and hepatocellular carcinoma worldwide.

     Risk of occupational transmission occurs whenever there is exposure to blood or body fluids. Hospital settings involved in invasive procedures, i.e. any use of needles, or instruments in penetrating the body, or otherwise in contact with blood or body fluid, who are most at risk. Up to September 1993 there had been 64 documented cases of seroconversion worldwide of healthcare workers infected with HIV through contact with their patients four of the cases having occurred in the UK (PHLS, 1993).

     Multiple studies of healthcare workers have been published in which the presence of antibody to HIV or evidence of clinical AIDS infection was investigated in association known infected material (LaDou 2004). Perioperative nursing is a high-risk nursing specialty. The nature of the work environment and the conditions in which surgical procedures take place put perioperative nurses at increased risk for occupational exposure and occupationally acquired disease transmission. The incidence of percutaneous and mucocutaneous exposure in the operating room far exceeds that that of percutaneous exposure and may occur in 30% to 50% of surgical procedures. The greatest risk for occupational transmission of bloodborne infections, however, is from needles and other sharp objects, which occurs in up to 15% of surgical procedures (Osborne 2003).      

As Holodnick & Barkauskas (2000) mentioned that the Centers for Disease Control and Prevention (CDC) report in 1998, 54 health care workers have documented cases of occupationally acquired HIV infection, and 134 have possible cases. Forty-six of those with documented HIV seroconversion had a percutaneous exposure. Hence, prolonged contact with open surgical sites, handling sharp instruments, and exposure to large quantities of blood contribute to the risk of percutaneous exposures among operating room personnel. As 1998, two surgical technologists had contracted HIV from job related exposures; six surgeons and two surgical technologists have had possible occupational transmission of HIV; and 22 nurses have had documented occupational transmission of HIV with an additional 33 possible infected.

           The annual incidence of percutaneous injuries in the United States has been estimated by both the CDC and the International Health Care Worker Safety Center (IHCWSC). The CDC reported that 384,325 percutaneous injuries occur in the hospital setting each year (IHCWSC, 2000). This estimate was based on 1997 and 1998 data from the CDC’s National Surveillance System for Health Care Workers and 1997 data from the national Exposure Prevention Information Network (EPINet) database. 

      Although, standard precautions were introduced in the 1980s, research continues to report less than 100% compliance among health care professionals with measures demonstrated to decrease disease transmission. The consequences of an occupational exposure to bloodborne pathogens extend beyond transmission of infection. It may relate to health which includes liver disease and subsequent transplantation complications, chronic disabilities, and premature death (Osborne 2003). Therefore, employers have a responsibility to provide a safe work environment without risk to the health of their employee. In the health care setting, it is essential that all healthcare workers must be given adequate education and training on all issues relating to the control of infection. In addition, employees also have a responsibility to comply with safety standards and procedures set by health care establishments, and should ensure that their work practices do not jeopardize the health and safety of themselves or any other person.

 

2.3 Universal Precaution

     Since medical history and examination cannot reliably identify all patients infected with HIV or other bloodborne pathogens, blood and body-fluid precautions should be consistently used for all patients. This approach, previously recommended by CDC and referred to as “universal precaution”, should be used in the care of all patients, especially including those in emergency-care settings in which the risk of blood exposure is increased and the infection status of the patient is usually unknown (Flaskerud 1989). However, universal precautions now is called standard precautions, mandate all blood and body fluids be treated as though contagious, regardless of the source. These precautions require the use of glove, masks, face shields, and gowns wherever a potential for exposure exists.

Patients with highly transmissible and dangerous infections, all healthcare workers should be appropriately and adequately immunized against infectious diseases, both for their own protection and the protection of others. They must follow basic infection control procedures at all activities to prevent exposure of micro-organisms to themselves and others (Damani 2003).

     It is not possible to identify all people who may be infected with bloodborne viruses, therefore guidance to protect healthcare workers against HIV and hepatitis viruses has been issued based on the concept of ‘universal precautions’.

       In clinical situations, transient micro-organisms acquired on the hands through contact with patients, their body fluid or environment need to be removed if cross-infection is to be avoided. Therefore, wash hands before and after every patient contact, and immediately after direct contact with blood or body fluids, avoid hand to mouth / eye contact (McCulloch 20000).

All healthcare workers who participate in invasive procedures must routinely use appropriate barrier precautions to prevent skin and mucous-membrane contact with blood and other body fluids of all patient. Gloves and surgical masks must be worn for all invasive procedures. An invasive procedure is defined as surgical entry into tissues, cavities, or organs or repair of major traucatic injuries e.g. in an operating room, emergency department or outpatient setting.    

      The protective clothing selected depends on the anticipated risk of exposure to body fluid during the particular activity. This assessment should consider the risk both to the patient and to the healthcare worker. Procedures in which there is a risk that splashing of blood or body fluid may occur require the use of mask and eye protection to protect these mucous membranes, and a water-resistant gown will be necessary. In the operating room, waterproof boots or shoes may also be required in come situation (Wilson 2001).

       Used sharps must be handled as little as possible to avoid injury. Needles should not be disconnected from syringes but discarded as one unit. Immediate disposal of used sharps diminishes the risk that they will cause injuries. Disposal of used sharps in inappropriate places may present a considerable risk to other people, for example used needles left on trolley. Every healthcare worker has a responsibility to ensure proper disposal of the sharps that they have used. Sharps should always be discarded into appropriate containers, and these should be readily accessible at the point where sharps are used (Wilson 2001).

 

 

2.4 Causes of sharps injuries

       Sharp injuries are wounds caused by sharp instruments accidentally puncturing the skin. A number of studies have investigated the causes of sharps injuries in healthcare workers. Injuries are commonly associated with the disassembly of devices such as vacuum blood taking systems or intravenous cannulas; recapping of needles; transfer of used sharps to point of disposal; sharps not discarded after use or overfilled sharps container(Wilson 2001).

       Although nurses appeared to the professional group most prone to sharps injuries, the types of instrument causing sharps injuries commonly include suture needles, disposable syringe needles, scalpels and lancets. Perioperative personnel who are involved in surgical procedures are exposed to a significant amount of blood and bloody fluids, which may be infected with hepatitis C, hepatitis B, or HIV. Surgical procedures require the use of many sharp instruments, so operating room personnel are at an increase risk of sustaining percutaneous injuries.

        The operating room is recognized for the high frequency of occupational blood contact and percutaneous injuries which there are factors that occur there. Factors that set the operating room apart from other health care settings include prolonged contact of surgical personnel with open surgical sites, frequent manipulation of sharp instruments, and the presence of relatively large quantities of blood. Furthermore, the hepatitis B virus (HBV) and the hepatitis C virus (HCV) are more readily transmitted than HIV; there is no surveillance system in the United States to document how many of these cases may have occurred among operating room personnel. The risk of acquiring bloodborne pathogens in the surgical setting is not limited to operating room personnel; however, there are several reports in the literature documenting healthcare worker to patient transmission of HIV, HBV, and HCV during invasive surgical procedures (Jagger 1998).

       One of major reason in order to increase percutaneous injuries which may due to recap needles despite universal precautions. These include the difficulty of unlearning habits that were previously considered good practice, devices that are engineered in a fashion that requires disassembly for disposal, a lack of conveniently located disposal containers, and time constraints due to high workloads or emergency situations (Vaughn 2004).

       Nursing personnel experience a higher rate of workplace exposure than other healthcare workers. High risk percutaneous exposures are most frequently reported by nurses, it may due to perform more bedside procedures than other workers. In developing countries, excessive handling of contaminated needles, high patient demand for injections, and lack of safe needle and sharp containers enhance the risk of sharp injuries (Wang et al 2003, Nsubuga et al 2005). The study findings confirmed the relationship between high workload, poor organizational climate, and an increased risk for sharps injuries. Nurses on units with less adequate resources, lower staffing, less nurse leadership, and higher levels of emotional exhaustion were typically twice as likely to report the presence of risks due to staff carelessness and inexperience, frequent recapping of needles, and inadequate knowledge and supplies. (Clarke et al 2002).

      

2.5 Prevention of sharp injuries

       Protection of healthcare workers should be an integral part of the Health and Safety programme of health care establishments. Health care facilities have a responsibility to ensure that all reasonably practicable steps are taken to ensure that the risk of infection to health worker is minimized. Transmissible infections in healthcare workers must be identified quickly so that they can be excluded from the work place or from direct patient contact until they are no longer infectious (Damani 2003). 

      In the United States of America, the Centers for Disease Control and Prevention (CDC) recommend the use of universal precautions to minimize exposure to blood borne pathogens, and implementation of universal precautions is overseen by the Occupational Safety and Health Administration (OSHA) (Wang et al 2003). All healthcare workers should adhere to universal precaution, including the appropriate use of hand washing, protective barriers, and care in the use and disposal of needles and other sharp instruments. Implementation of universal precaution contributes to decreased parenteral injuries (Beekmann et al. 1994), it is the most important source of major occupation exposure to bloodborne pathogen.

      Educational programmes may prevent needle or sharp injuries. To provide a systematic HIV/AIDS educational programme for healthcare workers, in order to have positive changes in their basic knowledge, attitudes and compliances with universal precaution (Wang et al 2003).

According to Wilson 2001, each clinical area should take a systematic approach to minimizing sharps injuries by safe handling of used sharp instruments as the following:.

l   Do not disassemble needles from syringes or other devices, discard as a single unit.

l   Do not resheathe needles.

l    Do not carry used sharps by hand or pass to another person.

l   Discard sharps immediately after use into a sharps container.

 

 

2.6 Purpose of the study

Therefore, the above published literature from books, articles or journals can provide methods for the collection of data and suggest solutions tried in prevention of sharp injuries in healthcare workers. To develop strategies for reduction of sharps injuries among healthcare workers in Hong Kong hospital, it is important to identify risk factors for blood and body fluid exposures to healthcare workers. It can be used to assess the benefits of prevention and reduction in risk factors for bloodborne. pathogens transmission due to sharps injuries

 

 

Chapter three: METHODOLOGY

3.1 Literature reviews as a research methodology    

  3.1.1 Definition of literature review

Polit and Hungler state the term ‘literature review’ is often used to cover both the process of search for relevant literature and the critical reporting of this literature. The review of the Literature is generally preceded by a brief introductory chapter. The introduction consists of an overview of the research problem and some indication of why the problem is worth exploring or what contribution the proposed study is apt to make to theory and/ or practice. Although it may begin by offering abroad context for the study, it quickly comes to the point with a narrowly focused definition of the problem (Rudestam 2001).

       The search and review of the literature is a critical evaluation, analysis and synthesis of existing knowledge relevant to research problem. It is an analysis in that you are required to extract different kinds of information from what you read. It is a synthesis to show the relationships that exist between different studies and show how these relate to research. Aiming of literature review is used to assess critically what definitions of the topic or problem have been offered and how they have been used and to evaluate the methodological approaches employed and to identify gaps in empirical work and assumptions used. A literature review is not therefore a summary, synopsis or series of annotations or a description of other people’s work (Hart 2005).   

Therefore, a good literature review can exhibit technical competencies in searching for and selecting items; has clarity of expression in writing and arrangement of materials; undertakes argumentation analysis in the evaluation of existing work.

 

  3.1.2 Benefits of doing a literature review 

       The literature review is integral to the success of academic research. A major benefit of the review is that it ensures the research ability of your topic before ‘proper’ research commences. Initial enthusiasm, combined with this common misconception, often results in broad, generalized and ambitious proposals. Therefore, it is the progressive narrowing of the topic, through the literature review, that makes most research a practical consideration. It also contributes to the development our intellectual capacity and practical skills, because it engenders a research attitude and will encourage you to think rigorously about your topic and what research you can do on it in the time you have available (Hart 1998).

       The methods for reviewing a literature can be used to extract and organize information, and how different ideas can be mapped out so that connections between them can be made. The literature review has no single purpose. Its purpose will be largely dependent upon the type of search that the author intends to do (Hart 2005).

3.2 Literature reviews as research methodology in this study      

Reviewing the literature on a topic can therefore provide an academically enriching experience, but only if it done properly. To achieve this review should be regarded as a process fundamental to any worthwhile research or development work in any subject irrespective of the discipline. The review forms the foundation for the research proper. The researcher needs to know about the contributions others have made to the knowledge pool relevant to their topic. It is the ideas and work of other that will provide the research with the framework for their own work; this includes methodological assumptions, data-collection techniques, key concepts and structuring the research into a conventional academic thesis. The review will also help the researcher to gain an understanding of the interrelationships between the subject being considered and other subject area (Hart 2005). Therefore, the review serves at least the following purposes in research:

l   Discovering important variables relevant to the topic;

l   Distinguishing what has been done from what needs to be done;

l   Identifying relationships between ideas and practice;

l   Synthesizing and gaining a new perspective;

l   Establishing the context of the topic or problem;

l   Rationalizing the significance of the problem;

l   Enhancing and acquiring the subject;

l   Understanding the structure of the subject;

l   Relating ideas and theory to applications;

l   Identifying the main methodologies and research techniques that have been used;

l   Placing the research in a historical context to show familiarity with state-of- the-art development.

       No one purpose is of greater significance than any other. They are all equally important in a review of relevant literature (Hart 2005). Therefore, basic research literacy is an essential prerequisite of knowledge-led practice. Reviewing the literature is a necessary skill both for researchers and for practitioners of a profession which claims to be founded on a knowledge-base; it means being able to locate and summarise the findings of research on a given topic – not uncritically, but assessing whether the evidence and argument which is presented sustains the conclusions which are put forward – and also setting the problem of research or practice within its context. It is a necessary skill for nurses academically based discipline (Abbott 1993).    

 

3.3 Searching for literature

       The literature search must be effective and systematic. Before a search can begin, the author must have performed two essential tasks. These will act as guidelines once searching starts, making the process more effective and efficient.

