Rajiv Gandhi University of Health Sciences Karnataka



RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

MR. BASIL K BABU

I YEAR M. Sc NURSING

MEDICAL SURGICAL NURSING,

(2010 –12 BATCH)

SRI SHANTHINI COLLEGE OF NURSING

#188/B, PARVATHI NAGAR, OPP: SUB REGISTRAR OFFICE, LAGGERE MAIN ROAD, LAGGERE,

BANGALORE -560058

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION.

| | |MR.BASIL K BABU |

| |NAME OF THE |1st YEAR M.SC NURSING, |

| |CANDIDATE AND |SRI SHANTHINI COLLEGE OF NURSING |

|01 |ADDRESS |#188/B,PARVATHI NAGAR, OPP:SUB REGISTRAR OFFICE, |

| | |LAGGERE MAIN ROAD, |

| | |LAGGERE,BANGALORE -560058. |

| | |SRI SHANTHINI COLLEGE OF NURSING , |

| |NAME OF THE |#188/B,PARVATHI NAGAR, |

|02 |INSTITUTION |OPP:SUB REGISTRAR OFFICE,LAGGERE MAIN ROAD, LAGGERE, |

| | |BANGALORE -560058. |

| | | |

| |COURSE OF THE |MASTER DEGREE IN NURSING |

|03 |STUDY AND SUBJECT |MEDICAL SURGICAL NURSING |

| | | |

| |DATE OF ADMISSION |30/06/2010 |

|04 |TO COURSE | |

| | |THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PREVENTION OF NEEDLE STICK |

|05 |TITLE OF THE |INJURIES AMONG GNM STUDENTS. |

| |TOPIC | |

6. BREIF RESUME OF THE INTENDED WORK

INTRODUCTION

“Reject your sense of injury and the injury itself disappears” -Marcus Aurelious

A needle stick injury is a percutaneous piercing wound typically set by a needle point, but possibly also by other sharp instruments or objects. Commonly encountered by people handling needles in the medical setting, such injuries are an occupational hazard in the medical community. These events are of concern because of the risk to transmit blood-borne diseases through the passage of the hepatitis B virus (HBV), the hepatitis C virus (HCV), and the Human Immunodeficiency Virus (HIV), the virus which causes AIDS. Despite their seriousness as a medical event, needle stick injuries have been neglected: most go unreported needle sticks have been recognized as occupational hazards.1

Needle stick injuries are a common event in the healthcare environment. When drawing blood, administering an intramuscular or intravenous drug, or performing other procedures involving sharps, the needle can slip and injure the healthcare worker. This sets the stage to transmit viruses from the source person to the recipient. These injuries also commonly occur during needle recapping and as a result of failure to place used needles in approved sharps containers. During surgery, a surgical needle may inadvertently penetrate the glove and skin of the surgeon or assistant. Penetrating accidents of the surgeon or assistant with the scalpel or other sharp instruments are also handled as a needle stick injury. Generally needle stick injuries cause only minor bleeding or visible trauma, however, even in the absence of bleeding the risk of viral infection remains. Scalpel injuries tend to be larger than a needle stick. In turn, a needle stick injury may also pose a risk for a patient if the injured health professional carries HBV, HCV or HIV. Needle stick injuries are not limited to the medical community. Any environment where sharps are encountered poses a risk. Needle stick injuries may occur not only with freshly contaminated sharps, but also, after some time, with needles that carry dry blood. While the infectiousness of HIV and HCV decrease within a couple of hours, HBV remains stable during desiccation and infectious for more than a week.1

While needle stick injuries have the potential of transferring bacteria, protozoa, viruses and prions, from a practical point the transmission of the hepatitis B and hepatitis C viruses and the Human Immunodeficiency Virus (HIV) is important The specific risk of a single injury depends on a number of factors when the patients harbor the virus of concern. Injuries with a hollow-bore needle, deep penetration, visible blood on the needle, a needle that was located in a deep artery or vein, or with blood from terminally ill patients are known to increase the risk for HIV infection.1

While the vast majority of needle stick injuries occur when the source-person does not carry the HBV, HCV, and HIV and thus do not carry a risk of infection, these events nevertheless cause stress and anxiety and signal a breakdown in protocol and prevention. Preventive steps can be taken at several levels and include reduction or elimination of use of sharps as much as possible, engineering controls (i.e. needles with safety devices), administrative controls including training and provision of adequate resources, and work practice controls; the latter may include using instruments (not fingers) to grasp needles, load scalpels, and avoiding hand-to-hand passing of sharp instruments. Engineering advances include the development of safety needles and needle removers. The adherence to "no-touch" protocols that eliminate direct contact with needles in their use and disposal greatly reduce the risk of injury. In the surgical setting blunt-tip suture needles are able to reduce needle stick injuries. After a needle stick injury, certain procedures must be followed to minimize the risk of infection for the recipient. The affected area should be rinsed and washed thoroughly with soap. 2 6.1 NEED FOR STUDY

