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The prevalence of nosocomial infection rates and needle sticks injuries at a teaching hospital, during 2013–2014

Published:February 06, 2020DOI:https://doi.org/10.1016/j.cegh.2020.01.020

      Abstract

      Introduction

      Nosocomial infections (NIs) and Needle stick injuries (NSIs) could play an important role in transfer NIs among the health care workers (HCWs).

      Objective

      The aim of this study was to evaluate the Prevalence of NIs and NSIs in Razi Hospital, Ahvaz, southwest of Iran, during 2013–2014.

      Materials and methods

      The present study was a descriptive study, conducted on all the patients who were hospitalized with signs and symptoms of infection after 48 h of hospitalization and 600 HCWs in Razi Hospital in Ahvaz, Iran during 2013–2014. Data about the patients’ site of infection, ward of hospitalization, type of NIs and about HCWs type of NSIs, ward, their activity were collected. Data were summarized using descriptive statistical methods and were analyzed by Excel and SPSS 16.0.

      Results

      The results of the present study showed that the incidence of NIs were low (NIs < 2%) and 70 cases of NSIs found in this hospital during 2013–2014. The most incidence rates of NIs were reported in wards of obstetrics and gynecological (OBGYN), orthopedic, Intensive Care Unit (ICU), general surgery, infectious diseases, internal medicine and Coronary Care Unit (CCU) during 2013–2014. Based on the findings, recapping the needles was the most risk factor for NSIs. Also the results indicated that nurses were the highest risk of NSIs among other HCWs groups.

      Conclusion

      Based on these findings, NIs and NSIs in this hospital had a lower frequency in comparison with the national rates. Training programs related to the prevention of NIs and NSIs would be one of the priorities in the Razi teaching hospital.

      Keywords

      1. Introduction

      Nosocomial infections (NIs) occur 48–72 h after hospital admission, due to a person's stay in the hospital.
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      The results our study showed that an increase in the HCWs knowledge can be reduce the rate of NIs and NSIs. This study aimed to determine the nosocomial infections (NIs) and needle stick injuries (NSIs) in Razi Hospital Ahvaz, southwest of Iran, during 2013–2014.

      2. Materials and methods

      2.1 Methods

      The present study was a descriptive and cross-sectional study that was performed on a all the patients who were hospitalized with signs and symptoms of infection after 48 h of hospitalization and 600 HCWs in Razi teaching hospital with approximately 220 beds, in the southwest of Iran during 2013–2014. Data's was taken from Razi Hospital. Criteria for the diagnosis of NIs and NSIs were based on the Center for Disease Control (CDC), National Nosocomial Infections Surveillance (NNSIS), reported and observation.
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      2.2 Description of study area

      Ahvaz city, the capital of Khuzestan Province, with a population of approximately 1 million and an area of 8152 square kilometers, is located between 48° and 49°29′ east of the Greenwich meridian and, 31°and 45′ minutes north of the equator.
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      Razi Hospital is a tertiary-care hospital with 220 beds, and is located in the center of Ahvaz. The location of the study area is shown in Fig. 1.
      Fig. 1
      Fig. 1Location of the study area Razi Hospital, in the south west of Ahvaz city.

      2.3 Statistical analysis

      The coded data were entered in SPSS software version 16. Data analyses were performed using descriptive statistics (frequency, mean and standard deviation for each variable).

