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Prevalence of Sharp Injuries and Associated Factors among Healthcare Workers

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INDIAN JOURNAL OF SCIENCE AND TECHNOLOGY

RESEARCH ARTICLE

Prevalence of Sharp Injuries and

Associated Factors among Healthcare
Workers in North Gondar (Debark),
West Gondar (Metema), and South
OPEN ACCESS
Received: 04-08-2022
Gondar (Addis Zemen) Primary
Accepted: 12-09-2022 Hospitals, Northwest Ethiopia
Published: 15-10-2022

Abebaw Alemayehu1 , Zewdu Baye2 ∗ , Meera Indracanti3 ∗

1 Lecturer, Department of Surgical Nursing, School of Nursing, College of Medicine and
Citation: Alemayehu A, Baye Z, Health Sciences, University of Gondar, PB No. 196, Gondar, Ethiopia
Indracanti M (2022) Prevalence of 2 Assistant Professor, Department of Comprehensive Nursing, School of Nursing, College of
Sharp Injuries and Associated Medicine and Health Sciences, University of Gondar, PB No. 196, Gondar, Ethiopia
Factors among Healthcare Workers 3 Professor, Department of Medical Biotechnology, School of Allied Health Sciences, Malla
in North Gondar (Debark), West Reddy University, Hyderabad, 500100, Telangana, India
Gondar (Metema), and South
Gondar (Addis Zemen) Primary
Hospitals, Northwest Ethiopia.
Indian Journal of Science and Abstract
Technology 15(39): 1987-1996. https
://doi.org/10.17485/IJST/v15i39.1615 Objectives: Occupation-related sharp injuries are a global problem; the death
∗ toll is around 2 million and is rising in low-income nations like Ethiopia. No
Corresponding authors.
information has been reported on sharp injuries in North and South Gondar
drmeera@mallareddyuniversity.ac.in
primary hospitals and present study aims to determine the prevalence of
tezerabaye21@gmail.com sharp injuries among healthcare workers. Methods: A institutional cross-
Funding: None sectional study conducted and 351 were randomly chosen. A self-administered
Competing Interests: None questionnaire was used to collect data and analyzed with SPSS ver23. Bivariate
Copyright: © 2022 Alemayehu et al.
analysis and Multiple logistic regression were used to understand confounding
This is an open access article factors. Findings: The prevalence of sharp injuries among Healthcare workers
distributed under the terms of the (HCWs) lifetime and preceding 12 months were 131 (37.3%) and 86 (24.5%),
Creative Commons Attribution
License, which permits unrestricted
respectively, of which 76 (58%) and 47 (54.65%) were reported by females. The
use, distribution, and reproduction chance of recurrent incidence of sharp injuries was more in operation theatre
in any medium, provided the (37.5%). The primary source of injury was syringe needles 52 (42.5%). HCWs >10
original author and source are
credited. years of work experience are more likely to experience sharp injuries compared
to those less experience (<5 years) [AOR: 0.40, 95% CI: (0.21, 0.79)]. Never
Published By Indian Society for
Education and Environment (iSee) had any training on sharp injuries were more likely to report a sharp injury
compared to those reported training [AOR: 0.55, 95% CI: (0.3, 1.024)]. Worked
ISSN
Print: 0974-6846 more than 48 hours/week reported more likely sustained sharp injuries [AOR:
Electronic: 0974-5645 0.95, 95% CI: (0.93, 0.98)]. HCWs dissatisfied with their work environment
reported sharp injuries more than satisfied ones [AOR = 0.34, 95% CI: (0.2,
0.6)]. Similarly, having low [AOR: 0.26, 95% CI: (0.13, 0.56)] and moderate risk
perception [AOR: 0.36, 95% CI: (0.19, 0.67)] significantly raised the odds of
sharp injuries occurrence compared to a high-risk perception for sharp injuries.
Novelty/conclusion: Present study showcases the moderate risk perception,

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2022;15(39):1987–1996

work hours more than 48 h/week were the key factors identified, along with job
dissatisfaction, lack of training and avoiding recapping may reduce the injury
burden.

