Occupational Exposure to Needlestick and Sharp Injuries among Hospital Waste Handlers in Selected Government Health Facilities of Bhopal District

Abstract

Introduction-Percutaneous injuries, caused by needle sticks and other sharps, are also a serious concern for waste handlers in hospitals and pose a significant risk of occupational transmission of blood borne pathogens. Objectives-1.To study prevalence and responses to needle stick and sharp injuries among waste handlers in selected government hospitals.2. To assess the risk factors among waste handlers leading to needle stick and sharp injuries in the above hospitals. Materials and Methods: It was a hospital based cross sectional study of 2 months duration i.e. from July-Aug 2014. 89 waste handlers were selected through random sampling and interviewed about their knowledge regarding waste handling from the selected government primary, secondary & tertiary health care institutions in Bhopal district. Results-out of the total 71.1 % of the waste handlers had a needle stick or sharps related injuries in last 6 months. Knowledge about the universal precaution in hospital waste handlers was minimal at all the three levels of health care institutions. On asking about the responses after needle sticks and sharps related injuries 28.5 % of the Waste handler had done nothing after injury.38.7 % of the waste handler said they washed their hand with water and the other 30.8 % of the Waster handler used soap with water. Hepatitis B vaccination was absent in the waste handlers of primary health care while the status of hepatitis B vaccination was minimal in the waste handlers of secondary and tertiary health care facility. Conclusion: needle sticks and sharp related injuries often get unnoticed in the waste handlers in hospitals. Some of the waste handlers even did not report it to their superior which is a matter of apprehension and need immediate awareness among the waste handlers about needle stick injuries.

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International Journal of Health Sciences & Research (www.ijhsr.org) 37
Vol.5; Issue: 5; May 2015
International Journal of Health Sciences and Research
www.ijhsr.org ISSN: 2249-9571
Original Research Article
Occupational Exposure to Needlestick and Sharp Injuries among Hospital
Waste Handlers in Selected Government Health Facilities of Bhopal District
Aditya Thakur1, Manju Toppo2, D.K.Pal3
1P.G.Resident, 2Associate Professor, 3Professor & Head,
Department of Community Medicine, Gandhi Medical College, Bhopal.
Corresponding Author: Aditya Thakur
Received: 30/03/2015 Revised: 21/04/2015 Accepted: 22/04/2015
ABSTRACT
Introduction- Percutaneous injuries, caused by needle sticks and other sharps, are also a serious concern
for waste handlers in hospitals and pose a significant risk of occupational transmission of blood borne
pathogens.
Objectives- 1.To study prevalence and responses to needle stick and sharp injuries among waste handlers
in selected government hospitals.2. To assess the risk factors among waste handlers leading to needle
stick and sharp injuries in the above hospitals.
Materials and Methods: It was a hospital based cross sectional study of 2 months duration i.e. from
July – Aug 2014. 89 waste handlers were selected through random sampling and interviewed about their
knowledge regarding waste handling from the selected government primary, secondary & tertiary health
care institutions in Bhopal district.
Results- out of the total 71.1 % of the waste handlers had a needle stick or sharps related injuries in last 6
months. Knowledge about the universal precaution in hospital waste handlers was minimal at all the three
levels of health care institutions. On asking about the responses after needle sticks and sharps related
injuries 28.5 % of the Waste handler had done nothing after injury.38.7 % of the waste handler said they
washed their hand with water and the other 30.8 % of the Waster handler used soap with water. Hepatitis
B vaccination was absent in the waste handlers of primary health care while the status of hepatitis B
vaccination was minimal in the waste handlers of secondary and tertiary health care facility.
Conclusion: needle sticks and sharp related injuries often get unnoticed in the waste handlers in
hospitals. Some of the waste handlers even did not report it to their superior which is a matter of
apprehension and need immediate awareness among the waste handlers about needle stick injuries.
Keywords: Injuries, waste handlers, Primary health centre, Hepatitis B, Vaccination etc.
INTRODUCTION
Occupational safety and health
including the performance of safe injections
and waste management are important
concerns to protect healthcare workers,
patients, and the community. Hospital waste
handlers (HWHs) often considered as the
ancillary group or often given secondary
status in health care provision but proper
sanitation greatly improves the success of
medical intervention and plays a critical role
in prevention, especially for the sick. The

