Analysis of exposure status and influencing factors of sharp injury at a third-class specialist hospital in 2019-2022

doi:10.21203/rs.3.rs-5230880/v1

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Analysis of exposure status and influencing factors of sharp injury at a third-class specialist hospital in 2019-2022

https://doi.org/10.21203/rs.3.rs-5230880/v1

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Objective

To learn the current situation of medical staff's exposure to sharp injuries in a tertiary hospital in Chengdu, analyze its influencing factors, improve the awareness of protection, and reduce the risk of exposure to sharp injuries.

Methods

A retrospective study was conducted on the data related to occupational exposure in a top-three hospital from 2019 to 2022. This study carried out statistical description, single factor analysis and multi-factor analysis from the aspects of gender, years of service, occupation, exposure department and so on.

Results

From 2019 to 2022, 151 cases of occupational exposure and 115 cases (76.16%) of sharp injuries occurred in the hospital. There were significant differences in age (P < 0.001), years of service (P = 0.04) and years of exposure (P = 0.02), but no statistically significant differences among medical personnel in occupation (P = 0.52), exposure location (P = 0.52) and exposure department (P = 0.59). The results of multi-factor analysis showed that: Medical personnel with 1 to 5 years of service had a lower risk of sharp injuries than those with less than 1 year of service (OR = 0.26, 95%CI: 0.09 ~ 0.76). In 2021, when the COVID-19 epidemic is high, the risk of sharp injuries among medical personnel is higher than that of medical personnel in 2019 (OR = 4.32, 95%CI: 1.23 ~ 18.25). In addition, the main exposure site of sharp instrument injury was the hand, and the blood pathogen of the source patients was mostly HBV. Sharp injuries mainly occur after needle removal, when sorting items and in the process of treating patients. The medical workers who had occupational exposure were followed up, and no cases of infection due to occupational exposure were found.

Conclusion

The hospital should strengthen occupational protection training and standardize occupational operations for medical staff with short working years Pay attention to the physical and mental health of medical personnel and strengthen training during the outbreak of emergencies to effectively reduce the incidence of sharp injuries.

Health sciences/Health care/Occupational health

Health sciences/Health occupations

Health sciences/Risk factors

Sharp injury

Occupational exposure

Occupational protection

Medical staff

Occupational exposure of medical personnel refers to the contact with blood, tissue fluids, etc. containing pathogens through broken skin, mucous membranes, or the gastrointestinal tract or contact with other potentially infectious substances in the process of diagnosis, treatment, and care ¹, which may cause direct or indirect injuries to medical personnel, and may even threaten their lives. The most common occupational exposure of medical personnel is sharps injuries, with a global prevalence of 8.57%, according to WHO². In the context of medical care in China, medical personnel are exposed to high workloads over a long period of time, and occupational exposure can cause serious physical and psychological trauma to them^3,4. With the inclusion of HIV infection among healthcare workers due to occupational exposure in the category of occupational diseases⁵, occupational exposure of healthcare workers, especially sharp force injuries, has received increasing attention. Therefore, this study analyzed the current situation of sharps injury exposure in a tertiary hospital in Chengdu City and explored its risk factors to provide a basis for improving the awareness of protection and reducing the hazards of sharps injuries among healthcare workers.

Research Objects

Derived from data from the 2019–2022 Occupational Exposure Case Registry of a tertiary care specialty hospital.