Keywords: Amhara; Ethiopia; Hospital; Nurse; Occupational injury 1

1 Introduction
Sharp injuries are accidental skin punctures or lacerations caused by a needle or other
sharp instrument in a healthcare setting (1) . Sharps include hypodermic needles, blood
collection needles, intravenous (IV) cannulas or needles, scalpels, razor blades, lancets,
retractors, scissors, pins, clamps, cutters, staplers, and glass objects (2) . Healthcare
workers (HCW) are likely to be exposed to contracting life-threatening blood-borne
infections at work (3) . Globally, 86 % of occupationally related infections are attributed
to needlestick injuries, and the disease burden caused by percutaneous sharps injuries
is approximately 3 million infections annually (4) .
Sharps injuries place healthcare workers at risk for contracting hepatitis B virus
(HBV), hepatitis C virus (HCV), and HIV. About forty % of all cases of HBV, forty
% of all cases of HCV, and four and a half % of all cases of HIV/AIDS among HCWs
are due to sharp injuries, and the consequences of these effects include absenteeism and
inadequate healthcare service delivery (2) .
In a meta-analysis, it was found that education to raise health workers’ awareness,
training them on universal safety precautions, safe injection practices, and sharp
waste disposal, and provision of engineered safety devices reduced such incidents by
62%. (1) . According to the WHO, each healthcare worker experiences an average of four
needlestick injuries annually. in Africa, the Western Mediterranean, and Asia (5) , and
healthcare workers (HCWs) in Africa experience an average of two to four needlestick
injuries annually (2) .
The developing world, particularly sub-Saharan Africa, has the highest prevalence of
HIV-infected patients, and more than ninety percent of occupational exposure occurs in
these nations (2) . In sub-Saharan Africa, workload, and inadequate personal protective
equipment (PPE) result in multiple injuries per healthcare worker per year. According
to one study, the prevalence of NSSIs among healthcare workers in sub-Saharan Africa
was 29.5% (6) .
Needlestick incidents are linked to a variety of occupational factors, including heavy
workload, working in surgical or intensive care units, insufficient work experience,
and youth. Despite the existence of data on the prevalence of NSSIs and associated
factors among HCWs in many larger urban health facilities in Ethiopia (7) , these study
results are not comparable due to differences in healthcare delivery, HCW occupations,
injection methods, blood collection, and needle disposal, and the practice of recapping
needles (6) . Therefore, needlesticks and sharp injuries pose a significant risk for the
transmission of occupational bloodborne pathogens to all healthcare workers (2,4) .
A limited reports on sharp injuries from the study region, mostly confined to
referral and urban settings, Northeast Ethiopia 60.2%, (8) Western Ethiopia 33.7%, (9) ,
Dessie 34.5%, (10) , Gambela 32.2%, (11) and Addis Ababa 36.2%, (2) . No study has been
conducted in South and North Gondar Zone primary hospitals in Ethiopia. The present
study aimed to assess the current prevalence and risk factors for sharp injuries among
HCWs in North, West, and South Gondar district hospitals in Ethiopia.

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2 Methodology
2.1 Study design
An Institutional based cross-sectional study evaluated the prevalence and associated factors of sharp injuries among HCWs in
North, West, and South Gondar primary hospitals.

2.2 Study area and period

The study was conducted from March to April 2018 in three primary hospitals in North Gondar (Debark), West Gondar
(Metema), and South Gondar (Addis Zemen). They are located 100, 160, and 150km far from Gondar town, respectively.
According to the Ethiopian census report (2007), the above three hospitals have a total population of 1,90,845, including 98,242
men, and 92,603 are women 368 HCWs existing (12) . Each primary hospital was serving a population of about 250,000 coming
from different geographical locations surrounding it.

2.3 Source and Study population

All HCWs worked in primary hospitals, and HCWs working in North, West, and South Gondar primary hospitals were included
in the study.

2.4 Inclusion and exclusion criteria

2.4.1 Inclusion criteria
All HCWs engaged in the direct day-to-day care of patients and those who directly contacted sharp injuries in the selected
primary hospitals were included in the study.

2.4.2 Exclusion criteria

Those HCWs who were not present during the study period on maternity, annual, or sick leave were excluded from the study.

2.5 Sample size determination

The sample size was ascertained using the formula for a single population proportion and considering that the prevalence of
sharp injuries was 31% based on studies conducted in Gondar town (13) , 95% level of confidence, and 5% margin of error.
Therefore, the sample size was determined as follows:
n = (Zα /2)2 P (1- P) n = (1.96)2 0.31(1-0.31) = 329
d2 (0.05)2
By adding 10% non-response rates, the final sample size was 362.