International Journal of Health Sciences & Research (www.ijhsr.org) 38
Vol.5; Issue: 5; May 2015
role of HWHs in ensuring safe environment
is irrefutable and utterly essential because
the environments for care are part of care. [1]
The collection, segregation and
disposal of injection waste entails labor
intensive operations, involving many
possibilities of direct contact with the waste
increasing the risk of infections to the
HWHs. [2,3]
Sharps or needle stick injury, a cut or
puncture wound resulting in penetration of
the skin by a hypodermic needle, surgical
blade, fragment of glass or metal or other
sharp item including rigid plastic, is the
primary hazard for those working with
healthcare wastes. Though much attention is
paid to the safety of healthcare workers and
their protection from sharps injury, the
welfare and safety of those in the waste
disposal sector has received very little
attention. []
Percutaneous injuries, caused by
needle sticks and other sharps, are a serious
concern for HWH in hospitals and pose a
significant risk of occupational transmission
of blood borne pathogens. Needle stick
injuries that occur immediately after an
injection are more likely to spread disease
caused by blood-borne pathogens, but
needle sticks from trash piles may cause
injury and infection from germs in the
environment. [5]
According to official statistics from
World Health Organization, in 2000, 5% of
the global HIV incidence was estimated to
occur because of poor waste handling and
contaminated injections (WHO, 2007). [6]
The segregation of infectious from non-
infectious waste is essential, and containers
should be used for sharps and not be
overfilled to avoid exposure to infections,
injuries, and toxic material. [7] Improper
disposal of waste, can lead to resale of
medical equipment on the black market.
Objectives
1. To study prevalence and responses to
needle stick and sharp injuries among
hospital waste handlers in selected
government hospitals.
2. To assess the risk factors among hospital
waste handlers leading to needle stick and
sharp injuries in the above hospitals.
MATERIALS AND METHODS
It was a hospital based cross
sectional study of 2 months duration i.e.
from July - Aug 2014. 11 government
health facilities were selected through
cluster sampling. HWHs those were working
in the above facilities were randomly
selected. Thus a total of 89 HWHs were
selected and interviewed about their
knowledge regarding waste handling from
the selected government primary, secondary
& tertiary health care institutions in Bhopal
district. The Data were coded and validated.
Data entry and analysis were using EPI info
(version 7) and MS Excel software.
Generation of descriptive Statistics was
done. Fisher exact probability test was used
to identify potential risk factor of needle
stick and other sharp related injuries. P value
of < 0.05 was considered statistically
significant.
The study was done according to
world Helsinki declaration and verbal
consent were obtained from the participants
before administrating questionnaire.
Anonymity of participants was maintained
by avoiding any information revealing the
identity of the participants in the
questionnaire.
RESULTS
Baseline characteristics of HWHs are
shown in table.1. The age of the HWHs
enrolled in the study ranged from 20 - 59
years with a mean age of 38.5 ± 7.85. It is
observed that majority of HWHs were aged
above 35 years followed the age group of
26-35 years. Male and female distribution in

