Educational Research (ISSN: 2141-5161) Vol. 4(9) pp. 654-658, September, 2013
DOI: http:/dx.doi.org/10.14303/er.2013.214
Available online@ http://www.interesjournals.org/ER
Copyright © 2013 International Research Journals
Full Length Research Paper
Sustained reduction in needlestick and sharp injuries
among nursing students: An initiative educational
program
Siham M. Al- Momani,*1 Maha Hdaib,2 Yahya W. Najjar3
*1
Assistant Professor, Department of Allied Medical Sciences
Al Balqa' Applied University
2
Lecturer, Department of Allied Medical Sciences, Al Balqa' Applied University
3
Lecturer, Department of Allied Medical Sciences, Al Balqa' Applied University
*Corresponding Authors E-mail: simomany @yahoo.com
ABSTRACT
Needlestick and sharp injuries are frequent and important cause of morbidity and mortality in
nursing students as other health care workers who come into contact with patient blood and body
fluids. Researchers identified education as an important aspect in reducing the needlestick and
sharp objects injuries among health care workers, and indicated the need for comprehensive
educational program which clearly links theory with practice rather than programs which
emphasized only on the knowledge part of infection control. This study determined the impact of a
comprehensive infection control initiative educational program on the reduction and sustainability
of lower rate of needlestick and sharp injuries among the nursing students participated in the
program. The comprehensive infection control initiative educational program was provided to
associate nursing students. The program aimed to increase the nursing students’ awareness of the
rate and risk of needlestick and sharp injuries, through establishing common improvement goals,
training on hand and environment care, wear protective measures, appropriate handling and
dispose of needles and sharp objects. Active teaching learning strategies such as audiovisual aid
presentation, focus group discussion and reflection were utilized. Incidents reports of needlestick
and sharp injuries among the nursing students over one semester before implementing the program
established the baseline data for the present study, indicated that the needlestick and sharp injuries
among the nursing students had been significantly declined as a result of their participation in the
program which sustained for two followed semesters. The comprehensive infection control initiative
educational program stimulates the participants to take an active part in defining their own
problems, establishing their goals, developing their solutions. It progressively reduced and
sustained reduction in needlestick and sharp injuries among the participants.
Keywords: Active teaching-learning strategies, associate nursing students, infection control initiative
educational program, infection control practices.
INTRODUCTION
Nursing Students as other health care workers who come
into contact with patient blood and body fluids may be
exposed to fatal infections as they perform their clinical
activities in the hospital (Ayranci and Kosgeroglu, 2004;
Yang et al., 2004; Smith and Leggat, 2005). They are
exposed to infections by pathogens, such as HIV,
hepatitis B and hepatitis C, from needlesticks, sharp
objects injuries and contacts with deep body fluids. The
risk of being infected following a single needlestick from a
source-patient with blood borne infection ranges from
Al- Momani et al. 655
as low as 0.3% for human immunodeficiency virus (HIV),
and 3% to 10% for hepatitis C to as high as 40% for
hepatitis B (Rpparini et al., 2007). The risk increases if we
know that 92.0% of needlestick and sharp injuries among
nursing students are unreported (Lukianskyte et al.,
2011).
Although infection control and management was a
pre requisite course for the nursing students for entering
the clinical practice placement, we have not been
successful in making the students aware of their
individual responsibility regarding their compliance with
infection control practices. Infection control and
management is an essential component of the associate
nursing curriculum, and it is a prerequisite course for
admitting nursing student to the clinical area, after which
a repeated incident of needlestick and sharp injuries
among nursing students were reported. This raised the
need to improve the nursing students’ orientation to and
compliance with infection control practices, in order to
reduce and sustained reduction in the needlestick and
sharp injuries rate among the nursing students the main
focus of the present study.
Researchers identified education as an important
factor in decreasing the incidents of needlestick and
sharp injuries among health care workers, and indicated
the need for more comprehensive infection control
educational programs which clearly links theory with
practice rather than programs which emphasized only the
theoretical part of infection control and management
(Wisniewski et al., 2007;Yang et al., 2007). Consequently,
this study sought to determine if comprehensive infection
control initiative educational program can reduce and
sustain lower rate of needlestick and sharp objects
injuries among the nursing students participated in the
program.
METHODS
This longitudinal, interventional study was conducted at
Al-Balqa Applied University/ Zarka College in the middle
of Jordan, with an approximate total enrolment of 3500
students. The comprehensive infection control initiative
educational program had been reviewed and approved
by the Institutional Review Board. The entire program
was divided into three phases. The first phase constituted
an analysis of the incidents reports documented the
needlestick and sharp injuries experienced by the nursing
students over one semester (16 – week period), which
help identify infection control practices and procedures of
the clinical practice area and the sources of deficits. This
time
period
(one
semester)
was
considered
representative of the needlestick and sharp injuries
happened among the associate nursing students.
