Sharps injuries (SIs) and other blood and body fluid (OBBF) exposures are important occupational hazards for transmission of bloodborne pathogens among healthcare workers (HCWs).Reference Beltrami, Williams, Shapiro and Chamberland1 The World Health Organization has estimated that SIs resulted in 40% of HBV and HCV infections and 2.5% of HIV infections among HCWs.2 OBBF exposure through mucosa or skin damaged is another important way that HCWs contract pathogens.Reference Beltrami, Williams, Shapiro and Chamberland1
This public health problem is even more severe in developing countries, where the occupational hazards may be underappreciated and poorly prevented.Reference Tanaka, Katayama and Kato3 Occupational hazards of HCWs have received increasing attention in China, but few studies have focused on SIs and OBBF exposures across a range of hospitals. In this study, we aimed to assess prevalence and factors associated with SIs and OBBF exposures among Chinese HCWs.
Methods
Setting and study participants
This study was conducted from March to May 2019 in 175 hospitals in Anhui, China. Anhui province is located in eastern China with population >63 million. Survey candidates included HCWs who have directly contacted with patients or medical equipments and materials used for patients, including doctors, nurses, and other technologists (anesthetists, midwives, laboratory personnel, and others).
Definition
An SI was defined as a penetrating skin injury caused by a sharp instrument. OBBF exposure was defined as a splash or direct contact of blood or body fluids onto mucous membranes or nonintact skin.
Questionnaire
A questionnaire comprising 37 questions was developed by referring the previous literature,Reference Yasin, Fisseha, Mekonnen and Yirdaw4 which contained hospitals’ and respondents’ characteristics, experiences of SIs and OBBF exposures, reporting and treatment behaviors, and other potential associated factors.
Data collection and procedure
A scanned notification, covering survey purpose and methods, was sent to the target hospitals. The hospital infection management departments then invited eligible participants in their hospitals to voluntarily and anonymously fill out the online questionnaire. Survey generally took 5–10 minutes and had no financial incentives. Study protocol obtained ethics approval from the Research Ethics Committees of the Second Affiliated Hospital of Anhui Medical University.
Statistical analysis
Data were exported to SPSS version 21.0 software (IBM, Armonk, NY) for analysis. Forward stepwise multivariate logistic regression model was applied to explore associated factors. Variables with P < .05 were entered and with P < .10 were retained. A P value <.05 was considered statistically significant.
Results
Sociodemographic characteristics
Among 33,156 HCWs, 18.6% worked in provincial hospitals, 41.2% worked in municipal hospitals, and 40.2% worked in district hospitals. Male participants accounted for 18.7% of participants, and most participants (78.2%) reported their age between 26 and 45 years. Nearly three-quarters (71.2%) had a bachelor’s degree or above. Approximately two-thirds were nurses (67.5%), followed by doctors (25.7%), and other medical technologists (6.8%) (Table 1).
Table 1. Univariate Analysis of Sharps Injuries (SIs) and Other Blood/Body Fluid (OBBF) Exposures Among 33,156 Healthcare Workers
Note. CSS, central sterile supply department.
SIs and OBBF exposures
In total, 12,178 HCWs (36.7%) had experienced an SI in the prior 12 months (Table 2). SIs had occurred among 40.1% of nurses, 32.5% of doctors, and 19.1% of other medical technologists. The device that caused the most SIs was a hypodermic needle (23.5%), followed by glass (13.6%) and surgical suture needle (5.8%).
Table 2. Prevalence of Sharp Injuries (SIs) and Other Blood/Body Fluid (OBBF) Exposure Among 33,156 Healthcare Workers
In total, 8,116 (24.5%) HCWs had experienced an OBBF exposure during the previous 12 months (Table 2). OBBF exposure prevalence among doctors (28.0%) was higher than among nurses (24.3%) and other medical technologists (12.6%). Exposure to OBBFs involved blood or blood products (17.2%), vomit/sputum (10.3%), and urine (7.9%).