International Journal of Health Sciences & Research (www.ijhsr.org) 39
Vol.5; Issue: 5; May 2015
the entire 3 tier of government health
facilities was almost equal. While analyzing
the experience of the waste handlers it was
observed that Majority of the HWHs had the
experience of more than 5 years in waste
handling. The work experience of the study
participants ranged between 1 and 15 years
(mean work experience of 5.67 ± 2.69
years). Majority of the HWHs in all the 3
tier of government health care facilities had
a primary education.
Table.1. Baseline Characteristics of healthcare waste handlers
When the exposure to needle stick
injuries was analyzed based on practice of
wearing gloves at the time of NSI exposure
it was noticed that only 28.5 % of the HWHs
was wearing gloves at the time of NSI while
71.5 % was not wearing gloves. However
this difference was not found statistically
significant. While on the other hand
comparing exposure to NSI and Knowledge
of universal precaution was also not found
statistically significant. When comparing the
training of injection waste handling and
Needle stick injuries in waste handlers it
was observed that 61.9 % of the waste
handlers who had NSI in past 6 month do
not had training on injection waste handling.
While 73 .1 % of the trained waste handlers
do not had any exposure of NSI in last 6
months. This difference was found to be
statistically significant (P= <0.005).
Table.2. Relationship between certain variables and needle stick injuries.
NSI
No NSI
P value *
Wearing gloves at the time of NSI
Yes
18 (28.5)
12(46.1)
NS
no
45(71.5)
14(53.9)
Knowledge of universal precautions
Yes
12 (19.1)
5 (19.2)
NS
no
51(80.9)
21(80.8)
Training of injection waste handling
Yes
24(38.1)
19(73.1)
P= 0.005*
No
39(61.9)
7(26.9)
Experience
<5
18 (28.5)
7 (26.9)
NS
≥5
45(71.5)
19(73.1)
Education
Primary
38 (60.3)
12 (46.1)
P = 0.010*
High school
7(11.1)
10(38.5)
No primary school
18(28.6)
4(15.4)
Total
63 (100)
26(100)
*Fisher exact probability test was performed.
Primary Health
care facilities (%)
Secondary Health
care facilities (%)
Tertiary Health care
facility (%) y h).
Age groups (Years)
<25
4 (23.5)
5 (12.2)
2(12.2)
26-35
5(29.5)
11(26.9)
8(26.9)
>35
8(47.0)
25(60.9)
21(60.9)
Sex
Male
9 (53)
22(53.6)
14(45.1)
Female
8(47)
19(46.4)
17(54.9)
Work experience (Years)
<5
6(35.2)
12 (29.2)
7(22.5)
≥5
11(64.8)
29(70.8)
24(77.5)
Education Status
Primary
5 ( 29.6)
26 ( 63.4)
19 (61.3)
High School
6(35.2)
8(19.5)
3(9.6)
No primary education
6(35.2)
7(17.1)
9(29.1)
Total
17(100)
41(100)
31(100)

International Journal of Health Sciences & Research (www.ijhsr.org) 40
Vol.5; Issue: 5; May 2015
Association between the years of
experience and exposure to needle stick
injuries was found to be statistically
insignificant in waste handlers. On
analyzing the education status with exposure
to needle stick injuries it was noticed that
the HWHs whose education status was of
primary school or above were less exposed
to needle stick injuries in the past 6 months.
This difference was found to be statistically
significant (P = 0.010). Relationship
between above variables with needle stick
injuries is shown in Table 2.
Fig.1. Responses of healthcare waste handlers after Needle
Stick injury.
Fig.2. Hepatitis B vaccination amongst Waste handlers in
different government health facilities.
Fig.1. shows the various responses of
HWHs after the needle stick injuries they
suffered in last 6 months. Majority of the
waste handlers 38.7 % only washed their
hands with water while 30.8 % of the
HWH’swashedwithsoapandwater.Matter
ofconcernisthe28.5%oftheHWH’swho
did nothing after the NSI. Post exposure
prophylaxis after NSI was not taken by any
of the waste handlers.
Fig.2. shows the Hepatitis B
vaccination status in the HWH’s in the all
the 3 tier of the government health facilities.
Itwasnoticed that32.1%oftheHWH’s in
the tertiary health care facility had complete
3 dose vaccination of hepatitis B while only
13.8 % of the HWH’s are completely
vaccinated against Hepatitis B in secondary
health care facilities.  No HWH’s in the
primary health care facilities was completely
vaccinated against hepatitis B which is
matter of concern.
DISCUSSION
The present study describe the
prevalence of NSI among Hospital waste
handlers of different government health
facilities involved in BMW handling but
also highlights the awareness of universal
precaution and responses at the time of
NSI’s. The prevalence of NSI’s in the
hospital waste handlers was found to be 70.7
% (N=63) in the present study.
Hospital waste handlers are consider
as ancillary group of the health care workers
which often remained obscure in many
studies done in the India about the
prevalence of NSI’s. Although sharps users
like doctors, Nurses etc are at greatest risk,
HWH and other support staff involved in
early stages of the disposal chain features as
the next most frequent group reporting
injury. [8] Whereas studies done in tertiary
health care center in south India and rural
North India among doctors, nurses and lab
technician has shown similar results to the

