The National Institute for Occupational Safety and Health (NIOSH), USA defines needle stick injuries as injuries caused by objects such as hypodermic needles, blood collection needles, intravenous (IV) stylets and needles used to connect parts of IV delivery systems [1]. Health-care workers are at increased risk of infection with blood borne pathogens because of occupational exposure to blood and other body fluids.

Most exposures among health-care workers are caused by percutaneous injuries with sharp objects contaminated with blood or body fluids. These sharps include needles, scalpels, lancets and broken glass. The pathogens most commonly transmitted to health-care workers in occupational settings are the hepatitis B and C viruses (HBV, HCV) and the human immunodeficiency virus (HIV) [2].

According to World Health Report 2002, of the 35 million health-care workers, 2 million experiences percutaneous exposure to infectious diseases each year [3].The rate of seroconversion after percutaneous exposure to HIV, HBV and HCV are 0.3 % (0.18 - 0.46 %), 18 % (6 - 30%) and 1.8 % (0.1-7%) respectively [4]. More than 90% of these infections occur in developing countries but most of these NSIs remain unreported.

It is also found that 37.6% of Hepatitis B, 39% of Hepatitis C and 4.4% of HIV/AIDS in Health-Care Workers around the world are due to needle stick injuries [3]. These blood borne infections have serious consequences, including long-term illness, disability and death [4].

Occupational percutaneous exposures to blood borne pathogens can be prevented by strategies that include: immunization against HBV; procedures to prevent percutaneous injuries; and post-exposure prophylaxis (PEP) to prevent the development of disease [2].

Nurses have the highest rate of needle stick injury among health care workers [5]. Studies conducted Worldwide [6-9] as well as in India [10-15] among healthcare workers, have shown that reporting of NSIs and acceptance of PEP measures is among them is poor.

Hence this study has been planned to assess the burden of NSIs and its associated factors along with prophylactic measures practiced among staff nurses and nursing students of this Hospital who assist

SPSS.v.25.0.

Among the 354 study subjects, majority 152(42.9%) were in the age group of 21-30 years. There were 339 (95.8%) females and 15(4.2%) males. Of the study subjects there were 218 (61.6%) staff nurses and 136 (38.4%) were nursing students.

As shown in Table.1, among the 218 staff nurses only 26 (11.9%) of them had experienced NSIs in the past three months while among the 136 nursing students, majority 79 (58.1%) had experienced NSIs and this association was found statistically significant (P = 0.001, OR = 0.098, 95 % C.I = 0.057 – 0.166). Majority of the study subjects 210 (59.3%) belonged to nuclear family.

There were 134 (37.9%) day-scholars and 220 (62.1%) hostellers. Among the 134 day scholars only 11 (8.2 %) had NSIs while among the 220 hostellers 94 (42.7 %) had NSIs and this association between residence and occurrence of NSIs was found statistically significant (P = 0.001, OR = 0.120, 95% C.I = 0.061 – 0.235).

Of the total study participants majority of them 277 (78.2%) had a total work experience of 1-10years and in the present institution most of them 189 (53.4%) had a work experience of less than one year. Among the study subjects majority 352 (99.4%) were right handed persons. Occurrence of NSIs in the past three months was reported by 105 (29.7%) among the 354 study subjects interviewed.

Of the 105 study subjects who had experienced NSIs in past the three months, majority 103 (30.4%) were females while only 2 (13.3%) were males. But this association between sex and NSI occurrence was not statistically significant (P = 0.247, OR = 0.353, 95 % CI = 0.057 – 0.166).

Table-1: Socio-demographic factors associated with Needle Stick Injuries (NSI):

site following an injury.

After the NSIs majority 78 (74.3%) had carried on their duty as usual while 6 (5.7 %) of them had cried or left their work location immediately. Of the various probable reasons cited for NSIs mostly 24 (22.9%) of them had reasoned NSIs due to lack of assistance followed by 22 (21.0%) of them to fatigue while 4 (3.8%) to problems in vision and lack of guidance in safe injection practices.

Reporting following a NSI is an important factor in analysis of the seriousness of the NSI and to decide upon the appropriate Post-exposure prophylactic measure. Of the study subjects who had NSIs majority 62 (59.0%) of them had never reported about the NSI while only 25 (23.8%) had reported regularly and 18 (17.1%) had reported occasionally.

