BioMed Research International
Volume 2021 (2021), Article ID 5698483, 7 pages
https://doi.org/10.1155/2021/5698483

Research Article

Investigation and Analysis of Sharp Injuries among Health Care Workers from 36 Hospitals in Shandong Province, China

Jian Sun,¹ Wen Qin,² Lei Jia,¹ Zhen Sun,¹ Hua Xu,¹ Yiyi Hui,¹ Anman Gu,¹ and Weiguang Li¹

¹Department of Infection Control, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
²Department of Infection Control, The Affiliated Hospital of Qingdao University, Qingdao 266062, China

Correspondence should be addressed to Weiguang Li; emlwg@sina.com

Received 8 May 2020; Accepted 5 June 2021; Published 12 June 2021

Academic Editor: Mihajlo Jakovljevic

Copyright © 2021 Jian Sun et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract.

Background. This study investigated and analyzed the current situation of sharp injuries among health care workers (HCWs) in China’s Shandong Province. Methods. By means of questionnaire survey, the incidence of sharp injuries among HCWs from 36 hospitals in China’s Shandong Province in October 2019 was investigated, and the results of this survey were compared with those of October 2012. Results. A total of 48165 HCWs were investigated. 549 cases of sharp injuries occurred. The incidence of sharp injuries was 1.14%, which was significantly lower than that in October 2012 (9.71%). In the occupational distribution of sharp injuries among HCWs, the proportion of nurses was 58.65%, doctors 23.32%, and interns 12.02%. Among the distribution of sharp injury departments, general wards, operating rooms, intensive care units, disinfection supply centers, and outpatient clinics were the high-incidence sites of occupational exposure among HCWs. The main instruments causing sharp injuries in HCWs were syringes, scalp steel needles, surgical suture needles, vacuum blood collection needles, and glass slides. Drug administration, double-handed loop needle cap, blood extraction, surgical suture needle, and arteriovenous needle extraction were high-risk operations causing sharp instrument injuries in HCWs. Conclusion. The incidence of sharp injuries among HCWs from 36 hospitals in Shandong Province in October 2019 was significantly lower than that in October 2012. Sharp injuries were a common type of occupational exposure for HCWs. The occurrence of sharp injuries should be effectively reduced by changing wrong habitual behavior and implementing standard protective measures.

1. Introduction

Professional exposure to sharp injuries among HCWs refers to the occupational injuries caused by various sharp instruments such as needles, knives, and glass fragments piercing the skin during the process of medical treatment [1].

About 3.35 million HCWs suffer from sharp injuries every year around the world [2]. It has been estimated that a HCW may suffer from sharp injuries 4 times every year in Africa, the Eastern Mediterranean, and Asia [3]. The Centers for Disease Control and Prevention estimate that 385,000 sharp injuries occur among HCWs in U.S. hospitals per year [4]. The World Health Organization (WHO) estimates suggest that 1 in 10 HCWs worldwide sustains a sharp injury each year [5]. In Egypt, a study conducted in Gharbiya Governorate showed that 66.2% of HCWs reported that they experienced at least one sharp injury in their working life [6]. Another study which was conducted at the 3 teaching hospitals of Alexandria University reported that 67.9% of HCWs had at least 1 sharp injury in the previous 12 months [7].

The report of sharp injury is the main way for the competent department to find sharp injury events. The probability of corresponding infection is small after being stabbed by a contaminated sharp instrument [2]. Once infection occurs, the consequences are serious. Timely reporting and corresponding interventions can effectively reduce the risk of infection after exposure.

Although sharp injuries are one of the most common types of injury reported by HCWs, it is believed that they are vastly underreported [8]. Various studies indicate that underreporting of sharp injuries is prevalent in health care facilities worldwide, with rates of underreporting ranging from 19% to 86% [9, 10]. Prompt reporting of needlestick injuries is important, not only for the management of the exposure (the efficacy of PEP regimens is approximately 81% for HIV8 and 85%-95% for HBV 9) but also for identification of workplace hazards and evaluation of prevention measures [2].

Only a few studies have been published on sharp injuries in developing countries [11–13]. In China, HCWs are facing a high risk of sharp injuries, and the situation is grim. Although HCWs’ understanding of occupational exposure has changed greatly after SARS and hospitals have also used various forms of occupational protection training and formulated corresponding systems and protective measures, still, it is difficult to resist the harm of occupational exposure to HCWs. The objectives of this study were to determine the incidence of occupational exposure and protection against sharp injuries among HCWs in Shandong Province during October 2019 and also to compare the current data with the October 2012 data.

2. Material and Methods

2.1. Investigation Design

An investigation about the occurrence of sharp injuries among HCWs was conducted in 36 public hospitals in China’s Shandong Province in October 2019. Prior to this, the same investigation was carried out in these hospitals in October 2012.

