Knowledge and Awareness of Needle Stick Injuries among Dental Healthcare Providers

Introduction

Needle stick injuries or accidental needle cuts are considered as one of the most common and preventable occupational hazards amongst healthcare providers. World Health Organization (WHO) defines needle stick injury as, ‘wounds caused by sharps such as hypodermic needles, blood collection needles, IV cannulas, or needles used to connect parts of the intravenous delivery system’.¹ Literature review suggests the risk of accidental needle cuts to be more during procedures such as administering local anesthesia (nerve blocks) and recapping the needle after use.² According to WHO data, worldwide, about 37.6% of Hepatitis B, 39% of Hepatitis C, and 4.4% of HIV/AIDS in healthcare workers (HCW) can be attributed to accidental needle cuts.^1,3

Various studies have reported the prevalence of accidental needle injuries among healthcare workers in hospitals. The incidence of accidental needle cuts can be significantly higher than that reported due to ignorance and lack of education regarding health hazards resulting from them. Despite published guidelines and training programs, accidental needle cut remains an ongoing health issue that urges prompt action. Hence to have a well-formulated system for the dissemination of basic knowledge concerning the prevention of accidental needle cuts, their disposal, and prophylactic measures among dental health care workers (DHCW) in all health care settings is a necessity. Thus, the current study was done to assess the knowledge and awareness of accidental needle cuts among the dental healthcare providers of our institution to obtain essential baseline data for emphasizing and implementing preventive measures for the improvement of a safe working environment.

Materials and Methods

A cross-sectional study was conducted among 160 DHCW comprising of dental faculty (DF), dental postgraduate students (DPS), dental house surgeons (DHS), and dental auxiliaries (DA) (nursing staff, supporting healthcare workers and housekeeping staff). Approval for the study was procured from the Institutional Ethical Committee of KVG Dental College & Hospital (Ref no: IECKVGDCH/SS10). The participants provided written informed consent following which the data was collected using a structured, guided interview-based questionnaire inclusive of demographic details and 17 dichotomized questions about knowledge and awareness regarding accidental needle cuts (5), disposal (6), and post-exposure prophylaxis (PEP) (6). Validation of the questionnaire was performed on a 5 point Likert scale by five experts. All the questions with a content validity ratio value of more than 0.6 were incorporated in the questionnaire. Cronbach's alpha coefficient, administered to evaluate the questionnaire's reliability yielded a good score of 0.82. Descriptive statistics were conducted with Chi-square analysis using SPSS version 21. P-value was set at < 0.05.

Results

A total of 180 questionnaires were circulated among the study population, of which 160 completed forms were received, yielding a response rate of 89%. The gender ratio of the respondents was 1:2 (33.33% males; 66.67% females).

Knowledge and awareness regarding accidental needle cuts

A statistical significance was noted among the respondent groups for most of the statements in response to knowledge and awareness regarding accidental needle cuts (Table 1). All the participants reported adequate knowledge regarding the importance of recording medical history. About 25% of dental postgraduate students and auxiliaries could not appropriately explain what could be termed as accidental needle cut. About 83% of the respondents recognized accidental needle injuries as a common occupational hazard among the dental community. Most of the participants (98.1%) were aware that the same can lead to the transmission of hazardous disease conditions like Hepatitis B, Hepatitis C, and HIV, and the parameters were noted to be statistically significant. About 28% of the respondents lacked knowledge regarding the importance of reporting exposures.

Knowledge and awareness about methods of disposal of disposable syringes and needles

Most of the participants (90.6%) agreed that needles should be recapped after use. They also agreed (85.7%) recapping using a mechanical device / one-handed technique to be a safer method. Knowledge regarding the proper disposal of sharps was high among dental faculties and auxillaries compared to the other groups as per Table 2.

Knowledge and awareness regarding the postexposure prophylaxis after accidental needle cuts

Knowledge and awareness of post exposure prophylaxis protocol were observed to be adequate. Participants demonstrated adequate knowledge regarding the immediate measures to be taken post accidental exposure. Confusion prevailed among the postgraduate students regarding the initiation of PEP (15%) (Table 3).