2.6 Sampling and Data collection procedure

The study participants were chosen using a simple random sampling technique.
Data was collected using a semi-structured and pretested questionnaire. Data collectors (Facilitators) employed a self-
administered questionnaire to the selected HCWs and collected the data.

2.7 Data quality assurance

The questionnaire was initially written in English and translated to Amharic and back to English to keep the questions’
consistent. The questionnaire was pretested to identify potential problem areas, unanticipated interpretations, and cultural
objections to any questions in 18 respondents having similar characteristics with the study subjects in the Dabat health
center. Based on the pretest outcome, the questionnaire was contextually adjusted and administered to the whole sample of
HCWs. Data consistency was ensured by training data collectors and supervisors and pretesting the questionnaire. Two days of
training proved to data collectors and supervisors by the Principal Investigator, made countercheck of the filled questionnaire,
constant supervision, and reviewed the completed questionnaires daily to ensure the collected information’s completeness and
consistency.

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2.8 Study variables

2.8.1 Dependent variable: Sharp injuries
2.8.2 Independent variables:
• Socio-demographic variables: Age, sex, job category, level of education, monthly salary, work experience.
• Behavioral factors: Recapping of needles, risk perception, awareness of diseases transmitted by sharp injuries, job
satisfaction, reporting pattern of sharp injuries, and use of personal protective equipment (PPE).
• Work environment: OHS training, length of working hours per week, the existence of safety guidelines, shift work,
availability of sharps containers (safety boxes), and working department.

2.9 Data processing and analysis

Data were entered using Epi Info version 3.5.3 and then exported to SPSS version 23 for further analysis. Descriptive statistics
were done for variables in the study using statistical parameters: percentages, means, and standard deviations. Bivariate analysis
was used initially to check which variables were associated with the dependent variable and then entered into multiple logistic
regressions for the possible effect of confounders. Finally, the variables with significant association were identified based on
odds ratio 95%CI (p≤0.05).

2.10 Ethical considerations

The present study got ethical clearance (DSN/577/13; dated: 15/06/2011 EC) from the Ethical Review Board, School of Nursing,
the University of Gondar. Written informed consent was acquired from each study participant of the district hospitals. The
purpose of the study was addressed to each respondent. At the end of data collection, the data collectors were brief about
preventing sharp injuries to each study participant. All methods were carried out in accordance with relevant guidelines and
regulations.

3 Results and Discussion

3.1 Socio-demographic characteristics of HCWs
Out of 362 HCWs, 351 participated in the study, resulting in a response rate of 96%. Of the total participants, 184 (52.4%)
were males. The study participants’ ages range from 18 to 55 years, with a mean age of 30.36 ± 7.71 SD years and the mean
employment of the study participants was 1 to 32 years (mean 6.81±7.57 SD) (Table 1). Most of the study participants’ religion
was Orthodox Christianity (73.5), nurses by profession (47.3%).

Table 1. Socio-demographic characteristics of HCWs in primary hospitals, Northwest Ethiopia, 2018 (n=351)
Variables N %
Male 184 52.4
Sex
Female 167 47.6
18–29 213 60.7
Age group 30–39 80 22.8
>40 58 16.5
Primary school 44 12.2
Secondary school 38 10.2
Educational level Technical and vocational school 7 1.5
College diploma 121 35.1
First degree and above 141 41
Married 140 39.9
Single 179 51.0
Marital status Divorced 19 5.4
Widowed 6 1.7
Separated 7 2.0
Housekeepers 75 21.4
Nurse 166 47.3
Midwifery 38 10.8
Job category Health officer 22 6.3
Continued on next page

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Table 1 continued
Laboratory technologist 31 8.8
Anesthetist 3 0.9
Physician 16 4.6
<5 202 57.5
Work experience (years) 5–10 80 22.8
>10 69 19.7
The mean age of the study respondents is 30.36 years (SDV. 7.71)

3.2 Working environment characteristics among HCWs

The absence of safety instructions and work guidelines was reported by 67.5% and 36.5% of the HCWs. Only 27.1% of the
respondents had ever received any training on OHS, and 42.7% on sharp injuries. The majority (92.1%) reported that they had
never been provided with written protocols for reporting sharp injuries in their organization. High levels of awareness (95.7%)
regarding disease transmission through sharp injuries were noted. 42.8% of the HCWs who sustained sharp injuries in the
previous 12 months had officially reported their injury to their respective managements. Recapping was common; only 33%
of the respondents reported never recapped needles after use. Most of the respondents (91.7%) used at least one type of PPE,
generally disposable gloves (Table 2).