2.2. Investigation Methods

By means of questionnaire survey, the occurrence of sharp injuries among HCWs in 36 hospitals in Shandong Province in October 2019 was investigated. The questionnaire was a slightly modified form based on the “2010 Needlestick and Sharp Object Injury Report Form” of EPINet®, which consisted of 20 variables grouped in blocks (general and individual information, the source of exposure, occurrence time, occurrence place, involved operation, occurrence department, and whether to report or not). The results of this survey were compared with those of October 2012. The two surveys were conducted in the same 36 hospitals, and all HCWs in each hospital participated in the survey. Due to the reasons of new entry, retirement, and resignation, the HCWs of each hospital changed, but the change rate was less than 3%. And the scale of each hospital did not change significantly.

2.3. Sampling Method and Study Population

A clustered random sampling method was conducted to perform the questionnaire among HCWs from 36 hospitals in Shandong Province. The sample size was determined from a prevalence estimate of 10% and a population of 370,000 to give a confidence level of 0.95 and precision of 2.5 to be 554 (Epitools epidemiological calculators, Ausvet Pty Ltd., available at https://epitools.ausvet.com.au). In order to reduce the sampling error and increase the accuracy of the survey and the representativeness of the sample, we increased the sample size. 50618 questionnaires were sent out, and 48165 valid questionnaires were collected.

2.4. Informed Consent and Ethical Review

The survey was officially approved by the participating hospitals, and an agreement was signed with each hospital. The participating hospitals informed the investigated HCWs of the objectives, contents, and procedures of the survey and obtained the HCWs’ consent. The survey was anonymous and did not involve the identity information of participants. This study was designed as a retrospective study, and collected data were confidentially kept. Therefore, it was exempt from ethical review.

2.5. Data Quality Control

These two investigations were both carried out with the same survey method in China’s Shandong Province. Uncertain or incomplete data was eliminated to ensure the accuracy and integrity of data. The incidence of sharp injuries in this study refers to the proportion of people who suffered from sharp injuries in the last month (October 2019 or October 2012).

2.6. Statistical Analysis

Data analyses were made using SPSS Statistics V20.0. The survey results were input into SPSS 20.0 software, and the Pearson test was used to analyze the relevant data. The test level was set as .

3. Results

3.1. Incidence of Sharp Injuries

A total of 48165 HCWs were surveyed. 549 cases of sharp injuries occurred. The incidence of sharp injuries was 1.14%, which was significantly lower than that in 2012 (9.71%). The specific data is shown in Table 1.

Table 1: The incidence of sharp injuries among HCWs in Shandong Province.

Survey time
Survey number
Number of sharp injuries
Incidencea (%)

October 2019
48165
549
1.14
<0.05

October 2012
46600
4526
9.71

aIncidence of sharp injuries refers to the proportion of people who suffered from sharp injuries in the last month (October 2019 or October 2012). : statistically significant.

3.2. Profession Distribution of Sharp Injuries

Nurses (322 cases, 58.65%) were the major components of sharp injuries, followed by doctors (128 cases, 23.32%) and interns (66 cases, 12.02%). Incidences of sharp injuries in various occupations are shown in Table 2.

Table 2: Incidences of sharp injuries in various occupations in Shandong Province in October 2012 and October 2019.

Profession
Survey number
Number of sharp injuries
Incidence (%)

October 2019
October 2012
October 2019
October 2012
October 2019
October 2012

Nurse
21953
21825
322
2918
1.47
13.37
<0.05

Doctor
18420
13746
128
916
0.69
6.66
<0.05

Intern
2320
4048
66
496
2.84
12.25
<0.05

Technician
2043
1993
17
58
0.83
2.91
<0.05

Cleaning staff
2578
2917
12
98
0.47
3.36
<0.05

Other
851
2071
4
40
0.47
1.93
<0.05

Total
48165
46600
549
4526
1.14
9.71
<0.05

: statistically significant.

3.3. Locations of Sharp Injury Events

Professional exposure to sharp injuries may occur in all kinds of hospital environments. This survey found that general wards, operating rooms, intensive care units, disinfection supply centers, and outpatient clinics were the top five locations in which HCWs were exposed to sharp injuries. The specific data is shown in Table 3.

Table 3: Locations of sharp injuries among HCWs in Shandong Province in October 2019.