The researchers identified target areas for
improvement which were validated by the hospital
infection control staff; the quality management staff and
the supervisors of nursing students in their clinical
practice. Four target areas for improvement were
approved by the experts; they are (1) Maximum
compliance with infection control practices, (2) hands and
environment care, (3) appropriate handling and disposing
of needles and sharp objects, and (4) wearing protective
measures.
The second phase included implementing the
comprehensive infection control initiative educational
program. Nursing students at a pre-planned meeting
were informed, oriented, and invited to participate in the
program. Then they received the program plan, and were
asked to facilitate the program through their participation.
Their participation was one mean of fulfilling the clinical
practice requirements according to which they were
evaluated for their compliance with infection control
practices.
Informed consent was obtained. Participants’
confidentiality and anonymity were maintained by
assigning random pseudonyms A, B, C, D and……….Z,
which were written on the questionnaire form. They
enabled the researchers to link the pre and post program
data. Potential participants required to pass copy of
needlestick or sharp object injury to the researchers and
assured that they could withdraw without prejudice at any
time.
Pre-intervention a covering letter that explains the
purpose of the study followed by the demographic
questionnaire in which the potential participant indicates
personal information about his/her age, total academic
average, total income of the family, medical insurance,
personal and family medical and surgical history of
hepatitis B vaccine and needlestick and sharp injuries.
Participants attended the first 8 hours workshop
which was divided into two days to gain the students
tolerance and collaboration. Reviewing of the infection
control practices, the importance of maximum compliance
with infection control practices, hands and environment
care, appropriate handling and disposing of needles and
sharp objects, and wear protective measures were
strengthened in this workshop. All nursing students
regardless of their decision to participate in the study or
not were allowed to attend the comprehensive infection
control educational program. The first educational day
was initiated through audiovisual presentations. In the
second day workshop, small and large focus group
discussions were utilized. Focus group discussions were
selected to stimulate the participants to take an active
part in defining their own problems, establishing their
goals, developing their solutions. The focus group
discussions as a strategy to capture the participants’
concerns and to describe their experiences had been
emphasized by many researchers (Parker and Tritter,
2006; Murray and King, 2010).
Toward the end of the workshop, potential
participants were asked to submit one or more pages
reflecting on one or more personal events of needlestick
656 Educ. Res.
Table.1 Participants Exposure to needlestick and other
sharp object injuries Baseline survey (N = 42)
Have you been Exposed to Needlestick or sharps
object injuries
Yes
No
24
18
57%
43%
and/or sharp injuries. Student’s reflective writing was
guided by group of questions derived from the work of
(Ruth-Sahd, 2003) which includes:
- What did I do?
- What should I have done that I did not?
- How would I act differently, what would I do next
time?
Reflection as a teaching learning strategy was driven
by issues and concerns rose by authors. Some authors
discussed the pervasive exercise of power that may
be inherent with reflection (Gilbert, 2001). While
other authors raised concerns about the importance of
sharing private thoughts (Bradbury-Jones et al., 2008),
and the importance of confidentiality and safe
environment in relation to reflection (Chirema, 2007).
Thus, nursing students were permitted to deliver the
individual reflective journals with the same pseudonyms
which were written on the demographic questionnaire.
After participating in the comprehensive infection control
initiative educational program, potential participants were
asked to submit a copy of any personal needlestick or
sharp injury occurred after their involvement in the
program to the researchers. Also, a copy of hepatitis B
vaccine document either if it is an initial or a follow up
dose should be given to the researchers. Excellent
participation in the educational activities was rewarded by
different forms of small gifts donated from the
researchers.
Four months after the first workshop, the second
workshop the same as the first workshop program was
conducted for all nursing students including the potential
participants before they returned to clinical practice for
the final pre-graduate semester. The researchers thought
that the repetition of the workshop will allow the nursing
students to exchange their experience and emphasize
the importance of maximum compliance with infection
control practices, hands and environment care,
appropriate handling and disposing of needles and sharp
objects, and wear protective measures. Both workshops
were planned, facilitated and coordinated by the
researchers.
Phase three: Evaluation of the impact of
implementing the comprehensive infection control
initiative educational program in the needlestick, sharp
injuries rate and the hepatitis B vaccine coverage.
RESULTS
Needlestick and sharp injury were defined as the
occurrence of one or more needlestick, or sharp injuries
with used needle, or contaminated sharp object. Hepatitis
B vaccine coverage used as an indicator for the nursing
student’s compliance with infection control practices.
During the entire study period, daily feedback on
needlestick and sharp injuries incidents was given to the
researcher – corresponding author - by the hospital
infection control staff to validate the participant’s report.
All the second year nursing students committed
completely to the comprehensive infection control
initiative educational
program
and
the
study
requirements, 36 students of them were female and 6
students were male. The average age of the participants
was 20 years (SD = 3.2), and their academic average
was 65% (SD = 7.5). The needlesticks, sharp injuries and
hepatitis B vaccine information for the potential
participants toward the end of the first clinical semester
period was considered as a baseline rate. The
comprehensive infection control initiative educational
program was implemented before the nursing students
admitted to the second clinical semester. The post
intervention period was the period extended over the
second and third clinical semesters. The third clinical
semester is the final pre-graduate semester for the
associate nursing students. The data were analyzed with
SPSS statistical package. Descriptive statistics were also
examined. An alpha level of 0.05 was used for all
statistical tests.