Table 2. Work Environment Factors Affecting sharp injuries Among HCPs in primary hospitals, Northwest Ethiopia, 2018 (n=351)
Question n Percent (%)
Are there safety instructions at No Yes 237 114 67.5 32.5
your workplace?
Are there work guidelines at No Yes 128 223 36.5 63.5
your workplace?
Have you ever had training on No Yes 256 95 72.9 27.1
Occupational Health Safety?
Have you ever had training on No Yes 201 150 57.3 42.7
sharp injuries?
Is there a written protocol to No Yes 320 31 91.2 8.8
report sharp injuries in your
organization?
What shift had you most often Morning Evening Night 302 24 25 86.0 6.8 7.1
been assigned in the last 12
months?
Is the availability of safety boxes No Yes 15 336 4.3 95.7
in your working room?
How often you recap the nee- Never Sometimes Most of the time All the time 116 72 85 78 33.0 20.5 24.3 22.2
dles after use?
How do you recap the needles Using single hand Using two hands 143 92 60.1 39.9
after use?
Do you use any personal protec- No Yes 29 322 8.3 91.7
tive equipment?
If not, what are the reasons for Lack of PE. Not comfortable to use Lack of safety 18 6 3 1 1 62.0 20.7 10.3 3.5 3.5
not using PPE? and HE Decrease work performance Create safety
and health hazards

3.3 Sharp injuries characteristics among HCWs

Near to half of the respondents exposed by syringe needles (45.2%), followed by intravenous cannula (catheter) (12.2%), were the
most common pieces of equipment involved in sharp injuries (Table 3). A majority of the injuries occurred when they performed
injection (22%), followed by assembling sharps after use and operation theatre (17.4%) and recapping of used needles (9.8%).
The highest percentage of sharp injuries occurred on Monday (31.3%), followed by Friday (19.6%). Among 351 HCWs, 86
(24.5%) reported sharp injuries in the preceding 12 months, 54.6% were females, and 32.6% reported sharp injuries experienced

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more than one such injury. Of 131 (37.3%) sharp injuries reported in the entire work experience, the highest percentage (47.3%)
was reported by nurses, followed by 22.9% housekeepers. The most common reasons for non-reporting were lack of awareness
about reporting procedures (35%) and awareness of the need for such reporting (22.3%).

Table 3. Frequency of sharp injuries associated factors among the HCWs in primary hospitals, Northwest Ethiopia, 2018 (N= 351)
n Percentage (%)
Experience of sharp injuries in the total of work experience
No 220 62.7
Yes 131 37.3
Frequency of sharp injury in the last year
1 58 67.4
≥1 28 32.6
Day of injury
Monday 35 31.3
Tuesday 15 13.4
Wednesday 9 8.0
Thursday 7 6.3
Friday 22 19.6
Saturday 5 4.4
Sunday 3 2.7
Do not remember 16 14.3
Timing of injury
Morning 63 48.1
Afternoon 33 25.2
Evening 15 11.4
Midnight 11 8.4
Do not remember 9 6.9
Type of item caused the injury (n=115)
Syringe needle 52 45.2
An intravenous cannula (catheter) 14 12.2
Scalpel blade 10 8.7
Suture needle 9 7.8
Glass item 7 6.1
Blade 7 6.1
Lancet 6 5.2
Butterfly needle 5 4.3
Scissor 3 2.6
Other sharps 2 1.8
Received medical care for injury
No 80 61.0
Yes 51 39.0
Work practice
Dressing and injection 29 22.0
Assembling needle and syringe after use 23 17.4
Operation theatre 23 17.4
Recapping of a used needle 13 9.8
Drawing blood 12 9.1
Opening the needle cap 11 8.3
Securing IV line 10 7.6
Catheterizing patient 8 6.1
Other 3 2.3
Reporting of sharp injuries
No 76 57.1
Yes 57 42.9
Reason for not reporting sharp injuries
Not aware of the reporting procedure 27 35.5
I did not think it was important 17 22.3
Continued on next page

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Table 3 continued
I thought the source patient was low risk for HIV 12 15.8
Lack of support by management 5 6.6
Fear of stigma/discrimination 5 6.6
Reporting is a too time-consuming process 5 6.6
I emphasized patient care 3 4.0
I thought I might be blamed or in trouble 2 2.6