Among those who reported NSIs (n=53) majority 27 (50.9 %) had reported immediately while 10 (18.8 %) of them had reported later than a week and only 6 (11.3 %) of them had reported within a week of occurrence of NSIs.

Of those who had reported of their NSIs (n=53) maximum 31 (58.4%) had reported it to their senior nursing staff and 17 (32 %) to their colleagues while only 5 (9.4%) of them had reported to ICTC.

Table-4: Distribution based on measures taken following a NSI:

Of those who got assessed for NSIs (n=12), only 2 (16.6 %) were prescribed PEP and had completed the course of PEP for HIV.

Table-5: Distribution based on Prophylactic measures taken for NSIs:

Among those 76 subjects who had disposed the syringe in a puncture proof container, only 12 (15.8%) of them had NSIs while 93 (33.5%) of the 278 subjects who did not dispose the needle in a puncture proof container had experienced NSIs and this association between usage of puncture proof container and prevention of NSIs was found to be statistically significant (P = 0.003, OR = 0.373, 95 % C.I = 0.192 – 0.725).

As shown in table.6, among those 31 subjects who had recapped the syringe using two hands, NSIs had occurred in 19 (61.3%) of them. There exists a statistically significant association between recapping of syringes with two hands and occurrence of NSIs (P = 0.001, OR = 4.363, 95% C.I = 2.033 – 9.364).

Of all the study subjects, majority 190 (53.7%) had reported that sufficient awareness posters on safe injection practices were available in their work place. In total, maximum 194 (54.8%) subjects had undergone dedicated training on safe injection practices of which, majority 138 (71.1%) had attended lecture on safe injection practices while only 37 (19 %) of them had ever undergone a hands-on training workshop on safe injection practices.

But the association between training on safe injection practices and occurrence of NSIs was not statistically significant. (P = 0.297, OR = 1.278, 95

Recapping of the needle is a major cause for NSIs. Especially two handed recapping has more risk over one handed recapping technique. As reported in our study where 20.0 % of the NSIs occurred during recapping of the needle, most other studies [19,20,21] in India and worldwide have reported recapping as the most common cause of NSIs.

In our study, most of the NSI (38.1%) had occurred at the In-patient wards which was in similar to the studies of Rais N et al [17] (41.6%) and Buraidah A.Q et al [22] (42.5%). In our study, majority 22.9% of the NSIs occurred due to lack of assistance, similar to 23.3 % in Laishram J et al [16] study.

In Rogers B et al [23] study, it has been shown that lack of experience in many procedures, insufficient training and fatigue leads to occupational sharp injuries. In our study 23.8% of them reported their NSI regularly while 59% did not report their NSI. Only 12 % of them reported the NSIs regularly in Mohapatra D et al [24] study whereas 80% of them reported in Beker J et al [7].

95.2% had known that the diseases were transmitted by NSI similar to Beker J et al [7] study (92.9%). In our study 90.7% knew about HIV, 56.8% knew about HBV and 34.7% knew about HCV as the diseases transmitted by NSIs this was higher when compared to Laishram J et al [16] study where only 72.1 %, 29.1 % and 19.8 % knew about HIV, HBV and HCV respectively.

In our study, of the 105 subjects who had NSIs, only 11.4 % of them had got assessed for their NSIs whereas it was 20 % of them as reported by Rajput PS et al [19] study. Our study reported that 53.3% were vaccinated with HBV vaccine as a pre-exposure prophylaxis whereas Kruger et al [8] had reported as 89.6 %. In our study 14.2 % had been vaccinated with HBV as a PEP measure while 31.4% had never been vaccinated with HBV.

In contrast, Rajput PS et al [19] study shows that 11.2 % of them had HBV vaccine as a PEP measure while only 21.2% of them had never been vaccinated for HBV. This shows the need for increase in awareness on prophylaxis for HBV among our nurses.

In our study only 20 % of them had taken all three doses of HBV vaccine as PEP whereas Kruger et al [8] have reported that 60.2 % had taken all three doses of HBV vaccine which shows the need to improve adherence to vaccination schedule among