      3. Results

      The Number of NIs and NSIs in different wards of the hospital are presented in Table 1. The predominant NIs distribution in OBGYN (Obstetrics and Gynecological), Orthopedic, ICU (Intensive Care Unit), general surgery, infectious diseases, internal medicine and CCU (Coronary Care Unit) ward were during 2013–2014. The highest rate of NSIs was observed in OBGYN [8 (27.58%)] and general surgery [10 (24.39%)] wards during 2013 and 2014, respectively (Table 1).
      Table 1Distribution of occupational NSIs in the hospital wards during 2013–2014.
      Hospital wardNumber of NIs 2013Number of NIs 2014Number of NSIs 2013Number of NSIs 2014
      General surgery6 (3.89%)25 (13.22%)7 (24.13%)10 (24.39%)
      internal medicine2 (1.29%)9 (4.76%)4 (13.79%)
      Infectious diseases27 (17.53%)35 (18.51%)2 (6.89%)2 (4.87%)
      ICU33 (21.42%)52 (27.51%)4 (13.79%)8 (19.51%)
      OBGYN51 (33.11%)50 (26.45%)8 (27.58%)7 (17.07%)
      CCU1 (0.65%)
      Operating room2 (6.89%)3 (7.31%)
      Orthopedic34 (22.07%)18 (9.52%)2 (6.89%)3 (7.31%)
      Emergency8 (19.51%)
      Total154 (100%)189 (100%)29 (100%)41 (100%)
      Abbreviations: OBGYN: obstetrics and gynecological; ICU: Intensive care unit; CCU: Coronary Care Unit.
      Fig. 2 shows the number of NIs and NSIs versus different wards during 2013–2014. Number of cases NIs was estimated which were 154 and 189 in 2013 until 2014, respectively. Also, based on Fig. 2 number of cases NSIs was estimated which were 29 and 41 during 2013–2014.
      Fig. 2
      Fig. 2Numbers of NIs and NSIs versus Razi teaching hospital during 2013–2014.
      The Number and Distributions of NSIs exposure among HCWs were estimated in Table 2. The results indicated that nurses to be at highest risk of NSSIs among other HCWs groups (n = 24, 34.28%) during 2013–2014. Totally, the incidence of NSIs was 70 cases in Razi teaching hospital (Table 2). Based on result Table 2 the numbers of NSIs between residents, doctors, nurses, midwife, operating room technicians, nurse aid and workers were 7(10%), 1(1.42%), 24(34.28%), 6(8.57%), 6(8.57%), 15(21.42%), 11(15.71%), respectively.
      Table 2The Number and Distributions of NSIs exposure among HCWs.
      Category of HCWsNeedle Stick Injuries (2013)Needle Stick Injuries (2014)Total number and percent NSSIs among HCWs (2013–2014)
      Residents3 (10.34%)4 (9.75%)7 (10%)
      Doctors1 (3.44%)1 (1.42%)
      Nurses9 (31.03%)15 (36.58%)24 (34.28%)
      Midwife4 (13.79%)2 (4.87%)6 (8.57%)
      Operating room Technicians2 (2.53%)4 (9.75%)6 (8.57%)
      Nurse aid6 (20.68%)9 (21.95%)15 (21.42%)
      Workers4 (13.79%)7 (17.07%)11 (15.71%)
      Total29 (100%)41 (100%)70 (100%)
      Totally, the incidence of NIs was in 2013 (0.975) and 2014 (1.8) percent in Razi teaching hospital. SSIs were the most frequent category of infection (54.55%), followed by blood stream infections (BSIs) (19.48%), pneumonia (18.18%) and UTI (7.8%) during 2013 (Fig. 3). Also Fig. 3 show that during 2014 the UTI, as compared to other types of infection, were the most frequent category of infection.
      Fig. 3
      Fig. 3Percentage of NIs based on type of infection, Razi Hospital during 2013–2014.
      The predominant activities at time of NSIs are presented in Fig. 4. Totally, the 70 respondents who had experienced NSIs in this center during 2013–2014, (n = 25) were recapping needle, passing needle (n = 9), suturing (n = 12), handling needle on tray (n = 15), transit disposal needle devices (n = 4) and dissembling needle devices (n = 5), respectively.
      Fig. 4
      Fig. 4The number of NSIs at time Activities, Razi Hospital during 2013–2014.