Statistics from the US provide some insight into these occupational risks. Every year, healthcare workers experience between 6,00,000 and 8,00,000 exposures to blood-borne pathogens. The most serious and commonly transmitted pathogens are Hepatitis B and C virus (HBV, HCV) and the human immunodeficiency virus (HIV), the virus that causes AIDS. Each of these viruses poses a different risk if a healthcare worker is exposed. More than 20 other infections can be transmitted through needle sticks, including syphilis, malaria, and herpes. At least 1,000 healthcare workers are estimated to contract serious infections annually from needle stick and sharp injuries.4 As of June 2001, there were at least 57 CDC documented cases of healthcare workers with occupationally acquired HIV and at least 137 cases of possible transmissions. According to world health report 2002 published by WHO, needle stick injury is accountable for 40 per cent of Hepatitis B, 40 per cent of Hepatitis C, and 2 per cent of HIV infections. The Centers for Disease Control and Prevention (CDC) estimates that each year 3,85,000 needle sticks and other sharps related injuries are sustained by hospital based healthcare personnel.3

Based on various studies, researchers have documented that needle stick injuries are under reported by health care workers and the number of exposures could potentially be much higher (Hamory, 1983). Chiarello (1992) cites several studies that found rates of under-reporting between 40.4% and 53% for nurses and 92% for laboratory personnel. Physicians under reported needle stick injuries by 70% to 95%. All the above studies shows that needle stick injury is common. so there is need to teach the students regarding prevention of needle stick injury and its management.4

6.2 REVIEW OF LITERATURE

Husoyam conducted a study on needle stick injury and reporting routines in Norwegian shows that health care workers transmission of blood-borne agents through percutaneous exposure. Reporting of sharps injuries is essential for instigation of adequate post-exposure prophylaxis and follow-up. We aimed at providing an account of number of sharps injuries reported by type of health care worker and the reporting systems used for injuries that have an inherent risk of transmitting blood-borne agents. On average, 210 sharps injuries are reported annually at Hauk eland University Hospital. In addition analyses of hepatitis and HIV linked to 159 sharps injuries that had not been reported otherwise, were requested annually. 51 % of sharps injuries were reported by nurses, 10 % by laboratory workers, 6 % by doctors and 33 % by others.5

Rajis conducted a study on on Guideline 'Needle stick injuries' risk assessment and post-exposure management in practice in Bithoven . The objective of the national guideline 'Needle stick injuries' is to make the assessment of needle stick injuries more structured and uniform. The injury is classified as high risk or low risk according to the volume of blood transmitted. For high-risk injuries measures to prevent hepatitis B, hepatitis C and HIV infection have to be considered, whereas for low-risk injuries only measures to prevent hepatitis B. The need for post-exposure prophylaxis is determined by the victim's immunity to hepatitis B and the presence of hepatitis B virus, hepatitis C virus or HIV in the source person. Post-exposure prophylaxis against hepatitis B consists primarily of hepatitis B vaccination; hepatitis B immunoglobulin is added in the case of a high-risk injury with a hepatitis B positive source or a source belonging to a risk group for hepatitis B. In high-risk injuries the victim is tested for hepatitis C and HIV transmission (except in case of a seronegative source). Antiretroviral post exposure prophylaxis is advised for high-risk injuries with a HIV seropositive source or a source belonging .6

Von Over Beck J Wess conducted a study on ” Needle stick accidents procedures following potentially infectious exposure in medical personnel in Bern (Germany)shows that exposure of blood carries with a definite risk for the health care worker of infection by various blood borne pathogens, especially the hepatitis B, hepatitis C, and human immunodeficiency virus. The risk of transmission from exposure to HIV is lower than that associated with exposure to HBV and HCV. Should HIV infection occur, however, the outcome is likely to be fatal. Although general infection control precautions, safer use of needles, gloves, and other procedures may substantially reduce the incidence of occupational exposures, they cannot eliminate the risk completely. The post-exposure management is discussed. Neither the efficacy nor the safety of AZT (zidovudine) for use as a chemo prophylactic agent following occupational exposures to HIV has been established. Nevertheless in selected cases it can be proposed to health care workers.7

Panuzio A conducted a study on biological fluid related accident amongst professionals working in calclinical laboratories in Maracaibo, Venezuelans. The occupational exposure biological medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure blood. This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p ................
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