       First, the author must decide which area of the topic is to be the focus and perhaps formulate a rough research question. Although, it is difficult to know which area or perspective of a topic to focus upon before reading around the broad subject area, it is often possible to either highlight areas of particular interest of rule out areas definitely not of interest (Bell 1998).

       As a researcher the author need to become completely familiar with her topic. This means searching out, obtaining and then reading as much as possible. The literature will be made up of different kinds of materials, including books, articles and theses. With a good working knowledge of how the literature is organized, and can be accessed, a comprehensive search can be done. A good literature search demonstrates the ability to search, identify and select materials relevant to the topic and which need to be reviewed at a level appropriate to the project. This means all relevant indexes, bibliographies way. The keys to a successful search are: planning the search, acquiring retrievable, maintaining accurate records, selecting potentially useful items and items and reading them to extract relevant information, including argument, data, theories, concepts and definitions (Hart 2001).           

       Therefore, set up management system in advance of starting my search of the literature. Keep accurate, consistent and clear records of what I did, when, and the results. I use timetables and forward planning to organize the use of my time. This is the basis of good project management.

 

3.4 Inclusion and exclusion criteria

       According to Steward (2004), stated that a review should have a beginning, middle and an end, just like any article. It has to be coherent, with the discussion and conclusions arising from the evidence elicited from the research method and in line with the critical appraisal. The end result should offer a ‘good read’, easily accessible without academic aloofness, targeted at a given audience and providing a good reflection of the interest, involvement and perhaps even the passion of searching analyzing. Therefore, the information as inclusion in literature review summarizes   the following:

l   The research question or topic of investigation

l   The electronic databases used

l   The electronic search strategies and any use of bibliographic software packages

l   Other search method used , for example, hand searching or citation searches

l   Methods used to locate and access grey data and other forms of non-journal literature

l   Other forms of data gathering, for example, consultation with experts or authors

l   Identification and justification of inclusion and exclusion criteria

l   Methods of syntheses, for example, categorization of evidence

l   The critical appraisal and analytical methods

l   Appraisal matrix

l   Critical evaluation of the review method

l   Analysis

l   Development of working theories

l   Implication for research and practice.

       Therefore, selecting papers for inclusion is only good quality papers and contain strongest evidence which includes systematic review, RCT, Quasi-experiment, survey and opinion. 

       However, it is useful to restate the points made above from the perspective of what to avoid. A review is a piece of research. The process allows themes to emerge, which challenge taken-for-granted ideas and position them against all the available evidence. Exclusion of literature review is necessary, if the review including opinionated, unbalanced, uncritical and lacking in focus or outcome must be excluded in selecting papers for research. There may be special cases that the author does not want e.g. boarding school, armed forces, mental illness, financially motivated and etc. 

 

3.5 Critical Appraisal of literature

      The subjects are different and contribute in different ways to out understanding of the world. Implicit in choices about the kinds of issues we have just outlined is the question of comparative judgments. It is tempting for any reviewer to find advantages in one theory or type of research on the basis of their prior assumptions about what should constitute research. As a result, research that seems to confirm the reviewer’s view of research might attract a favorable assessment. Very few accounts of a piece of research include the original design plan or proposal. Identify the design features of someone else’s research: effort is required to read research systematically and without prejudice. As some of these features have already been described, the remainder of this section will look at what is meant by focus and units of analysis (Hart 1998).   

      There are three types of research which is including experimental, quasi-experimental and non-experimental. This categorization will also help to make clear what is involved when selecting elements to include in a design. In some ways this simplifies comprehensions. It signals the fact that qualitative approaches often involve descriptive statistical data and identify proposes from those of experimental research (Milgram, 1974).

       The type of research the author chooses should be capable of addressing her research questions. In practice to stand on key methodological questions that shapes the character of the research study. Issues arising from differences between disciplines and methods can best be approached by understanding the connections between philosophical traditions and strategies for investigation. We might begin by noting that all research originates from some view of reality, which means that there are different ways of gaining an understanding of some aspect of the world and different ways of confirming our understanding (i.e. knowledge).In very general terms we can say that it is important to grasp the philosophical meaning ontology, epistemology and methodological meaning of validity, reliability and data. There is alternative views on different propositions about what reality is (ontology); different ways of establishing what can be accepted as real (epistemology); different strategies for validating our claims about reality; and different techniques for collecting data (questionnaires, observation, etc.). The object of our research is present in all forms of knowledge whether that knowledge is scientific or common sense (Hart 1998).

       Therefore, be aware of the elements that make up choices in research is an important prerequisite to being able to understand an author’s argument and research project. This awareness can be practiced through reading research and undertaking analysis of that research. Hence, a useful resource that will enable this to be done effectively and in a scholarly way is the development of knowledge about the different methodological traditions that researchers use as the epistemological basis of the research (Hart 1998).

      Therefore, the critical appraisal is one of step in the process of evidence-based clinical practice is an approach to decision making in which the clinician uses the best evidence valuable, in consultation with the patient, to decide the option which suits the patient best. To determine what is the best evidence, critical appraisal skills is needed to understand the methods and results of research and to assess the quality of the report research is good enough to be used (Hill & Spittlehouse 2003).     

Then, the author tries to select which kind of research orientation and culture accords with her research questions.

 

3.6 Thematic analysis of literature findings

As Aronson (1994) stated that thematic analysis is developed to manage the huge numbers of data which are collected by qualitative methodology in ethnographic interviews. After the research performed and information is gathered, researchers are faced with the decision on how to analyze the data. There are many way to analyze the data. There are many way to analyze all data ant thematic analysis is on such way.

      The information contained in the literature is often made up of specific theories based on certain choices people have made about the methodological assumptions they wish to employ in their work. The analysis element of the review and is essential if core ideas and concepts are to be properly identified from individual items and thereby used to produce a map of the knowledge on a phenomenon, topic or problem. The main use of mapping of a topic is to acquire sufficient knowledge of the subject to develop the necessary understanding of methodology and research techniques, to comprehend the history and diffusion of interest in the topic, and to undertake an analytical evaluation of the main arguments, concepts and theories relevant to the topic in order to synthesize from the analysis an approach or thesis that is unique. Mapping also enables analysis and synthesis to be undertaken; in mapping work on a topic, it can undertake the task of construction, putting together the different strands and elements of work that make up the body of knowledge on the topic (Hart 1998).   

      Therefore, mapping the ideas, arguments and concepts from a body of literature is an important part of the review of the literature. It is very useful to find the way around the literature, to identify the key landmark studies and concepts and at the time build a picture of the relationships that exist between individual pieces of work.

 

3.7 Ethical implications of literature review

       The journal, conference and report literatures of the social sciences contain many citations that discuss debate and define ethics. All social science disciplines have a code of ethics. It is used to illustrate what is taken to count as ethical and unethical research would, one would expect, and be in abundance in the literature and also in the codes (Hart 2005).

However, there is another way of looking at these considerations might be put alongside your time and effort as costs of carrying out the enquiry, to be set against benefits including the knowledge gained from the study, and possible changes and improvements to situations or service. These questionable practices arise from the kind of research questions we are asking, and the methods used to seek answers, particularly the procedures used to avoid misleading results (Robson 2002).

Ethical behaviour is that which is done out of a sense of what is good and this comes from a deep or inner respect for principles of right or wrong and good or bad. The ethical value of behaviour is done from a duty that expresses respect for the behaviour itself without regard for its consequences or to produce an effect. In the research paper may include: self-reflection; self-control and discipline; empathetic understanding; discretion; honesty; and integrity. However, if there is no purpose in deceiving subjects, providing false information or engaging in actions which are not open and honest, then there is nothing contingent on doing so, and such a stance would be unconditional and belong to categorical imperatives(Hart 2005).    

       Ethical issues can arise during all stages of your research, from the design stage through to the reporting stage, including the authorship of articles for journals and presentation of papers at conferences. The amplification that follows therefore assumes that the author already has an understanding of what would normally be right and what would normally be wrong in terms of research. Therefore by focus the author is referring to the specific dimensions and aspects of the topic that were studied. There are, in the main, three areas that a study can focus on: characteristics, orientations and actions. Characteristics are usually taken to be measurable or recordable attributes, such as age, sex, location and the like. In terms of social interactions these would be the location and the like (Hart 1998).   

 

Chapter four: Research method

4.1 Searching literatures

       As Hart 2001 noted that a search of the literature is an essential part of every research project. There are two areas to be searched including the literature relevant to the topic and the literature on research methodology and data collection techniques.

Hence, a good literature search demonstrates the ability to search, identify and select materials relevant to the topic and which need to be reviewed at a level appropriate to the project.

       Therefore, the author would search the topic about sharp injuries among healthcare workers by different kinds of materials, including books, articles, journals and report through library, intranet and internet.

 

4.2 Search method

       Author search books for the topic about ‘sharp injuries among healthcare worker in hospital’ through hospital and public libraries. The library card catalog is also becoming a thing of the past. Card catalogs are now maintained as computer databases or online public Access catalogs. These provide complete bibliographic information (e.g., author, title, publisher, date, etc.), location, call number, and circulation status of every item in the library. However, there is no books related with this topic can be found in public libraries in Hong Kong. Then, author search books through Hospital Authority (HA) library by using computer databases. There are only few books related to the author’ topic.

      Fortunately, an electronic information service of Hospital Authority called the e-Knowledge Gateway which is the main source for the author to retrieve most of the information including journals, article and reports.

eKG (e-Knowledge Gateway) is a knowledge management strategy to support evidence-based practice. It promotes active learning and knowledge sharing and provides easy one-stop access to selected external evidence and internal knowledge. It is accessible from Hospital Authority Intranet and the Internet: http://www.ekg.org.hk it contained over 20medical databases which is including MEDLINE, CINAHL, EMBASE, OVID and etc.

 

MEDLINE

       It is a database of indices and abstracts from the National Library of Medicine (U.S.), covering biomedical journal articles from approximately 4300 journals. The database is international in scope. Approximately 75% of the citations are published in English, and tend to be American oriented. The database is updated weekly.       

 

CINAHL

       Cumulative Index to Nursing & Allied Health Literature provides access to English-language medical, nursing and allied health journals, including publications of the American Nurses’ Association and the National League for Nursing, and primary journals from 13 allied health disciplines. CINAHL also includes pertinent articles from the biomedical, educational, behavioural science, management and popular literatures. Selected nursing and allied health-related books are included as well. The database is updated weekly.

 

EMBASE

       EMBASE features unique international journal converge and includes many important journals from Europe and Asia. It gathers information from approximately 4000 journals published in 70 countries. While similar specialties are also included in MEDLINE, which is American based, EMBASE’s strong focus on European journals may provide another perspective to users in their researches.

 

 OVID

       With the Multi-databases search, the author may search up to a maximum of 3 selected databases on OVID at one time. This feature saves the effort in searching one database after another and duplicate records from different databases can be removed.

       Author also find the e-journals by searching from Oxford Brookes University’s E-library ( http://www.brookes.ac.uk/services/library/) through Internet.

       There are many sources on the Internet where subject of sharps injuries among healthcare worker can be obtained. The web site from Yahoo and Google and can provide some information about sharps injuries among healthcare workers in hospital.   

  

 4.3 Electronic searching process

       A sub-set of logic developed in the nineteenth century by George Boole. It is now used to combine symbols for searching databases in a systematic way using logical operators (commands) normally made up of AND, NOT, NEAR and OR. This is the logical system of combining words into a statement for searching.  

       The Boolean search table and Boolean logic was used to search literature in Hospital Authority e-KG. It can narrow the author search by enabling to specify what are looking for and thereby exclude many irrelevant items.

       During the searching process, author put the keywords for searching in the Boolean search table and put the Boolean logic in between the Boolean search table. Boolean logic is important for going, widening or excluding any items during searching:

 ‘AND’ should be used to combine concepts on making a search to be more specific, e.g. healthcare worker And sharps injury.

 

‘OR’ should be used to expand a search when the author requires any set of words to be present or specific e.g. sharps injury or needlestick injury.

 

‘NOT’ should be used to exclude words e.g.’ healthcare worker’ NOT' medical student, Sharp injuries in hospital NOT Sharp injuries in community.

It is normally used at later stages in a search to incrementally eradicate irrelevant results.

 

‘Near’ should be used to require that two or more words or phrases are near to one another in a document. It is used to identify documents that have the terms near to one another e.g. safety Near occupational Near health.    .

 

 

Identifying search terms (Boolean search table):

Healthcare workers/ Health professionals/ Hospital workers/ Nurses

And/ Or/ Not/ Near

Occupational safety/OSH Needlestick injury/Needle stick injury Needle prick injury/Sharp injury/ Percutaneous injury Blood-borne pathogen/HIV/ Infectious disease.

 

       Author always use the e-KG system to find information because it contains a lot of recently published journals, material or abstract which is relevant to the topic of sharp injuries among healthcare workers in hospital. However, most of this information was not kept in Hospital Authority libraries. Therefore, author may order document from ‘Document Delivery’ service which can get relevant information from other Hong Kong University library.

 

 

4.4 Inclusion and exclusion criteria

       All literature will be found in English Published and related to sharps injury:  

Table for inclusion and exclusion criteria for searching literature 

Item	Inclusion criteria	Exclusion criteria
1. Language 2.Type of publication 3. Date of publication 4. Content 5. Study group   6. Study measure	English Full text/PDF formats Within ten years Related to keywords Healthcare workers in hospital Behavior	Other than English Abstract only More than ten years Not related to keywords Not in hospital   Safety device only

 

 4.5 Critique method

       As Rees (1995) stated that the first task when evaluating of critiquing a piece of research is to establish the general area the article covers which is the focus or theme. The focus is important in that it allows the author to establish some expectations about the research and its content. The second task is to establish the background. It can provide the author to have a clear justification for choosing this topic of research. Therefore, the critiquing framework by Rees (1995) is very useful for the author to assess the full text as critiquing an article. It is essential that author critically review the literature and make a judgment as a user of research.

The critiquing framework of Bray and Rees, (1995) is showed in the following:

1. Focus- what is the topic or theme of the articles? The title is often a good indicator of the focus.

2. Background – what justification is given for choosing the topic? Is there reference to previous reports, studies local problems? Is there a specific trigger which explains why they did the study?