      4. Discussion

      In recent years, NIs and NSIs have been considered a serious threat to the quality of life and health of patients and HCWs. Razi Hospital is a 220-bed, tertiary hospital in the southwest of Iran. In this study, we summarized cases of NIs and NSIs among patients and HCWs groups.
      Based on the results of this research, the number of cases of NIs was 154 and 189 during 2013 and 2014, respectively, and the incidence was 0.975% in 2013 and 1.8% in 2014, which was lower compared to rates of referenced NIs in the guideline book. In a study performed by Qader et al., prevalence rate of NIs has been reported about 36%.
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      According to the results of our study, SSIs were the most common type of infection in our hospital. In a similar work, Pellizzer's et al. in Italy reported that urinary tract (28.4%), surgical sites (20.3%), and bloodstream (19.3%) were the most frequent sites of infection.
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      reported in their studies that pneumonia was the most common type of infection. These differences may be due to the number of patients studied, place of study, and genetic susceptibility.
      As the results show, the highest rate of NSIs was observed in OBGYN [8 (27.58%)]and general surgery [10 (24.39%)] wards during 2013 and 2014, respectively. Pili et al. in their study showed that the NSIs in most cases occurred in the ICU and CCU wards, 24.7% and 12.4%, respectively.
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      to summarize, showed that ICU ward had the highest rate of NI as compared to other wards.
      According to Table 2, the number of NSIs between residents, doctors, nurses, midwives, operating room technicians, nurse aids and workers were 7(10%), 1(1.42%), 24(34.28%), 6(8.57%), 6(8.57%), 15(21.42%), and 11 (15.71%), respectively, during 2013–2014. Jaybhaye et al., in their study, showed that nurses had the highest rate of NSIs as compared to other HCWs.
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      • Durukan E.
      • Aras E.
      • Türkçüoğlu S.
      • Aygün R.
      Long working hours increase the risk of sharp and needlestick injury in nurses: the need for new policy implication.
      In a similar work by Smith et al. in a Japanese teaching hospital during 2006, nurses with 46% were the most frequent cases of NSIs.
      • Smith D.R.
      • Mihashi M.
      • Adachi Y.
      • Nakashima Y.
      • Ishitake T.
      Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital.
      Our results indicated that nurses were at the highest risk of NSIs compared to other HCW groups (n = 24, 34.28%) during 2013–2014. This observation is in agreement with the findings of Gholami et al.
      • Gholami A.
      • Borji A.
      • Lotfabadi P.
      • Asghari A.
      Risk factors of needlestick and sharps injuries among healthcare workers.
      and Martins et al.
      • Talaat M.
      • Kandeel A.
      • El-Shoubary W.
      • et al.
      Occupational exposure to needlestick injuries and hepatitis B vaccination coverage among health care workers in Egypt.
      However, the incidence of NSIs reported by nurses in our survey was considerably lower than those in Askarian's study in the Fars province of Iran (49.6%),
      • Askarian M.
      • Shaghaghian S.
      • McLaws M.-L.
      Needlestick injuries among nurses of Fars province, Iran.
      Smith's study in Japan (46%)
      • Smith D.R.
      • Mihashi M.
      • Adachi Y.
      • Nakashima Y.
      • Ishitake T.
      Epidemiology of needlestick and sharps injuries among nurses in a Japanese teaching hospital.
      and Smith's study in Korea (79.7%).
      • Smith D.R.
      • Choe M.-A.
      • Jeong J.S.
      • Jeon M.-Y.
      • Chae Y.R.
      • An G.J.
      Epidemiology of needlestick and sharps injuries among professional Korean nurses.
      Another study reported that doctors were the most frequent NSIs (64.7%), followed by waste workers (25.5%) and nurses (7.8%).
      • Prakash K.
      • Patel K.
      Epidemiology of needle-stick injuries in Mangalore.
      In a similar work, Rais et al. in Karachi reported that nurses (28.4%) and doctors (21.6%) were the most frequent cases of NSIs.
      • Rais N.
      • Jamil H.M.
      Prevalence of needle stick injuries among health care providers.
      This can be explained by the fact that nurses administer most of the injections and are involved in most of the procedures that require the use of needles.
      In the present study, the 70 respondents who had experienced NSIs in this center, (n = 25, 35.71%) were recapping needle, handling needle on tray (n = 15, 21.42%), suturing (n = 12, 17.14%), passing needle (n = 9, 12.85%), transiting disposal needle devices (n = 4, 5.71%) and dissembling needle devices (n = 5, 7.14%). Fredrich,
      • Nsubuga F.M.
      • Jaakkola M.S.
      Needle stick injuries among nurses in sub‐Saharan Africa.
      Jahan
      • Buraidah A.-Q.
      • Jahan S.
      Epidemiology of needlestick injuries among health care workers in a secondary care hospital in Saudi Arabia.
      and Cheng
      • Cheng H.-C.
      • Su C.-Y.
      • Yen A.M.-F.
      • Huang C.-F.
      Factors affecting occupational exposure to needlestick and sharps injuries among dentists in Taiwan: a nationwide survey.
      showed that recapping of used syringes is responsible for 13%, 29%, and 28% of injuries, respectively. According to results of the study by Saleh at Asirin Central Hospital, Saudi Arabia, needle recapping (26.4%), careless disposal of sharp instruments (16.9%), and blood extraction (11.5%) were responsible for more than 50% of NSIs.
      • Saleh Al Ghamdi M.
      • Al-Azraqi T.
      • Bello C.
      • Gutierrez H.
      • Hyde M.
      • Abdullah M.
      Needlestick and sharps injuries at Asir central hospital, Abha, Saudi Arabia.
      Based on the results of several studies, the main reason for the high frequency of NSIs was needle recapping after its use.
      • Ayas N.T.
      • Barger L.K.
      • Cade B.E.
      • et al.
      Extended work duration and the risk of self-reported percutaneous injuries in interns.
      ,
      • Mohammad Nejad E.
      • Sfandbud M.
      • Ehsani S.
      • Deljo R.
      Occupational exposure to needle stick among nurses.
      ,
      • Jayanth S.
      • Kirupakaran H.
      • Brahmadathan K.
      • Gnanaraj L.
      • Kang G.
      Needle stick injuries in a tertiary care hospital.

      5. Conclusion

      This study was conducted to estimate the NIs and NSIs in Razi Hospital Ahvaz, southwest of Iran, during 2013–2014. In conclusion, it should be mentioned that the incidence rate of NIs and NSIs among patients and HCWs in this hospital was low, medical and hygiene interventions such as wearing sterile gloves, hand washing, avoid re-capping, especially for the health-related personnel, careful monitoring of surveillance system, education on health, regular reporting NSIs, continuous supervision, having a NSIs protocol, correct use of disposable equipment, controlled use of antibiotics, precise care of surgical wounds, keeping infected patients away from other patients, appropriate nutrition and sufficient number of nurses are the most important to be considered to reduce NIs and NSIs and their adverse effects. In summary, we believe this information is useful not only for us but for others involved in the care of residents in long-term care facilities inasmuch as there are little published data on yearly NIs and NSIs rates among patients and HCWs.

      Funding/support

      The authors would like to thank Razi Teaching Hospital, Clinical Research Development Center for the technical support and providing the facilities. This work was financially supported by grant: ( 94s145 ) from Vice- Chancellor for research Affairs of Ahvaz Jundishapur University of Medical Sciences, Iran .

      Declaration of competing interest

      There are no conflicts of interests among the authors.

      Acknowledgements

      The authors would like to thank student Research Committee, Ahvaz Jundishapur University of Medical Sciences for providing financial supported by the grant: ( 94s145 ) of this research.

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