3.4 Factors associated with sharp injuries among HCWs

The bivariate analysis showed concerns about sharp injuries, job satisfaction, and OHS training decreased sharp injuries risk
over their counterparts. However, these were not showed significance in multivariate logistic regression analysis. The prevalence
of sharp injuries was significantly associated with tenure, lack of training on sharp injuries, high workload, lack of perception
of risk, and dissatisfaction with the work environment for multivariate analysis. HCWs with >10 years of work experience were
more than to experience sharp injuries in the previous 12 months compared to those with less experience (<5 years) [AOR =
0.40, 95% CI: (0.21, 0.79)].
HCWs who never had any training on sharp injuries were more likely to report a sharp injury than those reporting such
training [AOR: 0.55, 95% CI: (0.3, 1.024)]. HCWs who worked more than 48 h/week reported more sharp injuries than those
who had worked <=48h/week [AOR: 0.95, 95% CI: (0.93, 0.98)]. Similarly, having low [AOR: 0.26, 95% CI: (0.13, 0.56)] and
moderate risk perception [AOR: 0.36, 95% CI: (0.19, 0.67)] significantly raised the odds of sharp injuries occurrence compared
to their counterparts who had a high-risk perception for sharp injuries. There was also a statistically significant association
between dissatisfaction with the work environment with sharp injuries. HCWs dissatisfied with their work environment
reported sharp injuries more than the satisfied ones [AOR = 0.34, 95% CI: (0.2, 0.6)] (Table 4).

Table 4. Bi-variable and multi-variable logistic regression analysis of potential factors associated with sharp injuries among HCWs in
primary hospitals, Northwest Ethiopia, 2018 (N= 351)
Injury Crude OR (95%
Variables Category Adjusted OR (95% CI)
Yes No CI)
Working experience (years)
<5 39 163 1.00
5–10 20 60 2.68 (1.48, 4.87)b 0.90 (0.45, 1.18)
>10 27 42 1.39 (0.75, 2.57) 0.40 (0.21, 0.79)b
Ever had training on sharp injuries
No 72 184 2.71 (1.58, 4.66)a .55 (0.3, 1.02)c
Yes 14 81 1.00
The average number of hours worked per week
<=48 14 109 1.00
>48 72 156 3.6 (1.92, 6.69)a 0.95 (0.93, .98)a

Risk Low 19 26 3.93 (1.97, 7.85)a 0.26 (0.13, 0.56)b

perception Moderate 31 45 3.71 (2.08, 6.63)a 0.36 (0.19, 0.67)b
High 36 194 1.00
Work environment satisfaction
No 43 61 3.34 (2.0, 5.57)a 0.34 (0.2, 0.60)a
Yes 43 204 1.00
a Significant at p≤0.001; b Significant at p ≤ 0.01;c Significant at p ≤ 0.05.

4 Discussion
The prevalence of sharp injuries among HCWs in the last 12 months was 24.5%, in line with Tigray, northern Ethiopia’s 25.9%
prevalence rate (14) , Dire Dawa, Eastern Ethiopia (26.6%) (7) , Dessie City Hospitals, northeast Ethiopia 28.3% (15) . However, the
rate we obtained was higher than the 11.57% rate observed in Saudi Arabia (1) . Similarly, the rate of prevalence in our study was