Methods

Through a retrospective survey, we reviewed the Occupational Exposure Case Registry in the hospital data system reported in 2019–2022: (1) basic information: name, gender, length of service, etc. (2) occupational exposure: time, place, reason, and mode of exposure, results of the patient's transfusion immunization suite of tests (hepatitis B, hepatitis C, HIV, syphilis, etc), etc. (3) Post-exposure emergency treatment measures, post-exposure prophylactic medication, etc. The informed written consent was obtained from all participants.The ethics approval of this study was obtained from Medical Ethical Committee of West China School of Public Health and West China Fourth University Hospital that approved the research, confirm that all research was performed in accordance with Standard For Healthcare Associated Infection Surveillance(WS/T 312–2023).

statistical analysis

The Register of Occupational Exposure Cases was coded uniformly, and data entry was done using EpiData 3.1 software, while the data were organized, statistically described and statistically analyzed using R 4.2.2 software. For the statistical description of qualitative data, the component ratios were used; for the statistical description of quantitative data, the mean ± standard deviation was used. For one-way analysis, t-test, χ²-test or Fisher's exact probability method was used; logistic regression analysis was used for multi-factorial analysis. The test level α = 0.05.

Basic cases of sharp force injuries among medical personnel

The hospital reported 151 occupational exposures in 2019–2022, including 115 sharp injuries and 36 non-sharp injuries, as detailed in Table 1. The average age of medical personnel with occupational exposure was 28.7 ± 7.46 years, with a higher proportion of occupational exposure occurring among females, those with less than 1 year of service, and clinicians, accounting for 92.72%, 39.74%, and 29.80%, respectively, of each group. In terms of the occurrence of occupational exposures: the highest number of occupational exposures occurred in the sickroom (58.94%); other departments such as Rehabilitation Medicine, Occupational Disease, and Palliative Medicine were the departments with the highest number of occupational exposures (49.67%); and the number of occupational exposures in 2022 was the highest in four years (43.38%).

Table 1

Basic Situation Of Occupational Exposure Of Medical Personnel[n(%)]
Variable		In total^a	Sharp Injury	Non-sharp Injury	P-value^b
		151	115	36
Age		28.7 ± 7.46	28.30 ± 7.52	29.97 ± 7.19	< 0.001^***
Sex	Man	11 (7.28)	9	2	1.00
Sex	Woman	140 (92.72)	106	34	1.00
Years Of Service	≤ 1	60 (39.74)	51	9	0.04^**
	2 ~ 5	40 (26.49)	25	15
	> 5	51 (33.77)	39	12
Occupational Sategory	Clinician	45 (29.80)	33	12	0.52
	Nurse	85 (56.29)	64	21
	Others	21 (13.91)	18	3
Exposure Location	Sickroom	89 (58.94)	71	18	0.52
	Outside the sickroom	15 (9.93)	11	4
	Operating rooms	14 (9.28)	9	5
	Other locations	33 (21.85)	24	9
Exposure Department	Internal medicine department	33 (21.85)	27	6	0.59
	Surgical department	29 (19.21)	23	6
	Technical departments	14 (9.27)	9	5
	Other departments	75 (49.67)	56	19
Year Of Exposure	2019	40 (26.49)	28	12	0.02^**
	2020	32 (21.19)	19	13
	2021	36 (23.84)	32	4
	2022	43 (23.38)	36	7
Note: a: Quantitative data (e.g., age) indicate mean ± standard deviation, and qualitative data (e.g., gender, length of service, etc.) indicate number and composition ratio;
b: * indicates P < 0.05, indicates P < 0.01, and * indicates P < 0.001.

After univariate analysis, the results showed that the differences between the groups of whether the medical personnel had sharps injuries in terms of age (P < 0.001), years of service (P = 0.04), and year of exposure (P = 0.02) were statistically significant; the differences between the groups of whether the medical personnel had sharps injuries in terms of occupation (P = 0.52), exposure location (P = 0.52), and exposure department (P = 0.59) were not statistically significant.

Occurrence of sharp-force injuries among medical personnel

Of the 151 occupational exposures, 115 (76.16%) were sharp force injuries and all were hand exposures. The source pathogens of occupational sharps injuries in medical personnel were mainly HBV in 18 cases (15.65%), followed by syphilis in 1.74%, and unknown bloodborne pathogens in a further 50 cases (43.48%) of occupationally exposed source patients. The results showed that the instruments causing sharps injuries were mainly needles (86.09%) such as syringe needles (43.43%) and scalp needles (20.20%). The highest number of sharps injuries among medical personnel occurred after needle removal with 36 cases (31.30%), followed by organising items and during patient treatment.The incidence of sharps injuries among medical personnel is detailed in Table 2.

