Indian Medical Gazette

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In Practice

Needle Stick Injuries among Junior Doctors

Sh. Praveen, Associate Proessor, Microbiology,
H. Sanayaima Devi, Associate Professor, Community Medicine,
Ebenezer Phesao, PGT, Community Medicine,
N. Shugeta Devi, PGT, Community Medicine
Regional Institute of Medical Sciences, Lamphelpat, Imphal, Manipur.
Th. Netajini Devi, Assistant Professor,
Dept. of Obs & Gyne, JNIMS, Porompat, Imphal West, Manipur.

Abstract
Objective: To determine the prevalence of needle stick
injuries (NSIs) among junior doctors of RIMS and to assess
the measures undertaken by the respondents after the NSI.
Methods: A cross sectional study was conducted in RIMS,
Imphal, Manipur among internees, house officers and post
graduate trainees from Sept to Oct 2011. Self-administered
questionnaire was used to collect data. Descriptive statistics
like mean, percentage and standard deviation were used.
Analysis was done using Chi square test. And P-value of
<0.05 was taken as significant. Results: Out of 382 eligible
respondents, 289 participated in the study. Males were
70.2% (n=203). Prevalence of NSI among junior doctors
within the last one year was 39.4% (N=114). Of the three
designations, NSI was highest among the house officers.
Most NSI took place while blood withdrawal (33.3%),
suturing (27.3%), giving injections (16.6%) and recapping
(14.9%). Majority of those doctors injured, 56.1% attributed
NSI during rush hour. Around fifty-four percent of them
were not wearing gloves during the NSI. Nearly forty-five
percent of the doctors washed their injured part with water
and soap and also applied antiseptic as immediate measures
after NSI. Only 10 (8.8%) took Post Exposure Prophylaxis
(PEP). Conclusion: Needle stick injuries among junior
doctors are common and often not reported and majority
of them did not take post exposure prophylaxis. These

findings warranted the need for ongoing attention to

strategies to reduce such injuries in a systematic way and
to improve reporting system so that appropriate medical
care can be delivered.
Keywords
needle sticks injuries (NSIs), junior doctors, prevalence,
cross-sectional study, post exposure prophylaxis (PEP)
Introduction
A needlestick injury is a percutaneous piercing wound
typically set by a needle point, but possibly also by other
sharp instruments or objects. 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). Despite their seriousness as a medical event,
needlestick injuries have been neglected: most go unreported
and ICD-10 coding is not available1.
WHO reports in the World Health Report 2002, that of
the 35 million health-care workers, 2 million experience
per cutaneous exposure to infectious diseases each year.
37.6% of Hepatitis B, 39% of Hepatitis C and 4.4% of
HIV/AIDS in Health-Care Workers around the world are
due to needlestick injuries2.

Address for correspondence: Dr. H. Sanayaima Devi, Associate Professor, Wangkhel Lourembam Leikai, Near Durga Puja Lampak,
Imphal East 795 004. E-mail : drsanahj@gmail.com

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Needlestick 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. Needlestick
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 week3.
Hepatitis B carries the greatest risk of transmission, with
37 to 62% of exposed workers eventually showing
seroconversion and 22 to 31% showing clinical Hepatitis B
infection. The hepatitis C transmission rate has been reported
at 1.8%4, but newer, larger surveys have shown only a
0.5% transmission rate5. The overall risk of HIV infection
after percutaneous exposure to HIV-infected material in the
health care setting is 0.3%6.
Junior doctors have the greatest risk of exposure to
blood-borne pathogens, given their numerous encounters
involving the use of sharp instruments on patients and the
increased propensity for injury while learning new technical
skill sets. The hazard of injury is further compounded by
the high prevalence of human immunodeficiency virus
(HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV)
among hospitalized patients. Therefore this study was
conducted to determine the prevalence of needle stick
injuries among junior doctors and to assess the measures
undertaken by the respondents after the needle stick injuries.
Material and Methods
A cross sectional study was conducted in Regional
Institute of Medical Sciences (RIMS), Imphal, Manipur
among all junior doctors from Sept to Oct 2011. The total
number of junior doctors were 382 which included 92
Internees, 245 PGs and 45 House Officers. Data were
collected using a pre-tested and pre-designed selfadministered questionnaire that consisted questions eliciting
the particulars of respondent, number of needlestick injuries
during last one year and an expanded set of questions about
the recent needlestick event. For those who had more than
one NSI, information for the most recent NSI was taken.
After taking an informed verbal consent from the
respondents, the questionnaires were distributed during the