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lower than similar studies reported in Ethiopia and the prevalence of sharp injuries varied considerably across the different parts
of Ethiopia; 29.5% in Northwestern Ethiopia (6) , 32.2%, Gambella town, Southwest Ethiopia (11) , 33.7% Western Ethiopia (9) ,
34.5% in Dessie town, Northeast Ethiopia (10) , Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 36.2% (2) , 40.1% in
Northeast Ethiopia (8) , 75.5% North Wollo Zone Public Hospitals, Northeast Ethiopia, (16) . This may be due to the number of
HCWs in the facility, different work environments, and resource availability.
In the present study the overall prevalence of sharp injuries was 37.3%, higher than a similar study in Western Wollega
32.9% (4) . However lesser than a similar study in Dessie referral hospital Amhara region, Ethiopia, 43% (17) , Tigray, northern
Ethiopia’s 38.5% prevalence rate (14) , and 53.8% Dire Dawa, Eastern Ethiopia (26.6%) (7) .
In this study, the prevalence of sharp injuries was highest in nurses (47.3%), similar to several other studies in Dessie (17) ,
in Saudi Arabia (1) , and Dire Dawa, Ethiopia (7) , Northwestern Ethiopia (6) , Western Wollega (4) . It could be because nurses
administer most of the injections and are responsible for intravenous fluid administration and other procedures which require
the use of needles and other sharp devices. Also, the insufficient number of nurses and medical devices at workplaces, distraction
at work, heavy workload, poor organization, multiple or repeated attempts to complete a procedure, and spending more time
in direct patient contact may have increased their vulnerability to such injuries. The current study found that 67% of the study
subjects recapped needles after use, which was an important cause of sharp injuries, as observed in several other studies (1,4,7,14) .
The multivariate logistic regression in the present study revealed that low [AOR: 0.26, 95% CI: (0.13, 0.56)] and moderate
perceived risk of sharp injuries [AOR: 0.36, 95% CI: (0.19, 0.67)] was a significant association with their occurrence. HCWs
with a low perceived risk of sharp injuries might not take special care to avoid injury while performing different activities using
sensitive materials. According to a study conducted in Gambella, Ethiopia, (11) mishaps can also occur when sharps containers
are disposed of improperly. Each ward of the primary hospitals has a safety box for collecting discarded needles and other sharps
materials, which are replaced once full due to a shortage of safety boxes, impairing the appropriate collection and disposal of
this waste.
Consistent with a finding of similar study in Addis Ababa, Ethiopia (2) syringe needles were the most frequent cause of sharp
injuries, and this might be due to their use in every department of the HCFs. Replacement of the traditional needles with
safer needle devices such as needleless sets, safety cannula, self-capping intravenous catheters, self-retracting lancets for blood
glucose monitoring, and auto-disposable syringes certainly helps in reducing injuries among HCWs.
The number of sharp injuries has decreased after introducing such safety-engineered alternatives in Saudi Arabia (1) .
However, in an underdeveloped country like Ethiopia, health services are under intense economic constraint and often
understaffed and underequipped.
The present study detailed that most of the sharp injuries (22%) reported during injections were similar to a study in Dire
Dawa, Eastern Ethiopia (7) , which may be due to unexpected or sudden movement by the patient during injection or momentary
lack of concentration, resulting in injury.
Even though HCWs have repeated the procedure hundreds of times, one slip can cause injury with potentially serious
consequences.
After nurses, housekeeping staff sustained 22.9% of total sharp injuries in this study, slightly lower than a similar study where
lab technicians reported 46% (7) . Improper disposal at the upstream and lack of resources places these downstream workers at
risk. The Occupational Safety and Health and Health Administration (OSHA) standard, limiting exposure to infectious disease
pathogens, forbids recapping of needles after being used; nonetheless, a considerable number of employees are still becoming
sick from it. This could be because HCWs have not been properly trained or do not have sufficient expertise with the standard
procedures (10) . The injury occurrence of unnecessary needle incidents highlights the necessity of ongoing education, seminars,
and simulations as outlined in other studies about safety measures for healthcare workers at a tertiary care hospital, Awassa and
other similar studies (4,9,14,15) .
This study showed that most injuries (31.3%) occurred on Monday, which might be linked to comparatively high patient
flow and a heavier workload after the weekend. This finding was similar to a couple of studies in different parts of Ethiopia.
However, in a study done in Public Sector Tertiary Care Hospitals in Pakistan (18) , most injuries were reported on Saturday. This
variation could be explained by the two countries’ organizational and cultural differences.
About 48.1% of sharp injuries occurred in the morning shifts, which may be due to more patients in the morning shift,
sometimes causing inattentiveness among HCWs due to workload.
Similar observations in different studies in Ethiopia.
The participants who had no training on sharp injuries [AOR: 0.55, 95% CI: (0.3, 1.024)] were significantly at higher risk of
sustaining sharp injuries than those who underwent training.
Similar reports from different parts of Ethiopia: Dessie City Hospitals, Northeast Ethiopia more than 4.92 times probability
of having sharp injuries (15) . Western Ethiopia 2.25 times more exposed to the risk of occupational hazards than those who