Table 2

Analysis Of The Incidence Of Sharp Force Injuries Among Medical Personnel
Variable		N	%
Exposure Site	Hand	115	100
Pathogen Species	Unknown Pathogen	50	43.48
	Negative	44	38.26
	Hepatitis B	18	15.65
	Syphilis	2	1.74
	Hepatitis C	1	0.87
Types Of Occupational Exposure	Needle	99	86.09
	Syringe Needle	43	43.43
	Scalp Needle	20	20.20
	Blood Collection Needle	10	10.10
	Intravenous Needle	8	8.08
	Insulin Needle	7	7.07
	Acupuncture Needle	6	6.06
	Suture Needle	5	5.05
	Cutters	6	5.21
	Other Nquipment	10	6.70
Exposure Time	After Nemoving The Needle	36	31.30
	When Sorting Out Items	26	22.61
	During The Course Of Treatment	19	16.52
	When Covering The Needle Cap	16	13.91
	When separating or transferring instruments	8	6.96
	Others (pathological tissue sampling, blood collection, loss/retrieval of equipment, at the time of injection, etc.)	10	8.70

Analysis of factors influencing the occurrence of sharps injuries among medical personnel

A multifactorial logistic regression model was performed with the incidence of sharps injuries among healthcare workers as the dependent variable and age at work, gender, occupation, place of exposure, year of exposure and department of exposure as the independent variables. Due to the covariance between age and seniority, only seniority was included in the model. The detailed assignment of the variables is shown in Table 3.

Table 3

Multi-factor Analysis Variable Assignment Table
Variable	assign a value
Sharp Injury	0= "no ", 1="yes"
Sex	0="man", 1="woman"
Years Of Service	0="≤1", 1="2 ~ 5", 2=">5"
Occupational Category	0="Clinician", 1="nurse", 3="others"
Exposure Location	0="sickroom", 1="outside the sickroom", 2="operating rooms", 3="Other locations"
Exposure Department	0="Internal medicine department", 1="Surgical department", 2="technical departments", 3="other departments"
Year of Exposure	0="2019", 1="2020", 2="2021", 3="2022"

The results showed that there were two factors affecting whether or not a medical staff member suffered a sharps injury, namely, the length of service and the year of exposure, where medical staff with 2–5 years of service had a lower risk of sharps injuries than those with ≤ 1 year of service (OR = 0.26, 95%CI: 0.09 ~ 0.76), and the risk of sharps injuries in 2021 was higher than the risk of sharps injuries in 2019 (OR = 4.32, 95%CI: 1.23 ~ 18.25). The risk of sharps injury was high (OR = 4.32, 95%, CI: 1.23 ~ 18.25), as detailed in Table 4.