day in the hospital and during the night at the hostels. The
completely filled questionnaires were collected on the same
day or the next day. PGs in Community medicine,
Physiology, Forensic medicine, Pharmacology and Anatomy
were not included in the study. Ethical approval was sought
from Institutional Ethics Committee, RIMS, Imphal.
Confidentiality of the respondents was maintained.
Statistical analysis
Descriptive statistics like mean, percentage and standard
deviation were used. Analysis was done using Chi square
test. Data were analyzed using SPSS version 11. And Pvalue of <0.05 was taken as significant.
Results
Out of 382 eligible respondents, 289 participated in the
study with a response rate of 78%. The mean age of the
respondents was 27.6 4.1 years (range, 20 to 43years).
Males were 70.2% (n=203). Prevalence of NSI among
junior doctors within the last one year was 39.4% (N=114).
For the junior doctors who reported that they had sustained
an NSI, 57.1% (65/114) had one, 25.4% (29/114) two and
17.5% (20/114) three or more NSIs.
Table 1 shows that the frequency occurrence of NSI
was more among males and in the age group of 26-30
years. However, this was found to be statistically
insignificant. Of the three designations, NSI was highest
among the house officers (41.7%) but it was not significant.
Details of the most recent needlestick injury were shown
in Table 2. Most NSI took place while withdrawing blood
(33.3%), suturing (27.3%), giving injections (16.6%) and
recapping (14.9%). Nearly fifty-one percent reported injury
by an open bored needle and 54.4% of the respondents did
not wear gloves during the NSI. Majority of them (56.1%)
attributed NSI during rush hour.
Nearly forty-five percent of the doctors washed their
injured part with water and soap and also applied antiseptic
as immediate measures after NSI. Only 8.8% (10/114) took
Post Exposure Prophylaxis (PEP) and reported, though 57%
of the respondents had the knowledge on free availability
of PEP in the hospital. Of all the doctors who had NSI,
only 40.6% tested their blood for HIV and 29.7% for
Hepatitis B and C. About 63% of the doctors attended any
educational session, seminar or workshop related to Needle
stick injury (Table 3).

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Discussion
Needle stick injuries pose a significant occupational risk
for health care providers. In our study we found that nearly
40% of the junior doctors had needlestick injury during the
last one year. Different prevalence rates (30% to 71.1%)

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were reported from many studies conducted among

different study populations7,8,9,10,11. A higher prevalence
(83%) was recorded in a study done among postgraduate
trainees in United States and it was reported that the
frequency of injury was higher among surgical trainees
than among all medical trainees12. Our study revealed that
50.9% of NSI occurred by open bored needles. A higher

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percentages (60% to 76%) were reported by other

workers7,13. Drawing blood for laboratory test and during
suturing were the main activities when junior doctors got
NSI in the present study. In other studies8,12, suturing was
the most common accident situation (45%-52%) followed
by blood drawing (24%), whereas another study reported
that recapping of a needle after use and drawing blood
were the common reasons of injury14. In our study recapping
was not practiced by majority of the respondents, this might
be because 63% of the doctors had attended workshop or
seminars related to it. Similar findings were reported by
other workers10,12. Of the injured doctors, 62 (54.4%) were
not using gloves which is consistent with other reports8.
However, in another study only 28% of the nursing care
workers in Iran did not use any personal protective
equipment10. In the present study, respondents indicated
that being in a hurry was the leading cause of their injury
which is consistent with other findings12. In other studies,
it has been shown that lack of experience in many
procedures, insufficient training, work overload and fatigue
leads to occupational sharp injuries15.
Furthermore, in this study out of the doctors who got
NSI, majority of them (91.8%) did not take post exposure
prophylaxis. Similar findings were reported by other
researchers7,11. A more recent survey of all types of providers
from Iowa medical organization found that 34% reported
their exposure to an employee health service16. The risk of
under reporting and thus delaying or foregoing treatment is
significant. HIV, Hepatitis B and Hepatitis C being highly
prevalent in the state of Manipur, the chances of being
infected by these diseases are high as our study indicates
that most needle pricks went unreported and untreated by
PEP. Our study found out that majority of the respondents
had not done HIV, HBV and HCV testing after the injury.
Reporting the injury to an authorized centre enables
counseling regarding the risk of exposure and prevention
to secondary transmission, including possible transmission
to patients.
We assessed only junior doctors because they are at
higher risk for needle stick injury. It might not be
representative of the RIMS doctors as a whole but still our
study could give some important information regarding NSI.
In our knowledge probably, this is the first survey of needle
stick injuries in Manipur and particularly in RIMS.
Information was self reporting and there is a possibility of
misclassification, although anonymous nature of the survey

would be expected to facilitate accurate reporting.

Conclusion
Needle stick injuries among junior doctors are common
and often not reported and majority of them did not take
post exposure prophylaxis. These findings warranted the
need for ongoing attention to strategies to reduce such
injuries in a systematic way and to improve reporting system
so that appropriate medical care can be delivered.
References
1.

Needlestick injury. Available at URL: http://

en.wikipedia.org/wiki/Needlestick_injury. Accessed on
27th Sept. 2011.

2.

Occupational health. Available at URL: http://

www.who.int/occupational_health/topics/neelinjuries/
en/index.html. Accessed on 27th Sept 2011.

3.

Sarrazin U., Brodt H.R., Sarrazin C., Zeuzem S.

Prophylaxis against HBV, HCV and HIV after
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2239, 2005.

4.

Centers for Disease Control and Prevention, Updated

US Public Health Service guidelines for the
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Jagger J., Puro V. DeCarli G. Occupational

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CDC Cooperative Needlestick Surveillance Group R.

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8.

Meunier O., Almeida N., Hernandez C., Bientz M.

Blood exposure accidents among medical students.
Med Mal Infect. 31:537-543, 2004.

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9.

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Patterson J.M., Novak C.B., Mackinnon S.E., Ellis

R.A. Needlestick injuries among medical students.
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Knowledge, Attitude, and Practice of Iranian

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needle stick injuries in medical, dental, nursing and
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14. Azap A., Ergnl O., Memikolu K.O., Yeilkaya A.,

Altunsoy A., Bozkurt G., Tekeli E. Occupational
exposure to blood and body fluids among health care
workers in Ankara, Turkey. AJIC. 33(1):48-52, 2005.

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Student nurses in Taiwan at high risk for needlestick
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B.J., Syin D., Gilson M.M., Sulkowski, Pronovost
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