Overall knowledge scores revealed adequate knowledge among the respondents among which dental faculties and postgraduate students demonstrated highest knowledge scores (mean score 14.9) (Figure 1). In the category wise scoring, even though dental auxiliaries had comparatively less knowledge regarding accidental needle cuts (mean score 3.35), their knowledge regarding disposal was highest amongst the groups (mean score 5.5). Knowledge regarding PEP was high among postgraduate students (Table 4) (Figure 2).

Discussion

Accidental needle cut among healthcare workers is a recognized hazard; hence safe practice in the work area is the need of the hour. Occupational exposure through contaminated needles and sharps leading to transmission of blood borne diseases has been comprehensively reviewed and evidenced in the literature.⁴ The United States Centre for Disease Control and Prevention estimated that about 600,000–1,000,000 accidental needle cuts occur annually,⁵ of which approximately 0.2% are among dentists.⁶ This demonstrates either the frequency of such injuries among dentists is comparatively less or reporting of the same is neglected.

This survey conducted to assess the knowledge and awareness regarding accidental needle stick injuries among the study populace revealed adequate knowledge among the respondents of the study. Although overall knowledge score was not statistically significant between the groups, faculties and postgraduate students had marginally higher mean score, while dental house surgeons and auxiliaries had average overall knowledge scores (10%, 15%, respectively).

In terms of category wise scoring, the dental auxiliaries had comparatively less knowledge regarding accidental needle cuts, but were found to be more knowledgeable regarding disposal which may be attributed to skill based practice rather than a more theory-based training. Nevertheless, it is important to understand that since dental auxiliaries predominantly deal with the disposal and thereby are more prone to needle cuts, this lack of knowledge could prove detrimental. Knowledge regarding PEP was highest among postgraduate students and lowest among house surgeons.

Knowledge and awareness regarding accidental needle cuts

The importance of recording proper medical history of the patient before any surgical procedures was unanimously agreed upon by all the respondents (100%). About 14.4% of postgraduates and auxiliary staff could not explain the terminology of needle stick injury. In comparison, the percentage was found to be much lower than the study conducted by Saini et al.⁷ When asked if accidental needle cuts were considered a common occupational hazard in dentistry, 22.5% faculty, 10% house surgeons, and 35% auxillaries were unaware of the same. According to a study by Singru et al., Needle stick injuries (NSI) was the most common mode of occupational accident, exposing HCWs to blood and body fluids (92.21% of total exposures).⁸

About 98.1% of the respondents in our study were aware that accidental needle cuts could result in transmission of different blood borne pathogens to HCWs. A study conducted among undergraduate dental students reported that 72% of the participants were aware of the diseases caused by needle cuts.⁹ In another study, the awareness about the risk of HIV/AIDS from such exposures was reported to be 87.8%.¹⁰ In yet another study conducted to estimate the knowledge, attitude, and practice concerning the risk of HIV infection among dental students post accidental needle stick injury, 89% of the participants were informed of the likelihood of transmission of HIV through infected needles,³ which was much lower than that reported in the current study. According to literature, the risk of seroconversion is estimated to be less than 1% following parenteral exposure.¹¹ Though low, making HCWs aware of the probability of infection becomes essential as it was demonstrated in an earlier study that only 29% of exposed respondents reported the incident.¹²

In a study by Siddique et al., a high percentage of subjects (94%) had reported accidental needle exposures.¹³ In another study, around 40% of the HCWs reported having accidental needle cuts.⁵ Around 72.5% of the auxiliaries in our study weren’t aware of the essentiality to report accidental needle cuts. In yet another study undertaken to quantify the knowledge and practice methods of HCWs on needle stick injuries at a tertiary care center, nurses were noted to have experienced maximum needle stick exposures (76.7%) and this was linked to increased workload including night shifts.¹⁴ The Centers for Disease Control and Prevention (CDC) estimated that 53% of injuries from disposable syringes affect nurses more than any other single health professional group. Besides, it is estimated that 25% of all injuries occur downstream to the non-user (clinical team member/ support staff) of the devices.¹⁵ Underreporting in this group could be due to lack of education and negligence. This is appalling, as they are at a higher risk of exposure with immunization schedule less likely to be followed among them. Hence, reporting of sharp injuries should be considered mandatory and training with guidelines must be given at regular intervals in all health care settings.