3. Terms of reference – what was the particular question they wanted to answer? This will usually start with the word ‘to…’ E.G. The aim of the project was ‘to examine…’ Is there a hypothesis?

4. Study design – is this an experimental design where the author was looking for cause and effect relationship? Is it descriptive where the purpose was to describe a particular situation? Or is it action research where something new has been introduced into the provision of the services and then evaluated?

5. Tool of data collection – which method of collecting data has been used? Was it tested with a pilot study?

6. Ethical considerations – has confidentially, informed consent, and harm versus benefit been considered? Was an ethic committees involved?

7. Sample – who or what make up the sample? Is there inclusion and exclusion criteria? On how many people or things are the results based? How were they chosen? Do you feel that the sample are typical, or are there some limitations to them?

8. Data presentation – how dose the researcher present the results to you, are they in the form of tables, or figures. Are the results in the form of the raw numbers, or do they use percentages? The important point is can you make sense of them? Does the author explain the content of the tables and figures to you?

9. Main findings – what are the results which relate to the terms of reference?

10. Conclusions and recommendations – what is the author’s answer to the terms of reference? Is the hypothesis accepted or rejected? What recommendations are made?

11. Readability – what is it like to read? Is it hard going or does the writer help you understand what is going on? Is it written in plain language or is it full of unexplained research jargon?

12. Implications for practice – once you have read it, how does it relate to practice? Who might do what as a result of the study?

 

4.6 Thematic Analysis

       Reading a research article is a skill which requires a lot of thought and practice. In the following steps in the critique process, ten studies related to the topic of sharps injuries among healthcare worker in hospital were selected for literature review. These will be discussed in the next chapter.

Chapter five: Result

5.1 Introduction

       The vision for nursing in the twenty-first century is the development of a scientific knowledge base that enables nurses to implement an evidence-based practice. This vision can support clinical and basic research to establish a scientific basis for the care of individuals across the lifespan. This is encouraging the use of a variety of methodologies (quantitative, qualitative, outcomes research, and intervention research) to generate essential knowledge for nursing practice (Burns & Grove 2001). Therefore, scientific knowledge is generated through an application of logical principles and reasoning; whereby the researcher adopts a distant and noninteractive posture with the research subject to prevent bias (Newman 1992).

       Quantitative research and qualitative research complement each other because they generate different kinds of knowledge that are useful in nursing practice.

Quantitative research is conducted to describe and examine relationships, and determine causality among variables. Thus, this method is useful in testing a theory by testing the validity of the relationships that compose the theory. Quantitative research incorporates logistic, deductive reasoning as the researcher examines particulars to make generalization about the universe. While qualitative research is conducted to generate knowledge concerned with meaning and discovery. Inductive and dialectic reasoning are predominant in these studies (Burns & Grove 2001).

      It is usual to establish given criteria against which the type and quality of the evidence is elevated. It is important to explain how and why a critical method was applied to different types of evidence located in phenomenological, ethnographic, action research, randomized controlled trial (RCT), case or clinical studies. The critical method must be sensitive to the format of the publication. Appraisal is a process of critiquing the evidence of other. All research projects have weaknesses, some caused or exacerbated by the limitations imposed in publication (Steward 2004).    

       Therefore, reading a research article is a skill which requires a lot of thought and practice. The Bray and Rees (1995) can provide the critiquing framework for author to critique research paper which is generic and can be used with both positivist (quantitative) and naturalistic (qualitative) research. It is important to consider the work of the author from an analytical, objective and fair point of view. This consists of recognizing strengths and weaknesses and, above all, considering the implications for practice.

Therefore, this gives an outline of the important points of the author’s articles and an opinion about the papers’ quality. This process helps author to make comments about the strengths and weaknesses of research. It is essential for critiquing review the literature and makes a judgment as user of research.

 

5.2 Selection of paper

       Through the use of electronic databases, a large volume of references can be located quickly. A number of new nursing journals have been developed that are published only in electronic form. To obtain relevant articles from such a journal related to the topic of sharps injuries among healthcare workers in hospital, the author need to locate the electronic journal on the Internet and scan the title of articles published in it. Therefore, the author may find information relevant to the background, significance, framework, and design, methods of measurement, and statistical procedures for her study.

       Therefore, 16 research papers are found in related to sharps injuries among healthcare workers in hospital. Among these 15 papers, they contains of ten survey, three Randomized controlled trial (RCT), one ethnographic study and one literature review.  

Discussion on difference types of research design:

Survey	Survey is used to describe in technique of data collection in which questionnaires (collected by mail or in person) or personal interviews are used to gather data about an identified population. It can be used within many designs, including descriptive, correlation and quasi-experimental studies (Burns & Grove 2001).
Randomized controlled trial (RCT)	Classic means of examining the effects of various treatments in which the effects of a treatment are examined by comparing the treatment group with the no-treatment group (Burns & Grove 2001).
Ethnography	Ethnographic research provides a mechanism for studying our own culture and that of others. Although ethnography originated as the research methodology for the discipline of anthropology, it is now a part of the cultural research conducted by a number of other disciplines, including social psychology, sociology, political science, education, and nursing, and is also used in feminist research. Therefore, a qualitative research methodology for investigating cultures that involves collection, description, and analysis of data to develop a theory of cultural behavior (Burns & Grove 2001).
Literature review	This type of review will incorporate all types of literature relating the topic, not just those based upon empirical research, and will include both qualitative and quantitative studies (Crookes & Davies 1998).

 

       Among these 15 papers, the author is using the inclusion and exclusion criteria which noted in the chapter 4 – Method, 10 papers which are suitable for the author’s criteria. Those journals are selected in my literature review would not be published more than ten years and these should be in English only.

       However, those journals should be excluded which are including medical student and sharps injuries in community. Those studies focused on safety devices were also excluded in my literature review.

 

 

5.3 Summarized result of selected paper

Paper one:

Nsubuga, F M & Jaakkola M, S. (2005), Needle stick injuries among nurses in sub-Saharan Africa. Tropical Medicine and International Health.Vol 10(8), 773-781. Aug 2005.

Paper two:

Smith D R, Mihashi M, Adachi Y, Nakashima Y & Ishitake T. (2006), Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital. Journal of Hospital Infection 64, 44-49.

Available online at www.sciencedirect.com

Paper three:

Smith D R, Smyth W, Leggat P A & Wang R S.(2006), Needlestick and sharps injuries among nurses in a tropical Australian hospital. International Journal of Nursing Practice. Vol 12 (2), 71 -77.

 

Paper four:

Ganczak M, Milona M & Szych Z. (2006), Nurses and occupational exposures to bloodborne viruses in Poland. Infection Control and Hospital Epidemiology. Thorofare: Feb Vol 27(2), 175-181.

Paper five:

Tabak N, Shiaabana A M & ShaSha S. (2006), The health beliefs of hospital staff and the reporting of needlestick injury. Journal of Clinical Nursing.

 Retrieved from @2006 The Authors. Journal compilation@ 2006 Blackwell Publishing Ltd.

Paper six:

Vaughn T E, McCoy K D, Beekmann S E and Woolson R F, et al. (2004). Factors promoting consistent adherence to safe needle precautions among hospital workers. Infection Control and Hospital Epidemiology. Thorofare: Vol. 25(7), 548.

Paper seven:

Wang H, Fennie K, HE G, Burgess J &Williams A B. (2003). A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge, behaviour and incidence of needle stick injuries among student nurses in Changsha, People’s Republic of China. Journal of Advanced Nursing 41(2), 187-194.

 

Paper eight:

Raghavendran S, Bagry H S, Leith S & Budd J M. (2006). Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals. Anaesthesia 61, 867-872.

Retrieved from @2006 The Authors Journal Compilation @2006 The Association of Anaesthetists of Great Britain and Ireland.

Paper nine:

Kermode M, Jolley D, Langkham B, Thomas M S & Crofts N. (2005). Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. American Journal of Infection Control. Vol 33 (1), 34-41.  

Paper ten:

Ng L N, Lim H L, Chan Y H & Bachok D B. (2002). Analysis of sharps injury occurrences at a hospital in Singapore. International Journal of Nursing Practice. Vol 8 (5), 274-281.

 

 

5.4 Summary grip

Generally summarise the papers, perhaps in a summary grid as overleaf:

 

REFERENCE	FOCUS	BACKGROUND	TERMS OF REFERENCE	DESIGN	FINDINGS	APPLICABILITY TO PRACTICE
Paper1 Nsubuga and Jaakkola (2005)	The title “Needle stick injuries among nurses in sub-Saharan Africa” makes clear the phenomenon being studied and the population under study (nurses in sub-Saharan Africa). It stated concise.	Needle stick injuries issues are relevant to all aspects of nursing. Providers need to know how to characterize Needle stick injuries and identify influencing characteristics. The literature review is current and clearly justifies the research.	In the abstract of this study, the aim is made very clear, being to present a model of needle stick injuries and related factors, in a group nurses and midwives, and to conduct preliminary testing of that model. This is reaffirmed throughout the paper.	Quantitative questionnaires most appropriately using prevalidated tools.	The rate of needle stick injuries observed in this study during April and May 2004 was slightly higher than estimates in earlier African studies because this study population included only nurses and not included other healthcare workers. 57% of nurses and midwives had experienced at least one needle stick injuries. The strongest predictor was lack of training, long working hours, working habits and experience. Other important risk factors were related to long working hours, working habits (recapping needles) and experience.	Factors that may influence needle stick injuries for nurses in sub-Saharan Africa was lack of training, long working hours , working habits, and experience. By better understanding factors contributing to needle stick injuries, a more comprehensive training programme to nurses can reduce incident rate.

 

REFERENCE	FOCUS	BACKGROUND	TERMS OF REFERENCE	DESIGN	FINDINGS	APPLICABILITY TO PRACTICE
Paper2 Smith, Mihashi, Adachi, Nakashima and Ishitake, (2006)	The title “Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital” makes clear the phenomenon being studied and the population under study Them (nurses in a Japanese teaching hospital is concise.	Needlestick and sharps injuries are major occupational hazard in the healthcare industry. Nurses are also at significant risk from occupationally acquired infection. Providers need to know preventive strategies which are based on reflection of workplace events. The literature review is current and clearly justifies the research.	It stated clear in the study. Researchers tried to investigate the epidemiology of needlestick and sharps injuries may be influenced by a variety of psychological, cultural and workplace factors.	Quantitative questionnaires most appropriately using prevalidated tools.	Opening of ampoules or vials were most commonly implication in needlestick injuries. Nurses younger than 25 years of age were 2.18 times to have a single while 2.39 times to have multiple needlestick injuries. It represents a complex and multi-faceted problem for Japanese nurses. Almost one in 20 needlestick injuries events (4.9%) were not report because ignore the importance occupation risk. Another reason included they were too busy.	Japanese nurses clearly incur a high risk from serum-related transfer of bloodborne pathogens at work. As opening ampoules or vials was one of most common causes, future intervention and training programmes should focus on this specific issue.
REFERENCE	FOCUS	BACKGROUND	TERMS OF REFERENCE	DESIGN	FINDINGS	APPLICABILITY TO PRACTICE
Paper3 Smith, Smyth, Leggat and Wang, (2006)	The title “Needlestick and sharps injuries among nurses in a tropical Australian hospital” makes clear the phenomenon being studied and the population under study (nurses in a tropical Australian hospital) is concise.	Researchers pointed out needlestick and   sharps injuries is a major hazard in nursing practice, most studies rely on officially reported data and non have yet been undertaken in tropical environments. This study showed needlestick injuries events represent an important workplace issue for tropical Australian nurses.	In the abstract of this study, the aim is made very clear, being to present needlestick injuries events represent an important workplace issue or tropical Australian nurses. This is reaffirmed throughout the paper.	Quantitative questionnaire with cross-section.	Half of the nurses with needlestick injuries events occurred beside the patient’s bed. It showed needlestick injuries events represent an important workplace issue for tropical Australian nurse. One third (34%) occurring in the utility room. 27% of needlestick injuries were not reported because the incident was considered to be minor. 5% were not report because they were too busy.	This incidence rate is still much lower than that reported among hospital nurses in the USA. It is because all newly employed nurses required to have an orientation programme, which includes many aspects of occupational safety and training programme on prevention of needlestick injuries.

 

 

REFERENCE	FOCUS	BACKGROUND	TERMS OF REFERENCE	DESIGN	FINDINGS	APPLICABILITY TO PRACTICE
Paper 4 Ganczak, Milona and Szych, (2006)	The title “Nurses and occupational exposures to bloodborne viruses in Poland” is clear and concise.	Researchers need to know sharps injuries result from a combination of several factors, including inadequate training of management. It is a relatively high incidence of at least half of the nurses’ sustained 1 self-reported exposure to patient blood among nurses during the past 12 months.	The abstract of this study is to record descriptions of occupational exposures to blood, determine factors predictive of exposure, and identify interventions that might reduce the frequency of exposure.	An analytic, cross-sectional survey Quantitative questionnaire by mail to the administrators of the hospitals taking part in the survey.	The 601 responding nurses were aged 20-58 years. The majority of respondents(94%) were employed full-time and three-fourths respondents participated in special training on prevention of HIV/AIDS. .Almost half of respondents reported having had at least 1 puncture injury during the preceding year and more than half had worked at least once with a recent abrasion or cut on their hands. The percentage of nurses without percutaneous exposure during the preceding year was significantly higher in the group that received special HIV/AIDS training than in the group that did not. 74% of respondents were not reported to hospital’s infection control center. The most common reason for not reporting was the conviction that the source patient was not infected.	Factors that may influence of occupational exposures to blood. By better understanding factors predictive of exposure, and identify intervention that might reduce the frequency of exposure. It was important to note that nurses should adopt more adequate behavioral strategies to prevent the transmission of bloodborne pathogens. Policies for providing adequate education programs tailored to encourage nurses to report all exposures are urgently required.