The needlestick and sharp injuries rate during the
baseline period was 57%, which was significantly
decreased by 24% in the second period reading with (P <
.001) (Table 1).
In the third reading (second follow up period), there
was further reduction in needlestick and sharp injuries
rate to 2%, a fall of 55% from baseline reading with (P <
.001) (Table 2).
Hepatitis B vaccine coverage among the participants
significantly increased from 33% in the baseline reading
to 67% (P < .001) in the second period reading (Table 3).
In the third reading 100% of the participants reported that
they have received the full series of hepatitis B vaccine
with (P < .001) (Table 4).
Al- Momani et al. 657
Table 2. Participants Exposure to needlestick and other sharp object
injuries 36 week post participation in the educational program
comparative reading (N = 42)
Have you been Exposed to Needlestick or sharps object injuries
Baseline survey
36 wks post participation
Yes
No
Yes
No
24
18
1
41
57%
43%
2%
98%
(P < .001)
Table 3. Hepatitis B vaccine coverage among the
participants Baseline survey (N = 42)
Have you been received the full hepatitis B vaccine series
Yes
No
14
18
33%
43%
Table 4. Hepatitis B vaccine coverage among the participants 36 week
post participation in the educational program comparative reading (N = 42)
Have you been received the full hepatitis B vaccine series
Baseline survey
36 wks post participation
Yes
No
Yes
No
14
18
42
0
33%
43%
100%
0%
(P < .001)
DISCUSSION
The overall findings of this study provided evidence to the
potential value of the comprehensive infection control
initiative educational program in reducing the rate of
needlestick and sharp injuries among the participants.
The incidents of needlestick and sharp injuries declined
from 57% to 33% among the participants after 16 weeks
of implementing the program, and further decline in the
rate of the incidents to reach 2% among the participants.
This total significant decline in the rate of needlestick and
sharp injuries, and the sustainability of progressive
significant decline which reached 55% with only one
incident of needlestick among the participants over 16
week toward the end of the follow up period highlighted
the importance of moving from the traditional didactic
methods to more interactive approaches which match the
findings of Mikkelsen et al., 2007; Reime, 2008.
The study findings clarified that there is still
insufficient attention paid to the prevention of needlestick
and sharp injuries for nursing students during their
training in hospitals. This was indicated by the number of
needlesticks, sharp injuries and the coverage of hepatitis
B vaccine in the baseline survey of this study. It also
indicated that more attention should be paid to culture,
attitudes and practices in the clinical practice
environment among the clinical nursing staff and other
health care workers, which was emphasized and
recommended by Schelonka, 2006. The findings
highlighted the importance to use the medical devices as
one of the most important steps to reduce and prevent
needlestick and sharp injuries, which was recommended
by Adams and Elliott, 2006; Lamontagne et al., 2007. The
study findings also indicated that hepatitis B vaccination
series should be recommended to be obligatory prerequisite for admitting the nursing students to clinical
practice areas in order to protect them from the risk of
their or their colleagues’ malpractices.
The limitations of this study include the small sample,
lack of control group, and the purposive convenience
sample selection which could prohibit the generalization
of the study findings. Although, the study results depend
on the students self report of needlestick and sharp
injuries. Validity and reliability of the results could be
658 Educ. Res.
higher if mixed method as observation either by the
clinical teacher or the students’ preceptors used for
identifying the needlestick and sharp injuries to overcome
any unreported cases. The use of needlesticks, sharp
injuries and hepatitis B vaccination only as indicators for
the impact of the comprehensive infection control
initiative educational program may limit observing other
effects of the program, such as compliance with infection
control practices and procedures which could have
indirect effect on the reduction of needlestick and sharp
injuries rate reported in this study findings. However, the
outcomes of this study provide evidence that the
comprehensive infection control initiative educational
program which utilized different interactive teaching
learning strategies helped nursing students learn from
their own experiences and improve their own practices.
Taking into account that reduction of needlestick and
sharp injuries among the participants minimizes their risk
for hospital infection, collaborative effort including the
academics and hospital administrators is needed to plan,
implement, and evaluate hospital based programs to
increase compliance with standard precautions and
reduce the hospital infection rate. Faculty members of
nursing colleges need to consider ways in which they can
contribute to affect positive change in clinical settings.
In conclusion, further studies which rely on mixed
method approaches, interdisciplinary collaboration, and
involve all of the health care workers are highly
recommended.
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How to cite this article: Al- Momani SM, Hdaib M, Najjar YW
(2013). Sustained reduction in needlestick and sharp injuries
among nursing students: An initiative educational program. Educ.
Res. 4(9):654-658