Department
Number of sharp injuries
Proportion (%)

October 2019
October 2012
October 2019
October 2012

General wards
245
2242
44.63
49.54
<0.05

Operating rooms
98
855
17.85
18.89
>0.05

ICUa
37
236
6.74
5.21
>0.05

CSSDb
26
80
4.74
1.77
<0.05

Outpatient dept
23
116
4.19
2.56
<0.05

Emergency dept
21
121
3.83
2.67
>0.05

Blood-drawing dept
15
31
2.73
0.68
<0.05

Medical waste repository
14
43
2.55
0.95
<0.05

Rehydration room
10
101
1.82
2.23
>0.05

Clinical laboratory
5
41
0.91
0.91
>0.05

PIVASc
4
38
0.73
0.84
>0.05

Dental dept
4
146
0.73
3.23
<0.05

Hemodialysis room
3
13
0.55
0.29
>0.05

Ophthalmology dept
3
34
0.55
0.75
>0.05

Other
41
429
7.47
9.48
>0.05

Total
549
4526
100.00
100.00

aICU: intensive care units; bCSSD: central sterile supply department; cPIVAS: pharmacy intravenous admixture service. : statistically significant.

3.4. Tools That Caused Injuries

In the survey, we found that the top five tools causing sharp injuries were syringes, scalp steel needles, surgical suture needles, vacuum blood collection needles, and glass slides, as shown in Table 4.

Table 4: Tools that caused sharp injuries among HCWs in Shandong Province in October 2019.

Tool
Number of sharp injuries
Proportion (%)

October 2019
October 2012
October 2019
October 2012

Syringes
199
1578
36.25
34.87
>0.05

Scalp steel needles
110
1049
20.04
23.18
>0.05

Surgical suture needles
68
403
12.39
8.90
<0.05

Blood collection needles
26
90
4.74
1.99
<0.05

Glass slides
20
55
3.64
1.22
<0.05

Vein detained needle
17
141
3.10
3.12
>0.05

Scalpel
13
176
2.37
3.89
>0.05

Sectioning knife
6
44
1.09
0.97
<0.05

Scissors
5
40
0.91
0.88
>0.05

Puncture needle
3
23
0.55
0.51
>0.05

Other
82
927
14.94
20.49
<0.05

Total
549
4526
100.00
100.00

: statistically significant.

3.5. Operations That Caused Sharp Injuries

In the survey, it was found that the top five operations causing sharp injuries were recapping injector needle with two hands, drug administration, drawing blood, surgical suture, and withdrawing needles, as shown in Table 5.

Table 5: Operations that caused sharp injuries among HCWs in Shandong Province in October 2019.

Operation
Number of sharp injuries
Proportion (%)

October 2019
October 2012
October 2019
October 2012

Recapping injector needle with two hands
90
467
16.39
10.32
<0.05

Drug administration
82
508
14.94
11.22
<0.05

Drawing blood
51
173
9.29
3.82
<0.05

Surgical suture
49
397
8.93
8.77
>0.05

Withdrawing needles
36
371
6.56
8.20
>0.05

Tidying up surgical instruments
35
155
6.38
3.42
<0.05

Putting needles into the sharp box
29
317
5.28
7.00
>0.05

Preparation for infusion
27
278
4.92
6.14
>0.05

Intravenous injection
25
229
4.55
5.06
>0.05

Handling trash
24
346
4.37
7.64
<0.05

Needle or instrument delivery
19
113
3.46
2.50
>0.05

Contusion during rescue
14
124
2.55
2.74
>0.05

Intramuscular injection
13
113
2.37
2.50
>0.05

Draw arterial blood
9
72
1.64
1.59
>0.05

Surgical knife cuts
6
122
1.09
2.70
<0.05

Other
40
741
7.29
16.37
<0.05

Total
549
4526
100.00
100.00

P <0.05: statistically significant.

3.6. Report of Sharp Injuries

In the survey, the highest report rate of sharp injuries was technicians 64.71%, followed by doctors 38.28%, nurses 34.16%, and interns 31.82%. The overall report rate of sharp injuries among HCWs was 35.34% in Shandong Province in October 2019, which was significantly higher than that in 2012 (15.75%). The specific data is shown in Table 6.

Table 6: Report rates of sharp injuries among HCWs in Shandong Province in October 2019 and October 2012.

Profession
Sharp injuries
Reported number
Report rate (%)

October 2019
October 2012
October 2019
October 2012
October 2019
October 2012

Technician
17
58
11
12
64.71
20.69
<0.05

Doctor
128
916
49
152
38.28
16.59
<0.05

Nurse
322
2918
110
430
34.16
14.73
<0.05

Intern
66
496
21
88
31.82
17.76
<0.05

Other
5
40
1
9
20.00
22.50
>0.05

Cleaning staff
11
98
2
22
18.18
22.45
>0.05

Total
549
4526
194
713
35.34
15.75
<0.05

: statistically significant.