 

REFERENCE	FOCUS	BACKGROUND	TERMS OF REFERENCE	DESIGN	FINDINGS	APPLICABILITY TO PRACTICE
Paper5 Tabak, Shiaabana and ShaSha, (2006)	The title “The health beliefs of hospital staff and the reporting of needlestick injury” is clear and concise.	Needlestick injury to hospital staff is quite frequent and can result in infections and disease, but staffs frequently do not report the injury despite their awareness of the risk of bloodborne pathogen. The literature review is current and clearly justifies the research.	In the abstract of this study, the aim is made very clear, being to examine the connection between the health beliefs of hospital staff (doctors, nurses and auxiliary staff) and their failure to report needlestick injuries. This is reaffirmed throughout the paper.	Quantitative questionnaire	Nurses had the highest rate of needlestick injury, followed by auxiliary staff and doctors. Auxiliary staff showed the highest rate of compliance with the duty to report such injuries, while doctors showed the lowest. The perceived efficacy of reporting injuries and overall motivation to maintain health were the best predictors of reporting compliance. Non-complier emphasized the negative aspects of reporting the injuries, primarily which it took up too much time.	Factors that may motivate the worker to report/ not report needlestick injury. This is the first study to use the health beliefs model as means to predict level of compliance with the duty to report needlestick injuries in Israel.  Finding the reasons for compliance and non-compliance with the duty to report needlestick injuries will help in designing educational programmes for hospital staff and determining a strategy for improving health behaviour.

 

REFERENCE	FOCUS	BACKGROUND		TERMS OF REFERENCE		DESIGN		FINDINGS		APPLICABILITY TO PRACTICE
Paper 6 Vaughn, McCoy, Beekmann and Woolson, (2004)	The title “Factors promoting consistent adherence to safe needle precautions among hospital workers” is clear and concise.	Researchers noted that the reasons why healthcare workers may continue to recap needles despite universal precautions even safer sharps devices are available, it may due to inconvenience, interference with work, and healthcare workers’ beliefs.		In the abstract of this study, the aim is made very clear, being to examine organizational factors and occupational characteristics associated with adherence to occupational safety guidelines recommending never recapping needles.		A mail survey in this study		Fewer than half of the respondents consistently adhered to the no-recapping guidelines and fewer than half of the hospitals used needle less IV system and one-third used needle protection devices. Two-fifths of healthcare workers reported that their hospital still used the isolation category of blood and body fluids precautions. Healthcare workers who reported that their organizations used the isolation category of blood and body fluid precautions (i.e., who were informed about patients with known bloodborne pathogen infection) were less often consistently adherent. Then, greater levels of management support were associated with more consistent adherence, whereas increased job demands were associated with a lower likelihood of consistent adherence.      .		Healthcare organizations can improve staff by investing wisely in educational programs regarding approaches to minimize these risks, providing protective equipment and eliminating the use of blood and body fluid precautions as an isolation policy.
REFERENCE	FOCUS		BACKGROUND		TERMS OF REFERENCE		DESIGN		FINDINGS	APPLICABILITY TO PRACTICE
Paper 7 Wang, Fennie, HE, Burgess and Williams, (2003)	The title “A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge, behaviour and incidence of needlestick injuries among student nurses in Changsha, People’s Republic of China” is clear.		Although the human immunodeficiency virus epidemic in China is expanding rapidly, the principles of universal precautions and occupational protection against bloodborne pathogen were mentioned only infection control manual in China, lack of training might place student nurses at risk .Researcher designed a bloodborne pathogen prevention program for student nurses to minimize the risk of occupational infection in this population. The background and justification of this paper were stated clear.		In the abstract of this study, the aim is made very clear, being to examine the impact of structured training on prevention of occupational exposure to bloodborne pathogen on knowledge, behavior, and incidence of medical sharp injuries among student nurses in Changsha, China.		I t was a quasi-experimental study with randomized controlled trials design.		There was a significantly increase with knowledge and self-reported behavior after the training program. The group that received the bloodborne pathogens training scored significantly higher than the standard education group on both knowledge and behavior. A large percentage of students in both group washed their hands before procedures. Glove use was rarely observed in either group with a high risk of procedure. Students with training receiving standard education reported injuries. Therefore, researchers stated the main finding very clear in this study.	This study was worth to undertake since it provided empirical evidence to support and provision such training into curricula routinely in nursing in order to reduce the risk of occupational exposure to the serious infections agents and it was similar to local situation.

 

REFERENCE	FOCUS	BACKGROUND	TERMS OF REFERENCE	DESIGN	FINDINGS	APPLICABILITY TO PRACTICE
Paper 8 Raghavendran, Bagry, Leith and Budd, (2006)	The title of “Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals” is clear and concise.	Percutaneous injury was the commonest injury reported. Providers need to assess the practice and attitudes of staff with regard to the use of universal precautions and prevention of needle stick injuries. This is reaffirmed throughout the paper.	In the abstract of this study, the aim is made very clear, being to compare attitudes and experience in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside. To compare responses between the various groups and the two hospital.	This is a survey design in this study.	The responses were higher from medical staff (90%) than from non-medical staff (61%). Needle stick injuries cause significant stress and anxiety to the affected individual and their family. Over half of these injuries involving nursing staff. About 43% of the respondents recapped needles after use. Over half of the respondents had suffered a needlestick injury sometime in their practice. Only 65% of healthcare workers reported sharps injury while over one third of all needle stick injuries were unreported. Failure to report may due to lack of time or felt it did not serve any purpose.	There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend.

 

REFERENCE	FOCUS	BACKGROUND	TERMS OF REFERENCE	DESIGN	FINDINGS	APPLICABILITY TO PRACTICE
Paper 9: Kermode, Jolley, Langkham, Thomas and Crofts (2005)	The title “Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings” is a clear and concise.	High risk of exposure to bloodborne which are relevant to all aspect of healthcare workers. More than 90% of these infections are occurring in low-income countries, and most are preventable.	In the abstract of this study, the aim is to describe the extent of occupational exposure to blood and the risk of bloodborne virus infection among a group of healthcare workers in rural north India. This is reconfirmed throughout the paper.	A cross sectional survey. Quantitative questionnaire	The level of occupational exposure to blood and other body fluids among healthcare workers in rural north Indian health care settings is unacceptable high. 30% of percutaneous exposure is a very high level of exposure. The high level occupational exposure to blood found among this group if rural north India healthcare workers highlights the urgent need for interventions to enhance their occupational safety to prevent unnecessary nosocomial transmission of bloodborne virus.	The survey sample was not a probability sample and therefore not representative of all healthcare workers in rural north India, so the study findings should be generalized with caution. This study highlights the urgent need for interventions to enhance the occupational safety of workers in low income country health care setting. Therefore, the promotion of Universal Precautions and the provision of safety equipment are required.

 

 

 

REFERENCE	FOCUS	BACKGROUND	TERMS OF REFERENCE	DESIGN	FINDINGS	APPLICABILITY TO PRACTICE
Paper 10 Ng, Lim, Chan and Bachok, (2002)	The title of “Analysis of sharps injury occurrences at a hospital in Singapore” is clear and concise.	Sharps injuries sustained from the greatest occupational hazard for transmitting blood-borne pathogens to healthcare workers. Researchers need to examine the epidemiology and causes of sharps injuries. The literature review is current and clearly justifies the research.	In the abstract of this study, the aim is made very clear, being to examine the epidemiology and causes of sharps injuries at a university teaching hospital. This study aimed to analyse the incidence of reported sharps injuries that occurred over the past 4-year period from 1997 to 2000 at Alexandra Hospital, Singapore.	The type of instruments, site of injuries and personnel involved in each sharps injury were determined retrospectively by reviewing the Incident Reports forms and Infection Control records between 1997 and 2000.	From January 1997 to 2000, a total of 82 injuries were reported. Injection needles accounted the highest rates of injuries, medical staff sustained 40.2% of the injuries while nursing staff sustained 29.3% of the injuries.	Sharps injuries sustained form hollow bore instruments were associated with higher risk of transmitting blood-borne pathogens than instruments with a solid core. In recent years, the hospital studied had purchased various sharp injury devices to prevent recapping needles. Engineering controls had demonstrated considerable effectiveness in preventing sharps injuries.

 

Chapter six: Analysis

6.1 Introduction

       Since Florence Nightingale’s era, nurses have been expanding their professional practice foundation through research efforts designed to develop and test knowledge. Nursing is a professional as well as an academic discipline; hence, it incorporates a clinical practice component as an integral part of its activities. Nurses are responsible for provision of client care, administration of nursing and health-care services, and education of practitioners. Therefore, research in nursing encompasses systematic investigation into each of these areas (Gillis & Jackson 2002).

        Therefore, knowledge is the foundation of professional practice; all nurses can and should develop and apply research skills in practice. This requires an understanding of the research process and the ability to critically read and evaluate research studies, determine their credibility, and assess the appropriateness of research findings for use in practice. Prudent evaluation and use of findings are critical to the development of a scientific knowledge base for practice (Gillis & Jackson 2002). 

       In today’s world of health-care restructuring and reform, nurses are increasingly required to be accountable for the quality of care they provide and demonstrate that they are engaging in evidence-based practice. The information contained in the literature is often made up of specific theories based on certain choices people have made about the methodological assumptions they wish to employ in their work. As a researcher, the aim of the author review is to extract those methodological assumptions. Therefore, the author needs to elicit from the literature the ways in which core ideas, concepts and methodologies have been employed in argument and how they have been operationalized for empirical work. This is a process forms another part of the analysis element of the review and is essential if core ideas and concepts are to be properly identified from individual items and thereby used to produce a map of the knowledge on a phenomenon, topic or problem (Hart 1998).. 

       By using the method of mapping and analyzing ideas to develop Prevention of sharps injuries among healthcare workers in hospital is necessary in Hong Kong.

 

6.2 Development themes

6.2.1 Understanding the concept of Theme

       DeSantis and Ugarriza (2000) reviewed the literature and interdisciplinary definitions of theme and developed their own definition to help researchers analyze data. A theme is an abstract entity that brings meaning and identity to a recurrent experience and its variant manifestations. As such, a theme captures and unifies the nature or basis of the experience into a meaningful whole.

DeSantis and Ugarriza (2000) gleaned five aspects of a theme:

l   Overall entity (i.e., the experience).

l   Structure (i.e., the nature or basis of the experience).

l   Function (i.e., the capture and unification of the nature or basis of the experience into a meaningful whole).

l   Form (i.e., the stability and /or variability of the many manifestations of the experience).

l   Mode (i.e., the recurrence of the experience).

Four criteria that are fundamental to the definition of theme emerged from DeSantis and Ugarriza’s (2000) content analysis of the relevant literature. These criteria include a theme’s emergence from data, abstract nature, iteration or recurrence of patterns or behaviors, and levels of identification.

       The information contained in the literature is often made up of specific theories based on certain choices people have made about the methodological assumptions they wish to employ in their work. As a researcher, the aim of the author review is to extract, to an extent appropriate to those methodological assumptions. It is essential to elicit from the literature the ways in which core ideas, concepts and methodologies have been employed in argument and how they have been operationalized for empirical work. It is used to produce a map of the knowledge on a phenomenon, topic or problem (Hart 1998).

Therefore, the main use of mapping a topic is to acquire sufficient knowledge of the subject to develop the necessary understanding of methodology and research techniques, to comprehend the history and diffusion of interest in the topic, and to undertake an analytical evaluation of the main arguments, concepts and theories relevant to the topic in order to synthesize from the analysis an approach. Mapping enables analysis and synthesis to be undertaken; in mapping work on the topic (Hart 1998). Then, the author would undertake the task of construction, putting together the different strands and elements of work that make up the body of knowledge on the topic of sharps injuries among healthcare workers in hospital.  

 

6.2.2 Classification of problem

       According to Hart (1998), he noted that classification is the most basic, involves sorting and organizing things, such as ideas, into categories and labeling those categories, it is a way of reducing information into a manageable amount. We need to take a technical and reflexive attitude to classification, seeking to produce symmetry between organizing ideas in the literature.

   Therefore, the author uses the fishbone diagram to classify the cause of the sharps injuries among healthcare workers in hospital. It is an essential diagram to identify the causes of sharps injuries.

The cause and effect diagram of fish-bone diagram (Fig1):

       

 

         Material                Staff

 

Low rate of                            Not compliance universal precaution

using safety             Lack of knowledge

device                                   No-recapping of needle guideline

                            Higher incidence  

                         rate of less experience   

                                                                     Sharp injury  

Ignore importance of                Lack of training program

occupation risk                                    Poor management support   

                           

Neglect of occupation                          Low staffing with long working hours             health on handling of

            sharps                        Poor management support.             

Measurement                   Management

 

       When applying the fishbone technique, the cause and effect diagram is a valuable way of starting an investigation into, and opening up discussion about, quality questions. Fish-bone diagram is essential diagram to record discussion and ideas and connect them by lines (Naylor 1996)1. In the figure 1, in the starting point at fish’s head, was the problem of healthcare workers suffering sharps injuries in hospital. The other boxes represent main limbs where causes may lie and the small boxes suggest some detailed reasons for these areas. Therefore, the diagram can summarize ideas of cause and effect in an informal, hierarchy way.

             

6.2.3 Description of the causes of sharps injuries

       In these ten papers that the author were selected, these will find that some authors have dealt with general issues while others have looked at specific aspects of a problem or issue. The following is the description of their causes of sharps injuries:

Staff – They were not compliance to the universal precaution and no-recapping of needle guidelines. They were lack of knowledge on bloodborne pathogen infections disease. Higher incidence rate on less experience staffs. Therefore, the problem may have been caused by staff who are inexperienced, who cannot answer prompted questions and follow the guidelines of sharps injuries in departmental.   

Management – Lack of training program on prevention of sharps injuries, low staffing, long working hour, poor working climate and poor management support. This may indicate project management is in poor management decision making. 

Material – Low rate of using safety device. This may refer to physical theory.