Table 4

Logistic Regression Analysis Of Sharps Injuries Among Medical Personnel
Variable		β	SE	P-value	OR (95%CI)
Sex	Man	control subjects
Sex	Woman	0.07	0.90	0.94	1.07(0.14 ~ 5.45)
Years Of Service	≤ 1	control subjects
	2 ~ 5	-1.33	0.55	0.01^*	0.26 (0.09 ~ 0.76)
	> 5	-0.53	0.55	0.33	0.58 (0.19 ~ 1.72)
Occupational Category	Doctor	control subjects
	Nurse	-0.29	0.55	0.58	0.74 (0.24 ~ 2.14)
	Others	-0.40	0.91	0.66	0.67 (0.11 ~ 4.42)
Exposure Location	Sickroom	control subjects
	Outside The Sickroom	-0.81	0.73	0.26	0.44 (0.11 ~ 1.98)
	Operating Rooms	-0.86	0.83	0.30	0.42 (0.08 ~ 2.26)
	Other Locations	-0.35	0.64	0.58	0.07 (0.20 ~ 2.53)
Exposure Department	Internal Medicine Department	control subjects
	Surgical Department	-0.58	0.71	0.41	0.56 (0.14 ~ 2.26)
	Technical Departments	-0.22	0.93	0.82	0.80 (0.13 ~ 5.16)
	Other Departments	-0.41	0.58	0.48	0.66 (0.20 ~ 2.00)
Year of Exposure	2019	control subjects
	2020	-0.56	0.55	0.31	0.57 (0.19 ~ 1.69)
	2021	1.46	0.67	0.03^**	4.32 (1.23 ~ 18.25)
	2022	0.98	0.58	0.09	2.66 (0.87 ~ 8.74)
Note: * indicates P < 0.05, indicates P < 0.01, and * indicates P < 0.001.

Post-exposure care and follow-up monitoring

Occupationally exposed persons will receive emergency post-exposure treatment such as crushing, irrigation, disinfection and bandaging, as well as a series of pre-transfusion immunisation tests, and an occupational exposure risk assessment will be carried out based on the type of occupational exposure, autoimmunity and pathogens of the source patient, with targeted prophylactic use of medication. Health records of occupationally exposed persons are established in a timely manner, and regular follow-up and monitoring visits are carried out; to date, no one has been found to have contracted a disease due to occupational exposure.

A total of 151 occupational exposures occurred in 2019–2022, of which 115 or 76.16% were sharps injuries. The results of the multifactorial analysis showed that 2–5 years of service was a protective factor against the occurrence of sharps injuries, and the risk of sharps injuries was 0. 26 times higher than the risk of sharps injuries among medical personnel with ≤ 1 year of service, 95% CI: 0.09–0.76; and the risk of sharps injuries among medical personnel in 2021 was 4.32 times higher than the risk of sharps injuries among medical personnel in 2019, 95% CI: 1.23 ~ 18.25.

The results of this study showed that medical personnel with shorter years of service were more prone to sharps injuries, which is consistent with related studies^6–10. This may be related to the fact that medical personnel with shorter years of service are more prone to stress at a younger age, are less skilled in surgery, and undertake a large amount of clinical diagnosis and treatment⁹, as well as the fact that this tertiary specialist hospital, as a teaching hospital, receives a large number of interns, advanced training and training staff¹⁰. Low-working-age people are mostly interns, advanced learners and standardised trainers, who are not aware of self-protection, are not familiar enough with the work and environment of hospitals, are psychologically tense, have a low level of technical proficiency, and do not strictly implement the operating standards, which leads to a higher risk of occupational exposure law^11,12. It is recommended that preservice and on-the-job training for medical personnel with shorter years of service be strengthened to standardize practice and reduce the risk of sharps injuries.

The frequent occurrence of COVID-19 in 2021 is a risk factor for sharp force injuries. Following the major outbreak of COVID-19 in 2020, COVID-19 became a normalised situation in 2021, with frequent cases, an increase in the number of hospital visits and inpatients, and an increase in the physiological burden of medical personnel working long hours and at high intensity¹³. In addition, medical personnel are burdened with undue fear of infecting themselves and their families, as well as the psychological burden of frustration and self-blame for deaths¹⁴. The spread and outbreak of COVID-19 has placed significant physiological and psychological pressure on medical personnel, resulting in varying degrees of burnout and physical and mental fatigue^15,16. Therefore, it is recommended that the physical and mental health education of medical personnel be strengthened when similar special events occur, that necessary psychological guidance and physiological relaxation be provided, and that training be enhanced to effectively reduce the incidence of sharps injuries.