Factors associated with SI and OBBF exposure
As shown in Table 3, multivariate analysis showed that HCWs working in municipal and district hospitals were less likely to experience an OBBF exposure. Female HCWs were at higher risk of experiencing an SI and at lower risk of OBBF exposure. SIs were more frequent in those aged <45 years and OBBF exposures were more frequent in those aged 26–45 years. In terms of departments, HCWs working at in the operating room, the central sterile supply department, and the surgical ward were 1.5 times more likely to experience an SI than those working in the emergency unit. Also, HCWs working in the delivery room and operating room had significantly higher risk of OBBF exposure. HCWs with a bachelor degree or above were at lower risk of SI and at higher risk of OBBF exposure. In addition, SIs and OBBF exposures were consistently higher among HCWs who could not always conveniently access protective equipment when needed, and they were significantly lower among HCWs who worried about exposures, those who always followed standard precautions, those who always checked a patient’s bloodborne infections status before risky procedures, and those who received the safety guidelines ≥3 times.
Table 3. Multivariate Associations Between Sharp Injuries (SIs) and Other Blood/Body Fluids (OBBFs) Exposure and Covariates
Note. AOR, adjusted odds ratio; CSS, central sterile supply department.
Discussion
This study indicated a high prevalence of SIs and OBBF exposures in the previous 12 months among HCWs. This finding is in line with a meta-analysis showing that the 12-month prevalences of SIs and OBBF exposures were 36.0% and 18.2%, respectively, in African countries.Reference Auta, Adewuyi and Tor-Anyiin5 But the prevalence of SIs was lower in that study than in a Chinese multicenter survey that reported 71.3% prevalence among HCWs during the previous year in Fujian province.Reference Chen, Zhang and Yan6 Similar to previous studies,Reference Huang, Lu and Fan7–Reference Alemayehu, Worku and Assefa9 nurses experienced the highest proportion of SIs and doctors reported the highest rate of OBBF exposure.
Multivariate analysis indicated that HCWs working in municipal and district hospitals were less likely to experience an OBBF exposure. HCWs in provincial hospitals were more likely to treat more complex diseases, which might increase exposure risk. Female HCWs were at increased risk of SI and at decreased risk of OBBF exposure. This finding might be partly due to the difference in gender distribution among nurses (97.9% women) and doctors (41.3% women), which could be proven our findings that nurses experienced higher proportions of SIs and doctors experienced higher proportions of OBBF exposure. Notably, both age and degree level, related to practice activities and experiences, were predictors of SI and OBBF exposure, as expected. This finding highlights the importance of exposure prevention and management. Similar to other studies,Reference Huang, Lu and Fan7,Reference Alamgir, Cvitkovich, Astrakianakis, Yu and Yassi8 SI and OBBF exposure risks differed in different departments. The types of medical procedures carried out in the workplace determine the risks.Reference Yoshikawa, Wada and Lee10 In addition, adherence to standard precautions and self-protection awareness were important factors for preventing occupational exposure. Nevertheless, only 48% and 35% HCWs always followed standard precautions and checked the patient’s bloodborne infections status before risky procedures, respectively, which indicates that unsafe practices often still exist. In addition, approximately half of HCWs (45%) received occupational safety training <3 times. Taking occupational safety training ≥3 times was a significant protective factor. These findings indicate that safety training was further needed. Notably, HCWs who could not always conveniently access protective equipments when needed were more likely to experience SIs and OBBF exposure. These findings emphasize that providing adequate protective equipment is effective for preventing occupational exposure.Reference Yoshikawa, Wada and Lee10
This study has several limitations. First, information on exposures was collected retrospectively, which might have led to recall bias. Second, although the sample size was large enough, participation may have been influenced by the voluntary nature of the online survey. Finally, differences in exposure risks were investigated for common departments and could not be further classified due to insufficient information.
In conclusion, these results reflect the high prevalence of SIs and OBBF exposures among HCWs in Anhui, China. These findings imply that regular epidemiological surveillance, and strengthening occupational safety education and training are essential for HCWs. Prevention and control measures could be implemented on basis of these identified associated factors.
Acknowledgments
The authors thank all of the healthcare workers who participating in this study.
Financial support
No financial support was provided relevant to this article.
Conflicts of interest
All authors report no conflicts of interest relevant to this article.