Measurement – They ignore the importance of occupational risk. Neglect of occupational health of safety on handling of sharps instrument and needle. Therefore, it refers to metrics that are derived form a project. Problems may occur if measurements are wrong or the measurement technique used is not relevant.

 

6.2.4 Themes formation

       According to Crookes et al 1998, it is important to identify themes and concepts within the literature in order to determine the appropriate structure for the review. These should emerge from the literature rather than being imposed by the reviewer. A list of themes can then be developed and these can be condensed into broader themes once all the material for review has been considered. Therefore, the author develops themes on the basis of the ten papers which have been selected in chapter five.  

. The author may identify the themes from these ten studies; it was helpful to use the themes to conduct a detailed analysis. The followings are the detail of themes of sharps injuries among healthcare workers in hospital.

Theme one: Staffs were not compliance the universal precaution and no-recapping needle’s guidelines.

Theme two: Staffs were lack of relevant knowledge on universal precaution and bloodborne pathogen infections disease.

Theme three: Higher rate of sharps injuries in less experience staffs.

Theme four: Staffs under-reported the incidents of sharps injuries.

Theme five: Staffs who worked with poor management support and low staffing.

Theme six: Staffs needed training program on bloodborne pathogen infections disease and universal precaution.

Theme seven: Low rate of using safety device and protective equipment even it was supplied in hospital.

Theme eight: Staffs ignore the importance of occupational risk.

Theme nine: Staffs neglect of occupational health of safety on handling of sharps instrument and needle.   

       After identify the themes from the studies, it was helpful to use the themes to conduct a detailed analysis. Then, the author simply listed out the nine themes against ten article papers. Any themes identify by the author from the relevant paper were given a cross mark in response to the theme number. The author conducts a wide variety of thematic analysis devices and tabulates the themes into the following:

 

	Theme   1	2	3	4	5	6	7	8	9
Paper 1	X	X	X	X		X	X	X
2	X	X	X	X		X		X	X
3	X	X		X	X	X		X
4		X		X		X		X	X
5		X		X		X		X	X
6	X				X	X	X	X	X
7	X	X				X		X	X
8	X	X			X	X		X	X
9	X			X	X	X		X	X
10			X	X	X	X		X

 

6.3 Thematic analysis

       According to Leininger (1990), transferability, recurrent patterning, and saturation indicate consistency of study conclusions; credibility, conformability and meaning-in-contest indicate truth value. Although it might not be possible or appropriate to observe all these criteria in one study, Leininger suggests attention should be given to at least one criterion of consistency and one of truth value.

       Therefore, the process used to discern patterns, themes or relationships from the data must be described; including how the data were recorded and reviewed. The importance of the identified patterns and the interrelationships should be made clear. Then, the author indicate whether the findings were confirmed by agreement for classifying, validation from informant group or external consultant, reliability estimates using recurrent patterning of a common theme or other methods. This includes whether the data found are best highlighted in the context of an existing theory, or whether a new scheme needs to be developed (Brockopp &Hastings-Tolsma 1989).

             The broad aim of any literature review is to synthesize the critical evaluation of existing work on sharps injuries among healthcare workers in hospital. All researchers have observed high incident rate of sharps injuries happened in hospitals. Because of difference in education background, working practice and organizational management which may affect the chance of sharps injuries.

 

6.3.1. Theme one: Staffs were not compliance the universal precaution and no-recapping needle’s guidelines.

      To prevent the sharps injuries, universal precautions included use of glove, proper disposal of sharps and no-recapping of needle guideline were introduced and were recommended by Centers for Disease Control and Prevention (CDC).

       According the matrix of thematic analysis, seven papers agreed to theme two and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease.    

      

6.3.2. Theme two: Staffs were lack of relevant knowledge on universal precaution and bloodborne pathogen infections disease.

       To prevent the sharps injuries, the concept of using a range of infection control precautions routinely in the care of all patients, regardless of whether they are known to have infectious disease.

       According the matrix of thematic analysis, seven papers agreed the theme two and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease.

 

6.3.3. Theme three: Higher rate of sharps injuries in less experience staffs.

       To reduce the incident rate of sharps injuries, healthcare workers might not aware the importance of bloodborne pathogen disease with less working experience and follow universal precaution guidelines.    

        According the matrix of thematic analysis, three papers agreed the theme three and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease.

 

 6.3.4. Theme four: Staffs under-reported the incidents of sharps injuries.

       The incidence of non-reported sharps injuries acknowledge the importance of reporting such incidents, the size of the problem cannot be accurately determined. To prevention of sharps injuries, it is necessary to report and evaluation could be achieved to solve such incidents.

       According the matrix of thematic analysis, seven papers agreed the theme four and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease.

 

6.3.5. Theme five: Staffs who worked with poor management support and low staffing.

       Staffs on units with less adequate resources, lower staffing, less leadership support and higher levels of emotional exhaustion were typically high as likely to report the presence of risk due to carelessness and inadequate supplies. Heavier workloads may increase their risk for exposure to handle sharps.

According the matrix of thematic analysis, five papers agreed the theme five and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease.

 

6.3.6. Theme six: Staffs needed training program on bloodborne pathogen infections disease and universal precaution.

       Training is of key importance in ensuring safe and effective prevention of sharps injuries among healthcare workers. It should cover the universal precaution and safety on handling sharps. 

According the matrix of thematic analysis, ten papers agreed the theme six and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease without training.

 

6.3.7. Theme seven: Low rate of using safety device and protective equipment even it was supplied in hospital.

       Many devices for preventing sharps injuries are available but not effective and they may have limited application. This type of study provided an important insight into factors associated with injury and where preventive measures should be directed.

According the matrix of thematic analysis, two papers agreed the theme seven and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease without using safety device and protective equipment.

 

6.3.8. Theme eight: Staffs ignore the importance of occupational risk.

       The highest risk of transmission of bloodborne pathogens is via a hollow-bore needle sharps injury during use or after use but before dispose. However, healthcare workers always ignore the importance of occupational exposure.     

According the matrix of thematic analysis, ten papers agreed the theme eight and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease.

 

6.3.9. Theme nine: Staffs neglect of occupational health of safety on handling of sharps instrument and needle.  

        A number of studies have investigated the causes of sharps injuries in healthcare workers might due to recapping of needle; sharps not discarded after use. Many safety devices for preventing sharps injuries are available but not all the effective and they may have limited application.

According the matrix of thematic analysis, seven papers agreed the theme nine and showed that healthcare workers perceived risk of exposure to HIV/ AID or other bloodborne pathogen disease without using safety device and protective

  

Chapter 7: Discussion

7.1 Introduction

       The interaction between humans and microbes has changed considerably through history. The microbes responsible for the great epidemics of the past have largely been controlled through improvements in living condition, immunization and chemotherapy (Wilson & Jenner 2001). However, many parts of the world have yet to benefit from our ability to understand and control infectious disease, whilst the re-emergence of old disease such as tuberculosis and the appearance of new diseases, such as acquired immune deficiency syndrome (AIDS) and new variant Creutzfeldt-Jakob disease, present new challenges.

       Government policy and professional guidance insist that professional practice should be ‘evidence-based’. The pressure is on to justify both the choices made for particular clients and patients and the patterns of practice overall by reference to a body of evidence about efficiency and effectiveness. In health and social care, experiments have been the main source of producing sound knowledge about effective techniques of intervention, and surveys have been the main basis of knowledge about the causation of disease and social problem (Gomm & Davies 2000). Healthcare exposes patients to an increased risk of infection. This risk is particularly high when care is provided in a hospital setting, where contact with healthcare workers and equipment occurs frequently and other patients may act as a source of infections. The acquisition of infection as a result of hospital or other healthcare treatment has important implications both for the patients affected and the organizations concerned (Wilson & Jenner 2001).

Infection is a common, but largely avoidable, complication of healthcare which has a major impact on the patient and the health service. However, this is particularly the case with bloodborne viruses such HIV, hepatitis B and C, which are associated with prolonged asymptomatic carriage of which even the patient may be unaware. The implementation of special precaution on diagnosis of infection may therefore not prevent cross-infection before the diagnosis is made. 

Therefore, the author identifies causes of sharps injuries among healthcare worker through literature review, it is important to define key concepts and variables. It is used to draw together literature describing experiences of sharps injuries among healthcare workers, in order to identify a framework to guide practice that will help prevention of sharps injuries among healthcare workers in Hong Kong hospital.

 

7.2 Common causes of sharps injuries

       Although a considerable number of studies have been published on sharps injury rates in individual hospitals, the data can help the author to understand the problem and contributing factors. Sharps injuries remain a considerable health risk for healthcare workers in hospital.

7.2.1 Lack of knowledge on bloodborne pathogen infectious disease  

Healthcare workers were not compliance to the universal precaution and no-recapping of needle guidelines. They were lack of knowledge on bloodborne pathogen infections disease (Wang et al 2003, Vaughn et al 2004, and Nsubuga et al 2005).

In the past, infection control precautions have tended to be focused on special measures intended to prevent the transmission of infection form patients known to have infectious disease. Universal precaution was developed in response to the emerging HIV epidemic which was highlighting the problem of identifying patients with infection. However, if universal precautions were to be effective in preventing cross-infection between patients, as well as protecting staff from bloodborne viruses, then it was important to ensure that protective clothing was both used and changed appropriately (Wilson & Jenner 2001).

Universal precautions were first recommended by the Centers for Disease Control in Atlanta, USA, in 1985 in response to growing concerns about the risk to healthcare workers from the human immunodeficiency virus (HIV). HIV had highlighted the difficulty of identifying people who where incubating a disease and were infectious, but who had no outward signs of the infection. Universal precautions recognized that there were a few simple practices that could be used in the care of all patients that would minimize the risk of bloodborne viruses being transmitted to healthcare workers. These included the safe management of sharps, the use of protective clothing in situations where open skin lesions or mucous membrane may have contact with blood or body fluid, the use of waterproof dressings to cover cuts, and hand washing after and contact with body fluids. Therefore, universal precautions were first proposed, other workers have recognized their benefit as a means of protecting staff and patients from other pathogens that have a protecting staff and patients from other pathogens that have a propensity to spread in clinical settings (Lynch et al 1990, Wilson & Breedon 1990).      

Therefore, accidental sharps injuries occur frequently, posing a serious risk of transmitting fatal or chronic diseases to a wide range of healthcare workers.

 

 

7.2.2 Lack of training program on prevention sharps injuries

       Although needlestick and sharps injuries represent a major hazard in healthcare workers practice, most studies indicated training program on prevention sharps injuries that can reduce incident rate of sharps injuries (Wang et al 2003, Smith et al 2006 and Ng et al 2002).  

       As well as protecting the patient, infection control precautions are important for the protection of staff. Employers are responsible for ensuring that hazards in the workplace are identified, the risks they pose are assessed and appropriate precautions are taken to protect against them.

       By the nature of their occupation, healthcare workers throughout history have been exposed to infectious disease. In general was accepted that these exposure were an integral part of caring of sick people. With an increased understanding of the infectious disease process and development of antibiotics, caring for patients became less risky for care providers (Holodnick et al 2000). Therefore, sharps injuries prevention methods that combine education and training can increase awareness among personnel of their infection risk.

 

7.3 Recommendation for current healthcare workers’ practice on prevention of sharps injuries

       Accidental sharps injuries occur frequently, posing a serious risk of transmitting fatal or chronic diseases to a wide range of healthcare workers. As one physicians noted, “Rarely a day goes by in any large hospital where a needlestick incident is not reported”. Needlesticks have long been associated with transmitting both bacterial infections and viral infections, such as hepatitis B; now they also serve as the agent of transmitting of human immunodeficiency virus, which causes acquired immunodeficiency syndrome (Charney1999). Therefore, several methods of reducing the incidence of sharps injuries are available.

 

7.3.1 Education and training program to healthcare workers in hospital

       According to Armstrong 2001, training is the formal and systematic modification of behavior through learning which occurs as a result of education, instruction, development and planned experience. Training takes a long-term view of what skills, knowledge and levels of competence employees of the company need.

       Therefore, proper education of employees about the importance of following universal precautions, using approved disposal methods, including recommended impervious disposal containers; prompt emptying of disposal containers before they overflow; and using preventive devices are essential elements of a program to minimize sharps injuries occurrences. Brief description of the purpose of the training model, emphasizing the ultimate goal is that participants will teach others. Education on occupation risks for exposure to bloodborne pathogens, including identification of local procedures that increase risk. It is necessary to review of the principles of adult education and identification of teaching strategies that might be effective for healthcare workers in hospital (Huang et al 2002).

 

       According toTabak et al 2005, risk management initiatives in every department which can promote occupational health by education or information programs. Individual and group training in relevant clinical and other skill is one of strategy to advance personal and occupational health promotion behaviour.

A systematic HIV/AIDS educational programme for healthcare workers led to positive changes in their knowledge, attitudes, and compliance with universal precaution. Therefore, a well designed prevention programme for healthcare workers can minimize the risk of occupational infection. Training program covered epidemiology and transmission of bloodborne pathogen, modes of occupational exposure to bloodborne pathogen, concepts and techniques of universal precaution, and post exposure management of injuries. Teaching aids such as slides, transparencies, photos and videos were incorporated into the lecture (Wang et al 2003). It is also to encourage healthcare workers to compliance guideline on no-recapping needle.    

 

7.3.2 Top-Level Support

       Apply standard methods of occupational health using the hierarchy of controls framework to prevent exposure to blood and sharps in hospital. Prevention of sharps injuries involving needles and other sharp devices is just one part of the required plan, albeit an important one because needlestick and sharps injuries pose the greatest bloodborne infection risk to healthcare workers.

      Pugliese (1999) mentioned that support from senior management is essential because the program will likely require the use of resources for education and training and most accursedly will include changes in long-established practices, whether in the from of adopting new devices or paying closer attention to maintaining accurate records of injuries.