The majority of blood-borne pathogens in patients who had caused sharps injuries to medical personnel are the hepatitis B virus. Studies have shown that the prevalence of hepatitis B among medical personnel is approximately 10 times higher than in the general population¹⁷. Of the more than 20 pathogens that can be transmitted through sharps injuries, hepatitis B is considered the most dangerous¹⁸. It is therefore recommended that pathogens for which vaccines are available, such as HBV, should endeavour to achieve full immunization coverage. In addition, pathogens for which there are no specific preventive-related drugs, such as HCV and HIV, should strengthen occupational protection. A cause for concern is that 50 cases (43.48%) of occupationally exposed patients were exposed to unknown types of blood-borne pathogens. This suggests that the hospital's pathogen tracking in source patients needs to be strengthened, and that the tracking and treatment of occupational exposures after they occur needs to be further improved. The objective is to control the injuries of occupational exposures and sharps injuries of the medical personnel at the lowest level.

It is not possible to eradicate occupational exposure entirely. Nevertheless, the probability of such occurrences can be reduced by ensuring that the requisite level of protection is in place. (1) It is imperative to reinforce occupational protection training for medical personnel of a younger age, ensuring they are adequately informed of the requisite protection measures. Furthermore, it is essential to prioritise the physiological and psychological wellbeing of medical personnel, facilitating access to sufficient rest and psychological counselling. (2) It is imperative that medical personnel reinforce their standard operating procedures, particularly those pertaining to infusion and needle removal, in order to curtail the prevalence of high-risk behaviours and ensure the implementation of universal precautions. (3) It is recommended that improvements be made to the post-exposure disposal system, that there be an increase in awareness of the importance of proactive reporting, and that the tracking of pathogens in source patients be strengthened. It is incumbent upon medical personnel to adhere to the established management process in the event of occupational exposure, ensuring the prompt implementation of local treatment, proactive reporting, laboratory tests and medication.

This study aimed to identify the factors influencing the occurrence of sharps injuries in order to inform the development of enhanced protective awareness among medical personnel and the reduction of associated risks. Nevertheless, the study is subject to certain limitations. Firstly, the sample size was relatively small, and there is a lack of data, which may impact the extrapolation of the results. Secondly, the data were derived from the Occupational Exposure Case Registration Form of the hospital data system, which was completed and reported by medical personnel after the occurrence of occupational exposures. This may introduce recall bias.

In conclusion, medical staff with short working age and the epidemic frequency period in 2021 are risk factors for the occurrence of sharps injuries. It is recommended that this hospital implement more robust interventions for specific groups of medical personnel with limited working age, such as interns, and for special events, such as public health emergencies. These interventions should include enhanced training in occupational protection, a focus on the physiological and psychological wellbeing of medical personnel, and the standardisation of occupational procedures. This approach is likely to effectively reduce the incidence of sharps injuries.

Acknowledgements

We gratefully thank China National Natural Science Foundation and Sichuan

University for funding the study.

Author contributions

Data curation:Xiaoling Liu.

Methodology:Ruixin He, Guishuang Song.

Writing-original draft:Yuanyi Ji.

Writing-review & editing: Qiaolan Liu,Yongzhong Cheng.

Funding

This work was supposed by the National Natural Science Foundation of China (No.82273745) and Revitalisation Of Research Projects In The Management Discipline Of West China Forth Hospital, Sichuan University (No.2023MS02-02).

Competing interests

The authors declare no competing interests.

Consent for publication

Not applicable

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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No competing interests reported.

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You are reading this latest preprint version

Analysis of exposure status and influencing factors of sharp injury at a third-class specialist hospital in 2019-2022

Status:

Version 1

Abstract

Introduction

Methods

Research Objects

Methods

statistical analysis

Results

Basic cases of sharp force injuries among medical personnel

Occurrence of sharp-force injuries among medical personnel

Analysis of factors influencing the occurrence of sharps injuries among medical personnel

Post-exposure care and follow-up monitoring

Discussion

Conclusions

Declarations

References

Additional Declarations

Status:

Version 1