4. Discussion

The results of this survey showed that the incidence of sharp injuries among HCWs in Shandong Province was 1.14% in October 2019, which was basically consistent with the reports in other regions of China [14–16], lower than those in other countries [17–21]. On the one hand, government and medical institutions provided a lot of educational activities in recent years, the awareness of occupational exposure and protection among HCWs has increased significantly, and the protective equipment has been improved, so the incidence of sharp injuries has decreased; on the other hand, the HCWs involved in the survey failed to report or conceal sharp injury events for various reasons, which also led to a low incidence.

The incidence of sharp injuries in this survey was significantly lower than that in 2012, and incidences of sharp injuries in various occupations in October 2019 were also significantly lower than those in 2012. The survey results sufficiently demonstrated that the current situation of occupational exposure and protection of HCWs in Shandong Province had gradually improved.

Occupational exposure of HCWs may occur in any environment of the hospital. This current study found that general ward, operating room, and ICU were the top three departments of occupational exposure of HCWs, which was consistent with the reports in other regions of China [14, 15]. The operations prone to sharp injuries were mainly recapping injector needle with two hands, drug administration, and drawing blood, which was consistent with the reports in China [22]. Tools that caused sharp injuries among HCWs were mainly syringes, scalp steel needles, and surgical suture needles, which were basically consistent with the relevant reports at home and abroad [16, 17, 22].

However, there are still some problems in occupational exposure and protection of HCWs in Shandong Province. Firstly, the use rate of safety devices is low. Since the first safety devices came out in 1988, many studies have proved that safety devices can reduce sharp injuries of HCWs [23–26]. Although there are many types of occupational exposure among HCWs, sharp injuries are the most common and harmful [27]. A survey from China Hospital Association shows that although safety devices had been gradually promoted and used throughout the country in recent years, only 52.53% of hospitals were trying to use safety devices, and the utilization rate of safety devices is still low [22].

Secondly, the behaviors of HCWs were not standardized. Relevant studies showed that most nurses exposed to sharp injuries did not follow the relevant regulations and suggestions to prevent needlestick injuries during operation, and the incidence of sharp injuries was higher while disposing sharp instruments [28]. Gershon et al. showed that the incidence of sharp injuries was related to recapping injector needle [29]. In this survey, it was also found that recapping injector needle was a high-risk operation for sharp injuries, which was consistent with the above reports.

Thirdly, the report rate of sharp injuries is low. After occupational exposure occurs, the exposed person should report immediately and get further emergency treatment. Hospitals should establish appropriate emergency response mechanisms so that exposures can be timely reported and treated and receive regular monitoring and follow-up [30, 31]. In Salelkar et al.’s report, the report rate of sharp injuries was 32% [32], in Khader et al.’s report 22.9% [33], and in this survey 35.34%, which is basically the same as the above reports. The most common reason for failing to report is the lack of awareness among HCWs [22].

In the case of sharp instrument injury contaminated by blood-borne pathogens, the corresponding infection rate is estimated to be as follows: hepatitis B 3–10%; hepatitis C 0.8–3%; and HIV 0.3% [34]. Hospitals should establish corresponding emergency response mechanisms so that exposures can be reported and dealt with in a timely manner. In view of the risk of postsharp injury infection, medical and health institutions should assess the risk of infection based on the available information, including the results of examinations of the source patients and types and duration of occupational exposure; assess and determine the level of exposure and the level of infectious pathogenicity of the source of exposure; and determine whether to use preventive drugs and what preventive measures to take. The case should have been followed up. In view of the psychological barriers of HCWs after sharp injuries [35], we should also pay attention to the changes of psychological status of HCWs and provide timely psychological support and intervention to ensure the physical and mental health of HCWs.

5. Conclusion and Limitations

There were some limitations to this study. First, it relied on the respondents’ questionnaire data, which were subject to subjective consciousness and recall bias. This could have resulted in an underestimation of actual incidence of sharp injuries. In addition, the incidence of sharp injuries could vary among hospitals due to the difference in safety measures, reporting systems, and facility appliances. Due to the limitation of the survey content, it was difficult to compare and analyze the differences among these hospitals.

The incidence of sharp injuries among HCWs from 36 hospitals in Shandong Province in October 2019 was significantly lower than that in October 2012. Sharp injuries were a common type of occupational exposure for HCWs. The occurrence of sharp injuries should be effectively reduced by changing wrong habitual behavior and implementing standard protective measures.

Data Availability

The data used to support the findings of this study are included within the article.

Conflicts of Interest

The authors declare that they have no conflicts of interest regarding the publication of this paper.

Acknowledgments

This work was supported by the Nosocomial Infection Control Center of Shandong Provincial. The authors thank the participants of the 36 surveyed hospitals for their agreement to take part in the study and their contribution to the survey data collection.

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