       It may be very helpful for appropriate nurses and physicians to bring hospital executives up to date about the changing nature of risks in the health care setting, the demands and expectations of regulatory authorities, injury prevention program will have a better chance of success if they can quantify the costs related to occupational accidents and injuries from all sharps, as well as the cost of adopting preventive strategies.     

 

7.3.3 Issues in selecting a safety device

       Most needlestick and sharps injury prevention program will include the development of criteria for selecting safety devices. Deciding which safety device to evaluate first is a complex problem that must take several factors into consideration, including the impact on patients, the extent of available data on sharps-related injuries, the relative risk of transmission of a bloodborne infection, the availability of products on the market, and the cost effectiveness of the product (Pugliese 1999).

       Safer devices improved engineering controls are often among the most effective approaches to reducing occupational hazards and, therefore, an important element of a sharps injury prevention program. Such control includes eliminating the unnecessary use of needles and implementing devices with safety features (Dee & Sheelagh 2001).

 

7.3.4 Barrier to implementation

       The implementation should be preceded by a strategy for orientation of the staff, designation of a resource person familiar with the device for each department, and procedures for replacing the old devices throughout the facility. If workers have a choice between an old and a new device in stock, they will often choose the old device. Hospitals have also reported staff hiding old devices to avoid using the new ones. Some departments may refuse outright to use the new device. This is where management support is essential (Pugliese 1999).

       Therefore, healthcare workers must be made aware of their own risks of susceptibility to injury and disease and educated on how the new devices will reduce them. Convincing healthcare workers to adopt a new device, and perhaps a new procedure, is a formidable challenge. Thus, they must be made aware of their own risks of susceptibility to injury and disease and educated on how the new devices will reduce them.   

 

7.4 Ethical implication of the finding

       Several surveys of nursing and medical personnel have revealed that they do not perceive education as an effective means of reducing sharps injuries. In one article, the authors note that “most respondents reported some knowledge of proper needle disposal techniques and perceived lack of knowledge as the least important reason for needlestick injuries” (Jackson, Dechairo, and Gardner 1986).

Similarly, in other studies also mention that training and education could play a role in reducing the risk for occupational exposure to bloodbore pathogen (Wang et al 2003, Tabak et al 2005, Porta et al 1999, Ng et al 2002, and Ganczak et al 20060). Therefore, during basic HIV/AIDS training, healthcare workers can receive the description of their exposure risks and information on strategies to prevent and steps to manage work-related injury, including post exposure prophylaxis.

Employers are responsible for ensuring that hazards in the workplace are identified, the risks they pose are assessed and appropriate precautions are taken to protect against. Changing work practices may enable the risk to be minimized or avoided. There may also be equipment available with safety features that can prevent injury such as safety devices. In addition, administrative controls should be in place. These should include systems for ensuring that staffs know about the risk, are trained to comply with controls, and are aware of the actions to take should exposure to the hazard occur. Mechanisms for monitoring adherence to health and safety policies and for recording accidents should be in place and the information used to evaluate and review practice (Wilson 2001).       

      

7.5 Limitation of the study

      By using literature review as methodology, the author could only read the summary to get the finding. However, it was difficult to collect primary data directly. The topic of prevention of sharps injuries among healthcare workers was a research summary, which could not totally provide proper solution to this present question.

       Furthermore, there was no particular research has been done specifically focus on sharps injuries among healthcare workers in Hong Kong public sector. Then, author can only use selected articles from other countries or those relevant articles to form a balance picture to get the idea.      

 

7.6 Implications for the practice

       Hong Kong is endemic for hepatitis B virus infection, with a hepatitis B surface antigen (HBsAg) carrier rate of approximately 10%. Locally, chronic liver disease is the eighth leading cause of death, and out of all malignancies, cancer of the liver is the second leading killer (Ho et al 2004). Therefore, infection control procedures are also important to protect healthcare workers from bloodborne virus. Healthcare workers infected with bloodborne viruses may transmit infection to their patients and family members. Due to the high incident rate of sharps injuries in the author’s hospital, it is necessary to apply some recommendation to prevent hazards and risks.

         Healthcare workers should be made aware of the importance and principle of infection control. They should also emphasize the importance of continuing education and training for healthcare workers. Therefore, new employees should be offered an orientation and induction programme to increase their awareness and to assist in their understanding of the hospital policies and programme for infection control. Education and training programmes should be flexible enough to encourage participation.

       Healthcare workers should comply with local written policies which reflect compliance with the Control of Substances Hazardous to Health Regulations and extant expert guidance. These policies are drawn up by those with appropriate knowledge and expertise, such as health and safety representatives, the infection control team and occupational health department. This could provide comprehensive guidance and information on all aspects of sharps injury prevention and management.

       While undertaking risk assessment, consideration should be given to practices that are high risk and easy to avoid in my hospital. Sharps use could be eliminated, for example, by purchasing needleless devices or whether safer devices could be used to reduce risk such as syringes with needle guards and retractable needles.         

        Our hospital provides immunization and vaccination of all existing staff at the required time interval. It is also to keep records of all sharps injuries, arranging post exposure prophylaxis following sharps injuries and counseling of staff if necessary. It should include details for prompt reporting, evaluation, counseling, treatment and follow-up. 

      

7.7 Suggestion for future research

        The basic information gathered in study indicates possible root causes of the continued incidence of sharps injuries. Based on these findings and information in the literature, several recommendations can be made. These include providing education and training programs for healthcare workers.

       However, most of research papers always indicate incidence rate of sharps injuries among healthcare workers through self-report rather than observation, the number of exposures reported may be lower than actual numbers. The choice to convert a continuous scale to a dichotomous one may have introduced some bias.       

There are few research papers are examine the connection the health beliefs, attitude and their failure to report to be found.

 

7.8 The author’s reflection as a learner and researcher

       Bloodborne pathogen exposure is an issue of paramount importance and concern to the thousands of healthcare workers who place themselves at potential risk in caring for patients on a day to day basis. As a learner, this study can help the author to understand the major cause of sharps injuries such as many healthcare workers still lack of knowledge about exposure risk, the availability of immediate treatment, and the urgent need to begin treatment. As a responsible organization, it is responsible to provide a safe and healthy working environment for their staff and to fully comply with relevant regulations.

       Moreover, as a researcher for the author to find out there are some practical problems to identify in different perspectives. Therefore, careful selection of data is very important for the outcome of any research. Literature review has been utilized in this dissertation; collecting viewpoints should be reviewed so that research questions can be analyzed from different perspectives.

 

Chapter eight: Conclusion

       Healthcare workers are at risk of occupational exposure to bloodborne viruses following sharps injuries. Since the 1980s, there has been an increase in the reported incidence of bloodborne infections amongst healthcare workers and a concomitant enhanced awareness of the occupational risks of bloodborne virus transmission. Healthcare workers’ knowledge of correct procedures, which reduce the risk of percutaneous sharps injuries thus decreasing the likelihood of contracting bloodborne viruses, must be evaluated regularly in order to identify any need for further education. This is especially important as there is currently no post exposure prophylaxis for hepatitis C, and hepatitis B vaccination is not completely protective (Elliott et al 2005).

Despite of risk of sharps injuries, several studies have highlighted that knowledge and compliance among healthcare workers is inadequate regarding their prevention and management. Some of healthcare workers are particularly vulnerable to accidental exposure to sharps injuries because they lack experience and skill. Accidental needlesticks occur frequently, posing a serious risk of transmitting fatal or chronic diseases to a wide range of healthcare workers. By the nature of their occupation, education and training programs on prevention of sharps injuries is used to reduce sharps injuries among healthcare workers in hospital.

Employers have a responsibility to provide a safe work environment without risk to the health of their employees. In health care setting, it is essential that all healthcare workers must be given adequate education the training on all issues relating to control of infection. In order to develop an effective sharps injuries prevention program, strategies have been proposed by author in the previous chapter. Therefore, education and training program, top-level support and selecting a safety device can improve the incidence rate of sharps injuries among healthcare workers in hospital.

Managers of all health care establishments must ensure that healthcare workers should be made aware of the importance and principles of infection control. They should also emphasize the importance of continuing education and training for all healthcare workers. Employees should be offered an orientation and induction programme to increase their awareness and to assist in their understanding of the institutional policies and programmes for infection control .   

          The author also indicated that hospital executives up to date about the changing nature of risks in the health care setting, the demands and expectations of regulatory authorities, injury prevention program will have a better chance of success if they can quantify the costs related to occupational accidents and injuries from all sharps, as well as the cost of adopting preventive strategies. Policies must be widely available for all staff. In particular, staff should have access to, and be familiar with, their local sharps policy. This should provide comprehensive guidance and information on aspects of sharps injury prevention and management. Therefore, top level support is very important to implement the prevention program on sharps injuries.

       While undertaking risk assessment, consideration should be given to practices that are high risk and easy to avoid, thus helping to reduce the most significant as well as the simplest risks. Safer devices improved engineering controls are often among the most effective approaches to reducing occupational hazards and, therefore, an important element of a sharps injury prevention programme. Such controls include eliminating the unnecessary use of needles and implementing devices with safety features. 

       Due to high incidence rate of sharps injuries among healthcare workers in Hong Kong hospital, it is necessary to conduct a prevention program on sharps injuries. 

 

Chapter nine: Reference

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Bell, F J. (1998). Reviewing the literature: a student’s perspective. Journal of Child Health Care, 2(3), 122-127.

 

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Flaskerud, J. H. (1989), AIDS/ HIV Infection, A Reference Guide for Nursing Professionals, Canada: W. B. Saunders Company.

 

Gillis, A. & Jackson, W. (2002). Research for Nurses: Methods and Interpretation. U.S.A: F. A. Davis Company.

 

Gomm, R. & Davies, C. (2000). Using Evidence in Health and Social Care, London: Sage Publications Ltd.

 

Hagstrom, A. M. (2006), Perceived Barriers to Implementation of a Successful Sharps Safety Program. AORN JOURNAL 83(2), 391-396.  

 

Hart, C. (1998). Doing a Literature Review, London: Sage Publications Ltd.

 

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Hill, A & Spittlehouse, C. (2003). What is critical appraisal? Retrieved on 20^th March 2005 from the World Wide Web: http://www.evidence-based-medicine.co.uk.

 

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Hospital Authority (1998), Hong Kong Hospital Authority Occupational Safety and Health Management Handbook, Hong Kong: Hospital Authority

 

Huang J, Jiang D, Wang X, Liu Y, et al. (2002), Changing knowledge, behavior, and practice related to universal precautions among hospital nurses in China. The Journal of Continuing Education in Nursing, 33(5), 217-225.  

 

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McCulloch, J. (2000), Infection Control: Science Management and Practice, London: Whurr Publisher  

 

Milgram, S. (1974). Obedience and Authority. London: Harper Row.

 

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Newman, M.A. (1992). Prevailing paradigms in nursing. Nursing Outlook, 40(1), 10-13, 32.

 

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Robson, C. (2002). Real World Research 2^nd edition, USA: Blackwell publishing.   

 

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Rudestam, K E. & Newton, R R. (2001).Surviving your Dissertation A comprehensive Guide to Content and Process 2^nd edition, London: Sage Publications Ltd.      

 

Steward, B. (2004). Writing a Literature Review. British Journal of Occupational Therapy 67(11), 495-499.

 

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Research papers:

Paper one:

Nsubuga, F M & Jaakkola M, S. (2005), Needle stick injuries among nurses in sub-Saharan Africa. Tropical Medicine and International Health Vol 10(8), 773-781. Aug 2005.

Paper two:

Smith D R, Mihashi M, Adachi Y, Nakashima Y & Ishitake T. (2006), Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital. Journal of Hospital Infection 64, 44-49.

Available online at www.sciencedirect.com

Paper three:

Smith D R, Smyth W, Leggat P A & Wang R S.(2006), Needlestick and sharps injuries among nurses in a tropical Australian hospital. International Journal of Nursing Practice Vol 12 (2), 71 -77.

Paper four:

Ganczak M, Milona M & Szych Z. (2006), Nurses and occupational exposures to bloodborne viruses in Poland. Infection Control and Hospital Epidemiology. Thorofare: Feb Vol 27(2), 175-181.

 

Paper five:

Tabak N, Shiaabana A M & ShaSha S. (2006), The health beliefs of hospital staff and the reporting of needlestick injury. Journal of Clinical Nursing.

 Retrieved from @2006 The Authors. Journal compilation@ 2006 Blackwell Publishing Ltd.

Paper six:

Vaughn T E, McCoy K D, Beekmann S E and Woolson R F, et al. (2004). Factors promoting consistent adherence to safe needle precautions among hospital workers. Infection Control and Hospital Epidemiology. Thorofare: Vol. 25(7), 548.

Paper seven:

Wang H, Fennie K, HE G, Burgess J &Williams A B. (2003). A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge, behaviour and incidence of needle stick injuries among student nurses in Changsha, People’s Republic of China. Journal of Advanced Nursing 41(2). 187-194.

Paper eight:

Raghavendran S, Bagry H S, Leith S & Budd J M. (2006). Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals. Anaesthesia 61, 867-872.

Retrieved from @2006 The Authors Journal Compilation @2006 The Association of Anaesthetists of Great Britain and Ireland.

Paper nine:

Kermode M, Jolley D, Langkham B, Thomas M S & Crofts N. (2005). Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. American Journal of Infection Control. Vol 33 (1), 34-41.  

Paper ten:

Ng L N, Lim H L, Chan Y H & Bachok D B. (2002). Analysis of sharps injury occurrences at a hospital in Singapore. International Journal of Nursing Practice. Vol 8 (5), 274-281.

 

Appendix:

Critiquing a research paper:

Paper one:

Nsubuga, F M & Jaakkola M, S. (2005), Needle stick injuries among nurses in sub-Saharan Africa. Tropical Medicine and International Health Vol 10(8), 773-781. Aug 2005.

 

1. Focus The title “Needle stick injuries among nurses in sub-Saharan Africa” makes clear the phenomenon being studied and the population under study (nurses in sub-Saharan Africa). It stated concise.