International Journal of Health Sciences & Research (www.ijhsr.org) 41
Vol.5; Issue: 5; May 2015
present study i.e. 71.9 % and 73%
respectively therefore not much difference
was found in the Prevalence of NSI’s. [9,10]
A study done in IRAN among Hospital
waste handlers in government hospital
shown proportion of NSI to be 31.3 %
which is very less when compared to the
present study it may be most likely due to
lack of awareness and knowledge in our
study population. [11]
In present study many hospital
facilities do not had a infection committee
while those who had, received very minimal
reporting on NSI’s and in  many hospital
waste handlers were not aware of such
committee. According to NHS policy in the
UK, it is compulsory when staff sustain a
NSI to report the incident. [12]
The education status of the most
hospital waste handlers (56.5 %) in present
study was up to primary school. A study
done in Coimbatore, India showed that most
of hospital waste handlers (61%) in their
study population had no primary education.
[13] The association between education status
and NSI’s prevalence was statistically
significant (p =<0.01) in present study.
Higher the education status lower the
prevalence in NSI’s in hospital waste
handlers. Whereas the training status of the
hospital waste handlers was 48.4 % in the
present study. A similar study done in
Nigeria showed that 65.8 % of the hospital
waste handlers received training before
commencing on the job. [14] The association
between training status and NSI’s
prevalence was statistically significant (p =
<0.005) in present study. This shows that
training and re-training of the health workers
is important and should be encouraged.
This study has demonstrated that the
inadequate reporting of NSSIs to medical
staff was a common occurrence amongst
Hospital waste handlers. As many as 28.5
% of the hospital waste handlers did nothing
after an injury, which is a similar finding to
studies carried out elsewhere. [15-17] For the
most part the common reasons for this may
be scarce knowledge and meager practices.
While none of the waste handlers
approached for PEP in the present study.
The observed high level of under-reporting
suggests that workers need education on
prevention, especially focusing on the
importance of reporting all NSSI's and the
possibilities of prophylaxis after exposure to
BBV. [18-20]
Vaccination is one of the best ways
to protect hospital waste handlers from
infection, but vaccination is only available
for HBV and tetanus. In the present study,
the number of HBV vaccinated waste
handlers in the tertiary health care center
was 32.1 % and in secondary health care
centers it was 13.8 % while none of the
waste handlers in the primary health care
centers had a complete hepatitis B
vaccination. This figure would suggest that a
greater awareness of the requirement of the
HBV vaccination is required.
CONCLUSION
Needle stick injuries have been
recognized as common occupational hazards
among health care workers. The present
studyrevealedthehigh proportion of NSI’s
among the hospital waste handlers in the
government health institutions. Despite the
proper guidelines of safe injection practices
and unambiguous legislation of waste
management by hospital administrations,
there is a need for training and retraining of
waste handlers by hospital administrations.
All the waste handlers should have pre-
employment immunization against hepatitis
B. The result of the study should be
interpreted with caution as the present study
was done only in selected government health
institutions and has not taken into account
thesitesofNSI’s and the circumstance that
ledtoNSI’s.

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Vol.5; Issue: 5; May 2015
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How to cite this article: Thakur A, Toppo M, Pal DK. Occupational exposure to needlestick and sharp
injuries among hospital waste handlers in selected government health facilities of Bhopal district. Int
J Health Sci Res. 2015; 5(5):37-43.
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