Knowledge and awareness regarding methods of disposal of needles and syringes

With regard to methods of disposal, 90.6% of respondents agreed that needles should be recapped after use. In a study by Makade KG et al., subjects who had experienced accidental needle cuts stated that the most probability of encountering them is while drawing blood sample (29.2%), followed by handling the used uncapped needles (26.4%) and recapping the used needle (25.0%).⁴ International Safety Center Report for Needle stick and Sharp Object Injuries stated that disposal-related activities are the most common cause of such injuries.⁶ A study by Pavithran et al. evaluated that 41.8% of dental healthcare professionals were injured during recapping of the device and 5.45% during disposal.¹⁶ The risk of exposure among dental practitioners may be due to lack of necessary skills and sufficient training. This underlines the need to know the process of disposal of needles and syringes.

Almost half of the participants (49.4%) reported confusion regarding the disposal of needles and sharps. Among the groups, the auxiliaries had better knowledge. There was a statistically significant difference among groups regarding technique, methods, and measure of disposal of needles and sharps similar to the studies reported by Guruprasad et al. and Pavithran et al.^3,16

Knowledge and awareness concerning the precautions taken after accidental needle stick injury

In our study, most of the participants had adequate knowledge of the precautionary measures to be taken after accidental needle cuts. When data were collected and analyzed, it was found that 77.5% participants in the current study were aware of PEPs. About 91.9% reported that they would clean the injury site with soap and running water. 100% of the respondents recognized the importance to record the HIV/ Hepatitis B and C status of the patient. About 22.5% of respondents lacked knowledge regarding PEP, which is higher than that reported in previous studies^5,16 and lower than that reported by Singh et al. ¹⁴ PEP for HIV is shown to be 80% effective in preventing onset of infection.¹⁷ This shows that awareness regarding management of occupational exposure among dental healthcare workers needs to be raised. Hence, DHCWs should be made acquainted of the protocol to be followed on encountering accidental exposure and institutional policies pertaining to the same are to be strictly adhered to.

According to CDC, in the event of exposures with transmission risk, immediate initiation of Post-Exposure Prophylaxis (PEP) is essential. Puncture wounds and small injuries should be thoroughly cleaned with soap and water for 15 minutes. Direct pressure must be applied to lacerations for control of bleeding and prompt medical attention should be sought. In instances of blood and body fluid exposure, swift reporting and evaluative test for risk determination should be done to facilitate timely medical evaluation and counseling. Ensuring completion of incident reports, where applicable, can facilitate root cause investigations for preventing similar incidents.¹⁸

To mitigate complications in dental settings, proactive measures are crucial. Implementation of routine blood borne pathogens training programs for all healthcare providers within institutions is imperative. According to International Safety Center Exposure Prevention Information Network, sharp injuries can be abated by augmenting focus on prevention devices. Also, it must be stressed that safety mechanisms and appropriate disposal protocol are not just for the user of the device, but also those who come into contact with the device.¹⁹

Conclusion

Our findings indicate that knowledge among dental healthcare providers about the hazards associated with accidental needle cuts and the use of preventive measures were adequate. Despite standard protocols, training and preventive measures being available, proper awareness and enforcement regarding the same are lacking in dental institutions/ practitioners.

Ethical Statement

Ethical approval for the study was obtained from the Institutional Ethical Committee (ref no: IECKVGDCH/ SS10).

Conflict of Interest

The authors have no conflict of Interest to report.