2. Background: Needle stick injuries issues are relevant to all aspects of nursing. Providers need to know how to characterize Needle stick injuries and identify influencing characteristics. The literature review is current and clearly justifies the research.

3. Terms of references: In the abstract of this study, the aim is made very clear, being to present a model of needle stick injuries and related factors, in a group nurses and midwives, and to conduct preliminary testing of that model. This is reaffirmed throughout the paper.

4. Study design: Quantitative questionnaires most appropriately using revalidated tools.

5.Tool of data collection:  A total of 526 nurses and midwives involved the direct day- to-day management of patient answered a questionnaire inquiring about occurrence of needlestick injuries and about potential predictors, including working experience, work load, working habits, training and risk behavior. A questionnaire on needle sticks injuries and piloted it among 10 nurses at Mulago hospital. Their comments were used to design the final version of the questionnaire.

6. Ethical considerations:  In this study, researchers only mentioned the study was approved by the ethical research committee of Mulago hospital and the procedures followed were in accordance with the Helsinki declaration. Signed informed consent was obtained from the participants. The issues about confidentially, privacy, and handling study data during and after study had not been addressed.

7. Sample: In this study, researchers conducted a cross-sectional study at Mulago national referral hospital in Kampala, Uganda, to access the occurrence and risk factors of needle stick injuries among nurses and midwives. The participation rate was 66%. A 57% of the participants had experienced at least one needle stick injury. Only 18% had not experienced any such injury while the rates of needle stick injuries was 4.2 per person-year. The findings could be generated to other healthcare workers such as doctor, but only nurses and midwives.

8. Data presentation: The data presented in the study showed clearly, they were presented both in table form and in text and in terms of raw number and percentage.

9. Main findings: The rate of needle stick injuries observed in this study during April and May 2004 was slightly higher than estimates in earlier African studies because this study population included only nurses and not included other healthcare workers. 57% of nurses and midwives had experienced at least one needle stick injuries. The strongest predictor was lack of training, long working hours, working habits and experience. Other important risk factors were related to long working hours, working habits (recapping needles) and experience.

10. Conclusions and recommendations: In this study, researchers suggested that training can improve needle stick injures. Other important risk factors were related to long working hours, working habits, and experience.

11. Readability: This paper was easy to read because the results were stated précised.

12. Implications for practice: Factors that may influence needle stick injuries for nurses in sub-Saharan Africa was lack of training, long working hours , working habits, and experience. By better understanding factors contributing to needle stick injuries, a more comprehensive training programme to nurses can reduce incident rate.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Paper two:

Smith D R, Mihashi M, Adachi Y, Nakashima Y & Ishitake T. (2006), Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital. Journal of Hospital Infection 64, 44-49.

 

. Focus The title “Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital” makes clear the phenomenon being studied and the population under study Them (nurses in a Japanese teaching hospital is concise.

2. Background: Needlestick and sharps injuries are major occupational hazard in the healthcare industry. Nurses are also at significant risk from occupationally acquired infection. Providers need to know preventive strategies which are based on reflection of workplace events. The literature review is current and clearly justifies the research.

3. Terms of references: It stated clear in the study. Researchers tried to investigate the epidemiology of needlestick and sharps injuries (NSI) may be influenced by a variety of psychological, cultural and workplace factors.

4. Study design:   Quantitative questionnaires most appropriately using revalidated tools.

5.Tool of data collection:  In this study, researchers used an anonymous questionnaire of needlestick injuries might by influence by a variety of psychological cultural and workplace factors. A 12 month recall period was used throughout the questionnaire. Questionnaires were distributed and collected anonymously over a one week.

6. Ethical considerations:  Ethical approval was obtained form an institutional ethics committee, and the study was conducted in accordance with ethical protocols appropriate to Japan.

7. Sample: Researchers mentioned clearly about inclusion criteria of needlestick and sharps injuries for nurses who had worked a large hospital in Southern Japan. The sample size was 1162 nurses and response rate was 74%. 46% had experienced a needlestick injury. 22% of all needlestick injuries involved device (contaminated device). Nurses younger than 25 years of age were 2.18 times more likely to have sustained a single needlestick injury.

8. Data presentation: The data presented in the study showed clearly, they were presented both in table form and in text and in terms of raw number and percentage.

9. Main findings: Opening of ampoules or vials were most commonly implication in needlestick injuries. Nurses younger than 25 years of age were 2.18 times to have a single while 2.39 times to have multiple needlestick injuries. It represents a complex and multi-faceted problem for Japanese nurses. Almost one in 20 needlestick injuries events (4.9%) were not report because ignore the importance occupation risk. Another reason included they were too busy.

10. Conclusions and recommendations: In this study, almost half the Japanese nurses had sustained NSI in the previous year. Ampoules or vials were most commonly implicated in NSI among Japanese nurses. Needle recapping was also an important cause of NSI. Nurses less than 25 years were higher of NSI. Although the relationship between perceived psychosocial factors and occupational disease is well known in Japan. However, why psychosocial factors would increase a nurse’s NSI risk is unclear. Researchers suggested that in future study, established psychosocial inventories related to NSI.

11. Readability: The paper is easy to read because the results were stated précised.

12. Implications for practice: Japanese nurses clearly incur a high risk from serum-related transfer of bloodborne pathogens at work. As opening ampoules or vials was one of most common causes, future intervention and training programmes should focus on this specific issue.

 

Paper three:

Smith D R, Smyth W, Leggat P A & Wang R S.(2006), Needlestick and sharps injuries among nurses in a tropical Australian hospital. International Journal of Nursing Practice Vol 12 (2), 71 -77.

 

1. Focus The title “Needlestick and sharps injuries among nurses in a tropical Australian hospital” makes clear the phenomenon being studied and the population under study (nurses in a tropical Australian hospital) is concise.

2. Background: Researchers pointed out needlestick and sharps injuries is a major hazard in nursing practice, most studies rely on officially reported data and non have yet been undertaken in tropical environments. This study showed needlestick injuries events represent an important workplace issue for tropical Australian nurses.

3. Terms of references: In the abstract of this study, the aim is made very clear, being to present needlestick injuries events represent an important workplace issue or tropical Australian nurses. This is reaffirmed throughout the paper.

4. Study design: Quantitative questionnaire with cross-section.

5.Tool of data collection:  In this study, researchers used a questionnaire-based method. This survey instrument also contained a detailed cover sheet outlining the purposes of the study and instructions for the return of completed. Nurses were sourced form 11 wards across three different institutes- medical, surgical and maternity/neonatal. Surveys were distributed in August 2004 and a reminder was sent to senior nursing staff after 5 days. All forms were collected from confidential return envelops over a 10 day period.

6. Ethical considerations:  In this study, researchers only mention the study was approved by the district health service and from a university ethics committee. The informed consent was implied when participants completed and returned their questionnaires.

7. Sample: In this study, researchers entire cohort of 287 nurses, form whom 220 completed questionnaires were obtained (overall response rate is 76.7%).Almost half of the respondents (44.5%) had over 15 years of experience as a nurse. The findings could be generated to the other healthcare worker, but only those work as a nurse.

8. Data presentation: The date presentation in this study showed clearly, they were presented both in table form and in text and in terms of raw number and percentage.

9. Main findings: Half of the nurses with needlestick injuries events occurred beside the patient’s bed. It showed needlestick injuries events represent an important workplace issue for tropical Australian nurse. One third (34%) occurring in the utility room. 27% of needlestick injuries were not reported because the incident was considered to be minor. 5% were not report because they were too busy.

10. Conclusions and recommendations: In this study, half of the nurses’ needlestick injuries events occurred beside the patient’s bed (50%).Almost 18% of the nurses within this study reported experiencing a NSI in the past 12 months. The comparatively lower NSI prevalence and incidence rate during this study might have occurred for a few reasons. First, all newly employed nurses were undergo a thorough orientation programme. Second, the safe use of NSI to prevent injuries. However, drawing up medication and the disposal of sharps were shown to be high-risk in this study, researcher suggested workplace education for tropical nurse should focus on these procedures.

11. Readability: This paper is easy to read because the results were stated précised.

12. Implications for practice: This incidence rate is still much lower than that reported among hospital nurses in the USA. It is because all newly employed nurses required to have an orientation programme, which includes many aspects of occupational safety and training programme on prevention of needlestick injuries.

 

 

Paper four:

Ganczak M, Milona M & Szych Z. (2006), Nurses and occupational exposures to bloodborne viruses in Poland. Infection Control and Hospital Epidemiology. Thorofare: Feb Vol 27(2), 175-181.

 

1. Focus The title “Nurses and occupational exposures to bloodborne viruses in Poland” is clear and concise.

2. Background: Researchers need to know sharps injuries result from a combination of several factors, including inadequate training of management. It is a relatively high incidence of at least half of the nurses’ sustained 1 self-reported exposure to patient blood among nurses during the past 12 months.

3. Terms of references: The abstract of this study is to record descriptions of occupational exposures to blood, determine factors predictive of exposure, and identify interventions that might reduce the frequency of exposure.

4. Study design: An analytic, cross-sectional survey Quantitative questionnaire by mail to the administrators of the hospitals taking part in the survey.

5.Tool of data collection:  In this study, researchers conducted from January to March 29, 2003 at 18 hospitals. Researchers developed 32-item questionnaire according to the guidelines. The questionnaires were sent by mail to the administrators of the hospitals taking part in the survey. None of the nurses present at the time the survey was conducted refused to participate.

6. Ethical considerations:  In this study, researchers stated that there was no requirement for ethics committee approval in Poland. However, the purpose of the study was explained to the respondents, who were assured that they would not be identified in any presentation or publications. The issues about confidentially and completed questionnaires were stored in a locked filling cabinet and had been addressed clearly.

7. Sample: In this study, researchers chose random with 18 hospitals selected form 2 urban and rural locations. A total of 601nurses form surgical wards, operating room, and emergency departments were the study population.

8. Data presentation: Researchers presented the results, most appropriately, in table form and also in text.

9. Main findings: The 601 responding nurses were aged 20-58 years. The majority of respondents(94%) were employed full-time and three-fourths respondents participated in special training on prevention of HIV/AIDS. .Almost half of respondents reported having had at least 1 puncture injury during the preceding year and more than half had worked at least once with a recent abrasion or cut on their hands. The percentage of nurses without percutaneous exposure during the preceding year was significantly higher in the group that received special HIV/AIDS training than in the group that did not. 74% of respondents were not reported to hospital’s infection control center. The most common reason for not reporting was the conviction that the source patient was not infected.

10. Conclusions and recommendations: In this study, researchers noted that a large number of occupational exposures to blood, especially those due to injuries with hollow-bore needles, nurses should adopt more adequate behavioral strategies to prevent the transmission of blood-borne pathogens. Researchers suggested routinely offer education about bloodborne pathogens to personnel. Then, the efforts to reduce the number of NSI among nurses remain crucial to creating a safe workplace environment for healthcare workers.

11. Readability: This paper is easy to read because the results were stated précised.

12. Implications for practice: Factors that may influence of occupational exposures to blood. By better understanding factors predictive of exposure, and identify intervention that might reduce the frequency of exposure. It was important to note that nurses should adopt more adequate behavioral strategies to prevent the transmission of bloodborne pathogens. Policies for providing adequate education programs tailored to encourage nurses to report all exposures are urgently required.

 

Paper five:

Tabak N, Shiaabana A M & ShaSha S. (2006). The health beliefs of hospital staff and the reporting of needlestick injury. Journal of Clinical Nursing.

 Retrieved from @2006 The Authors. Journal compilation@ 2006 Blackwell Publishing Ltd.

 

1. Focus The title “The health beliefs of hospital staff and the reporting of needlestick injury” is clear and concise.

2. Background: Needlestick injury to hospital staff is quite frequent and can result in infections and disease, but staffs frequently do not report the injury despite their awareness of the risk of bloodborne pathogen. The literature review is current and clearly justifies the research.

3. Terms of references: Needlestick injury to hospital staff is quite frequent and can result in infections and disease, but staffs frequently do not report the injury despite their awareness of the risk of bloodborne pathogen. The literature review is current and clearly justifies the research.

4. Study design:   Quantitative questionnaire

5.Tool of data collection:  In this study, researchers conducted a pretest to 20 staff that was not part of the research population. Five questionnaires were constructed based on three existing research tools and were tested for validity and reliability. 240 questionnaires were distributed to eight randomly chosen department of a single Israeli hospital. The response rate was76%.The theoretical model for the study hoping that it would enable to recognize the beliefs underlying the non-reporting of needlestick injuries among hospital staff.

6. Ethical considerations: In this study, researchers mentioned that consent to conduct the study was obtained from the hospital.

7. Sample: Researchers mentioned clearly about inclusion criteria of the connection between the health beliefs of hospital staff (doctors, nurses and auxiliary staff) and their failure to report needlestick injuries.

8. Data presentation: The date presentation in this study showed clearly, they were presented both in table form and in text and in terms of raw number and percentage.

9. Main findings: Nurses had the highest rate of needlestick injury, followed by auxiliary staff and doctors. Auxiliary staff showed the highest rate of compliance with the duty to report such injuries, while doctors showed the lowest. The perceived efficacy of reporting injuries and overall motivation to maintain health were the best predictors of reporting compliance. Non-complier emphasized the negative aspects of reporting the injuries, primarily which it took up too much time.

10. Conclusions and recommendations: In this study, researchers stated that this was the first study to use the health beliefs model as means to predict level of compliance with the duty to report needlestick injuries. This study illustrated and explained the complexity of the issue of NSI reporting by hospital personnel. It also indicated that hospital personnel lacked of compliance with the duty to report. Researchers suggested that the study was generalizability conducted and respondents’ reported intentions to comply with the duty to report in the future were verified.

11. Readability: This paper was easy to read because the results were stated précised

12. Implications for practice: Factors that may motivate the worker to report/ not report needlestick injury. This is the first study to use the health beliefs model as means to predict level of compliance with the duty to report needlestick injuries in Israel.  Finding the reasons for compliance and non-compliance with the duty to report needlestick injuries will help in designing educational programmes for hospital staff and determining a strategy for improving health behaviour.