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had (AOR: 2.25, 95% CI: 1.22, 4.13) (9) a higher risk of getting sharp injuries, Gambella, Ethiopia [AOR=4.89, 95% CI: (2.21,
10.84)] (11) . This finding is vital for planning preventive measures in a setting such as Ethiopia, where arranging proper training
is more practical than buying expensive equipment. Due to a lack of OHS training, HCWs may not be familiar with the different
mechanisms of preventing sharp injuries associated with their activities and may be at risk for such injuries. Studies showed
Sub-Saharan Africa supported the importance of training among HCWs.
In our study, participants with working experience of >10 years had a high rate of sharp injuries [AOR: 0.40, 95% CI: (0.21,
0.79)] compared with those having <5 years were significantly at higher risk of getting sharp injuries compared to ≥5 years (8,15) .
So merely having work experience is not enough. Training on preventive behaviors and the use of safety-engineered needles are
needed. It is recognized that adverse schedule characteristics such as long work hours significantly increased the risk of sharp
injuries. HCWs with >10 years of work experience were more likely to experience sharp injuries (10) .
In the current study, workload >48h/week significantly increased the prevalence of sharp injuries compared to those who
worked 48h/week [AOR: 0.95, 95% CI: (0.93, 0.98)]. One potential explanation is that working long hours can cause stress and
emotional and physical distress, which are likely to increase the chance of human error and lead to a tendency towards risky
behaviors, such as recapping needles and poor compliance with the precautions.

5 Limitations of the study

This study might have recall bias, constraints of time, and finance for study. The study might be subjected to the response set
bias from the respondent. Since it was a cross-sectional study design, it was difficult to draw causal relationships. We excluded
seriously ill participants as they might suffer from sharp injuries and sharp acquired bloodborne pathogens.

6 Conclusion
In this study, the incidence of needle stick injuries among healthcare workers over the previous 12 months was 24.5%, and
more than half of the injuries went unreported. The likelihood of an occupational injury increased in Ethiopia due to factors
like working longer than eight hours a day, a lack of personal protective equipment, a lack of supervision, and a lack of training
in occupational health and safety. Future research must examine the causes of sharp injuries and evaluate how well preventive
measures can lower the risk. The nurse should follow the recommendations for preventing infections, avoid recapping the
needles, and reduce work-related stress. It is strongly advised to raise HCWs awareness of the issue and conduct regular training
on how to use sharp objects safely. It is also advised to enhance the current sharp injury reporting systems to guarantee that
post-exposure prophylaxis is used as soon as possible. The use of safety precautions, safe injection techniques, and the provision
of engineered safety devices may all help to further lower the risk of sharp injuries.

7 Declarations
6.1 Ethics approval and consent to participate
The present study got ethical clearance (DSN/577/13; dated: 15/06/2011 EC) from the Ethical Review Board, School of Nursing,
the University of Gondar. Written informed consent was acquired from each study participant of the district hospitals. The
purpose of the study was addressed to each respondent. At the end of data collection, the data collectors were provided brief
information about preventing sharp injuries to each study participant.

6.2 Consent for publication

All authors read and agreed to the final form of the manuscript.

6.3 Availability of data and materials

The datasets used to support the findings of this study are available on reasonable request. All relevant data are within the
manuscript.

6.4 Authors’ contributions

AA, ZB, and MI were involved in proposal development, data collection, statistical analysis, manuscript write-up. All authors
read and approved the final manuscript.

https://www.indjst.org/ 1995
 Alemayehu et al. / Indian Journal of Science and Technology 2022;15(39):1987–1996