 

 

Paper six:

Vaughn T E, McCoy K D, Beekmann S E and Woolson R F, et al. (2004). Factors promoting consistent adherence to safe needle precautions among hospital workers. Infection Control and Hospital Epidemiology. Thorofare: Vol. 25(7), 548.

 

1. Focus The title “Factors promoting consistent adherence to safe needle precautions among hospital workers” is clear and concise.

2. Background Researchers noted that the reasons why healthcare workers may continue to recap needles despite universal precautions even safer sharps devices are available, it may due to inconvenience, interference with work, and healthcare workers’ beliefs.

3. Terms of references: In the abstract of this study, the aim is made very clear, being to examine organizational factors and occupational characteristics associated with adherence to occupational safety guidelines recommending never recapping needles.

4. Study design:   A mail survey in this study.

5.Tool of data collection:  In this study, researchers mentioned that three data sources were linked for the study clearly. First, a mail survey was sent to healthcare workers to collect provider-level data. Second, a mail survey was sent to infection control professionals in all 129 hospitals in lowa to collect organization-level data. Third, data from the 1996 American Hospital Association annual guide to hospitals 47 provided additional organizational contest information.

6. Ethical considerations: The ethical consideration had not been stated in this study. The participants took part in the study only based on the self-willing without any written or verbal consent.

7. Sample: In this study, researchers stated clearly about inclusion criteria for the healthcare workers who had to work in a setting and position in which they were likely to routinely handle needles. The healthcare workers sample size was 5,362 and yielded 3,223 unable returned surveys (63% response rate). Infection control professionals at 99 hospitals returned the survey (79% response rate. The analyses were based on 1,454 healthcare workers (of 2,069) who identified one of these hospitals as their primary hospital (70% response rate) with no missing data on the variables of interest. The number of responses by hospital ranged from 1 to 145.

8. Data presentation: The date presentation in this study showed clearly, they were presented both in table form and in text and in terms of raw number and percentage.

9. Main findings: Fewer than half of the respondents consistently adhered to the no-recapping guidelines and fewer than half of the hospitals used needle less IV system and one-third used needle protection devices. Two-fifths of healthcare workers reported that their hospital still used the isolation category of blood and body fluids precautions. Healthcare workers who reported that their organizations used the isolation category of blood and body fluid precautions (i.e., who were informed about patients with known bloodborne pathogen infection) were less often consistently adherent. Then, greater levels of management support were associated with more consistent adherence, whereas increased job demands were associated with a lower likelihood of consistent adherence.      .

10. Conclusions and recommendations: In this study, researcher suggested that healthcare organization can improve staff safety by educational programs, the importance of the specific policies being promulgated and management’s general commitment to employee safety.

11. Readability: This paper was not easy to read because researchers had not explained about the organizational-level and worker-level factors influence in detail.

12. Implications for practice: Healthcare organizations can improve staff by investing wisely in educational programs regarding approaches to minimize these risks, providing protective equipment and eliminating the use of blood and body fluid precautions as an isolation policy.

 

Paper seven:

Wang H, Fennie K, HE G, Burgess J &Williams A B. (2003). A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge, behaviour and incidence of needle stick injuries among student nurses in Changsha, People’s Republic of China. Journal of Advanced Nursing 41(2). 187-194.

 

1. Focus The title “A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge, behaviour and incidence of needlestick injuries among student nurses in Changsha, People’s Republic of China” is clear

2. Background: Although the human immunodeficiency virus epidemic in China is expanding rapidly, the principles of universal precautions and occupational protection against bloodborne pathogen were mentioned only infection control manual in China, lack of training might place student nurses at risk .Researcher designed a bloodborne pathogen prevention program for student nurses to minimize the risk of occupational infection in this population. The background and justification of this paper were stated clear.

3. Terms of references: In the abstract of this study, the aim is made very clear, being to examine the impact of structured training on prevention of occupational exposure to bloodborne pathogen on knowledge, behavior, and incidence of medical sharp injuries among student nurses in Changsha, China.

4. Study design: I t was a quasi-experimental study with randomized controlled trials design.

5.Tool of data collection:  A self-administered questionnaire was used to collect demographic data. Ten questions assessed knowledge and each correct answer was worth 1 point for a total knowledge score of 10. The study was conducted for 3 months after students began practice. Students were observed individually for 30 minutes and were aware that they were being watched. 20 students in the experimental group and 18 in the control group were observed. Finally, students in both groups submitted anonymous reports of injuries with needles or medical sharps occurring during the 4-month follow-up period.

6. Ethical considerations:  In this study, researcher stated clear about the oral consent was contained from all participants and questionnaire data were collected anonymously. However, researchers did not mention about the usage of the study results to the participants

7. Sample: In this study, researchers conducted in only one university based school of nursing and the sample size was too small to show significance. This study population consisted of 106 student nurses in two classes. Two of three classes of students were randomly chosen for the study. One of the classes was randomly assigned to receive the educational intervention (n=56) and the other served as a comparison group, receiving standard education (n=50).

8. Data presentation: The date presentation in this study showed clearly, they were presented both in table form and in text and in terms of raw number and percentage.

9. Main findings: There was a significantly increase with knowledge and self-reported behavior after the training program. The group that received the bloodborne pathogens training scored significantly higher than the standard education group on both knowledge and behavior. A large percentage of students in both group washed their hands before procedures. Glove use was rarely observed in either group with a high risk of procedure. Students with training receiving standard education reported injuries. Therefore, researchers stated the main finding very clear in this study.

10. Conclusions and recommendations: In this study, researchers found that training universal precautions significantly improve healthcare workers’ knowledge, self-reported behaviour and incidences of needle stick/ sharps injury. Researchers suggested that this study did only one university involved and did not represent all student nurses in China.

11. Readability: This study was easy to read because the comparison between these two groups was explained in detail and the results were stated precisely.

12. Implications for practice: This study was worth to undertake since it provided empirical evidence to support and provision such training into curricula routinely in nursing in order to reduce the risk of occupational exposure to the serious infections agents and it was similar to local situation.

 

Paper eight:

Raghavendran S, Bagry H S, Leith S & Budd J M. (2006). Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals. Anaesthesia 61, 867-872.

 

1. Focus The title of “Needle stick injuries: a comparison of practice and attitudes in two UK District General Hospitals” is clear and concise.

2. Background: Percutaneous injury was the commonest injury reported. Providers need to assess the practice and attitudes of staff with regard to the use of universal precautions and prevention of needle stick injuries. This is reaffirmed throughout the paper.

3. Terms of references: In the abstract of this study, the aim is made very clear, being to compare attitudes and experience in the operating theatre and critical care units of two UK hospitals located in the Midlands and Merseyside. To compare responses between the various groups and the two hospital.

4. Study design: This is a survey design in this study.

5.Tool of data collection:  In this study, researchers stated clearly that the survey was conducted between April and May 2005 as anaesthetc departmental audits. Identical anonymous from s were distributed to anaesthesia and critical care physicians, nurses in the operating theatres and critical are units and operating department practitioners a t two UK hospital.

6. Ethical considerations:  In this study, researcher only mentioned the study was conducted as anaesthetic departmental audits. The issues about confidentially, privacy, handling study data and approval had not been addressed.

7. Sample: In this study, researchers chose the target population working in the critical care, anaesthetic and operating departments of Midlands and Merseyside hospital. In all, 258 doctors, nurses and operating department practitioners responded to this study. The response rate was 68% (Midlands 60% compared with Merseyside 75%).

8. Data presentation: The date presentation in this study showed clearly, they were presented both in table form and in text and in terms of raw number and percentage.

9. Main findings: The responses were higher from medical staff (90%) than from non-medical staff (61%). Needle stick injuries cause significant stress and anxiety to the affected individual and their family. Over half of these injuries involving nursing staff. About 43% of the respondents recapped needles after use. Over half of the respondents had suffered a needlestick injury sometime in their practice. Only 65% of healthcare workers reported sharps injury while over one third of all needle stick injuries were unreported. Failure to report may due to lack of time or felt it did not serve any purpose.

10. Conclusions and recommendations: In this study, researchers illustrated the presence of several deficiencies in safe needle practice that expose healthcare workers to blood-borne viruses. Strict adherence to universal precautions was fundamental and needed to be emphasized. Not only departments and trusts but also important that every healthcare workers must reflect on their individual practice and address these deficiencies.

11. Readability: The paper was easy to read and the comparison between these two hospitals was explained in detail and the results were stated precisely.

12. Implications for practice: There were significant deficiencies in several aspects of the safe practice of universal precautions. These deficiencies were similar in the two hospitals surveyed and may reflect a national trend.

 

 

Paper nine:

Kermode M, Jolley D, Langkham B, Thomas M S & Crofts N. (2005). Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. American Journal of Infection Control. Vol 33 (1), 34-41.  

 

1. Focus The title “Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings” is a clear and concise.

2. Background: High risk of exposure to bloodborne which are relevant to all aspect of healthcare workers. More than 90% of these infections are occurring in low-income countries, and most are preventable.

3. Terms of references: In the abstract of this study, the aim is to describe the extent of occupational exposure to blood and the risk of bloodborne virus infection among a group of healthcare workers in rural north India. This is reconfirmed throughout the paper.

4. Study design: A cross sectional survey. Quantitative questionnaire.

5.Tool of data collection:  In this study, researchers mentioned that a cross-sectional survey of healthcare workers was conducted in the seven rural north Indian health care setting during late 2002. The survey involved self-administration of an anonymous written questionnaire. They were distributed and collected in unmarked envelopes by one of the research (M.K.) with the support of senior hospital personnel.

6. Ethical considerations: Researchers stated clearly that ethics approval for the study was granted by the Deakin University Human Research Ethics committee, and senior personnel from the participating Indian organization were asked to review and endorse the ethics application prior to submission in Australia.

7. Sample: Researchers mentioned clearly about inclusion criteria for the health care workers who had employed by the surveyed health settings and contacted with blood, needles and sharps with the exception of first year student nurse. 307 questionnaires distributed, 266(87%) were completed. The majority of respondents was nurses.

8. Data presentation: The data presented in the study showed clearly, they were presented both in table, in test and in terms of raw number and percentage.

9. Main findings: The level of occupational exposure to blood and other body fluids among healthcare workers in rural north Indian health care settings is unacceptable high. 30% of percutaneous exposure is a very high level of exposure. The high level occupational exposure to blood found among this group if rural north India healthcare workers highlights the urgent need for interventions to enhance their occupational safety to prevent unnecessary nosocomial transmission of bloodborne virus.

10. Conclusions and recommendations: The level of occupational exposure to blood and other body fluids among healthcare workers in rural north India health care settings is high. The estimation of risk was based on this survey sample underestimates the risk for most other healthcare workers in India. Training in the practice and safety device might reduce the incidence rate of injuries.

11. Readability: This paper was easy to read because the results were stated précised.

12. Implications for practice: The survey sample was not a probability sample and therefore not representative of all healthcare workers in rural north India, so the study findings should be generalized with caution. This study highlights the urgent need for interventions to enhance the occupational safety of workers in low income country health care setting. Therefore, the promotion of Universal Precautions and the provision of safety equipment are required.

 

 

Paper ten:

Ng L N, Lim H L, Chan Y H & Bachok D B. (2002). Analysis of sharps injury occurrences at a hospital in Singapore. International Journal of Nursing Practice. Vol 8 (5), 274-281.

 

1. Focus The title of “Analysis of sharps injury occurrences at a hospital in Singapore” is clear and concise.

2. Background: Sharps injuries sustained from the greatest occupational hazard for transmitting blood-borne pathogens to healthcare workers. Researchers need to examine the epidemiology and causes of sharps injuries. The literature review is current and clearly justifies the research.

3. Terms of references: In the abstract of this study, the aim is made very clear, being to examine the epidemiology and causes of sharps injuries at a university teaching hospital. This study aimed to analyse the incidence of reported sharps injuries that occurred over the past 4-year period from 1997 to 2000 at Alexandra Hospital, Singapore.

4. Study design: The type of instruments, site of injuries and personnel involved in each sharps injury were determined retrospectively by reviewing the Incident Reports forms and Infection Control records between 1997 and 2000.

5.Tool of data collection:  In this study, researchers had extracted epidemiological information of sharps injuries from both the incident reports forms and Infection Control Unit records of the incident reports, this chart served as a tool for data collection from each Incident Report form. Data collection was conducted over 2 weeks. Two members were data collectors. Incident reports from all departments in this hospital.

6. Ethical considerations:  In this study, researchers mentioned that the ethical consideration was granted by medical ethics committees and the nursing director. Further consents were obtained from each unit supervisor before reviewing the Incident Report forms at each individual clinical setting.

7. Sample: In this study, researchers mentioned clearly about 53 medical and 303 nursing staff in Alexandra Hospital. This study analyzed the incidence of reported sharps injuries that occurred over the past 4-year period from 1997 to 2000. A total of 82 injuries were reported.

8. Data presentation: The data presented in the study showed clearly, they were presented both in table, chart and in test and in terms of raw number and percentage.

9. Main findings: From January 1997 to 2000, a total of 82 injuries were reported. Injection needles accounted the highest rates of injuries; medical staff sustained 40.2% of the injuries while nursing staff sustained 29.3% of the injuries.

10. Conclusions and recommendations: In this study, researchers stated that injection needles accounted for the highest rates of injuries. Difference in the proportions of sharps injury incidence between these health-care setting can be attributed to the type of sharps devices used and the variations in clinical practices between different health-care systems.

11. Readability: This paper was easy to read because the results were stated précised.

12. Implications for practice: Sharps injuries sustained form hollow bore instruments were associated with higher risk of transmitting blood-borne pathogens than instruments with a solid core. In recent years, the hospital studied had purchased various sharp injury devices to prevent recapping needles. Engineering controls had demonstrated considerable effectiveness in preventing sharps injuries.