References
1) Alsabaani A, Alqahtani NSS, Alqahtani SSS, Al-Lugbi JHJ, Asiri MAS, Salem SEE, et al. Incidence, Knowledge, Attitude and Practice Toward Needle Stick
Injury Among Health Care Workers in Abha City, Saudi Arabia. Frontiers in Public Health;10:771190–771190. Available from: https://doi.org/10.3389/
fpubh.2022.771190.
2) Liyew B, Sultan M, Michael M, Tilahun AD, Kassew T. Magnitude and Determinants of Needlestick and Sharp Injuries among Nurses Working in Tikur
Anbessa Specialized Hospital, Addis Ababa, Ethiopia. BioMed Research International. 2020;2020:1–14. Available from: https://doi.org/10.1155/2020/
6295841.
3) Lakshmi A, Raja A, Paul CM. A cross sectional study on needle stick and sharp injuries among health care providers in tertiary centers, Tamil Nadu. Int
J Community Med Public Health. 2018;5(3):982–988. Available from: 10.18203/2394-6040.ijcmph20180524.
4) Yohannes BG. Sharp Injuries and Associated Factors Among Health Care Professionals in Western Wollega Public Hospitals, West Ethiopia. American J
of Clin and Exp Medicine. 2020;8(5):88–95. Available from: https://doi=10.11648/j.ajcem.20200805.12.
5) Kols A, Kibwana S, Molla Y, Ayalew F, Teshome M, Van Roosmalen J, et al. Factors Predicting Ethiopian Anesthetists’ Intention to Leave Their Job. World
Journal of Surgery. 2018;42(5):1262–1269.
6) Berhan Z, Malede A, Gizeyatu A, Sisay T, Lingerew M, Kloos H, et al. Prevalence and associated factors of needle stick and sharps injuries among healthcare
workers in northwestern Ethiopia. PLOS ONE. 2021;16(9):e0252039–e0252039. Available from: https://doi.org/10.1371/journal.pone.0252039.
7) Mekonnen R, Yosef H, Teklegiorgis K, Tesfaye F, Dagne I. Magnitude and Impact of Occupational Related Needle Stick and Sharp Injuries and Associated
Factors among Health Care Workers in Dire Dawa, Eastern Ethiopia. Medical Safety & Global Health. 2018;07(01):2–7.
8) Bazie GW. Factors Associated with Needle Stick and Sharp Injuries Among Healthcare Workers in North East Ethiopia</p>. Risk Management and
Healthcare Policy. 2020;Volume 13:2449–2456. Available from: https://doi:10.2147/RMHP.S284049.
9) Abadiga M, Mosisa G, Abate Y. Magnitude of Needlestick and Sharp Injury and Its Associated Factors Among Nurses Working at Health Institutions in
Western Ethiopia, 2020</p>. Risk Management and Healthcare Policy. 2020;Volume 13:1589–1602. Available from: https://doi:10.2147/RMHP.S254641.
10) Kebede A, Gerensea H. Prevalence of needle stick injury and its associated factors among nurses working in public hospitals of Dessie town, Northeast
Ethiopia, 2016. BMC Research Notes. 2018;11(1):413–413. Available from: https://doi:10.1186/s13104-018-3529-9.
11) Mengistu YB, Desta AA, Fekadu SA. The pattern of sharp injuries and its associated factors among healthcare workers in Gambella town, Southwest
Ethiopia. International Journal of Scientific Reports. 2021;7(2):101–101. Available from: https://dx.doi.org/10.18203/issn.2454-2156.IntJSciRep20210093.
12) Summary and statistical report of the 2007 population and housing census: population size by age and sex. Ethiopia, Addis Ababa. 2008. Available from:
https://www.ethiopianreview.com/pdf/001/Cen2007_firstdraft(1).pdf.
13) Kebede G, Molla M, Sharma HR. Needle stick and sharps injuries among health care workers in Gondar city, Ethiopia. Safety Science. 2012;50(4):1093–
1097. Available from: https://dx.doi.org/10.1016/j.ssci.2011.11.017.
14) Weldesamuel E, Gebreyesus H, Beyene B, Teweldemedhin M, Welegebriel Z, Tetemke D. Assessment of needle stick and sharp injuries among health care
workers in central zone of Tigray, northern Ethiopia. BMC Research Notes. 2019;12(1):654–654. Available from: https://doi:10.1186/s13104-019-4683-4.
15) Assen S, Wubshet M, Kifle M, Wubayehu T, Aregawi BG. Magnitude and associated factors of needle stick and sharps injuries among health care workers
in Dessie City Hospitals, north east Ethiopia. BMC Nursing. 2020;19(1):31–31. Available from: https://doi.org/10.1186/s12912-020-00422-0.
16) Getie A, Wondmieneh A, Tesfaw G. The Prevalence of Needlesticks and Sharp Injuries, and the Associated Factors Among Midwives and Nurses in North
Wollo Zone Public Hospitals, North East Ethiopia: An Institution-based Cross-sectional Study</p>. Drug, Healthcare and Patient Safety. 2020;12:187–193.
Available from: https://doi:10.2147/DHPS.S273669.
17) Abebe AM, Kassaw MW, Shewangashaw NE. Prevalence of needle-stick and sharp object injuries and its associated factors among staff nurses in Dessie
referral hospital Amhara region, Ethiopia, 2018. BMC Research Notes. 2018;11(1):840–840. Available from: https://doi.org/10.1186/s13104-018-3930-4.
18) Zafar A, Aslam N, Nasir N, Meraj R, Mehraj V. Knowledge, attitudes and practices of health care workers regarding needle stick injuries at a tertiary care
hospital in Pakistan. J Pak Med Assoc. 2008;58(2):18333520–18333520.

https://www.indjst.org/ 1996

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