ISSN: 2161-1165                   Epidemiology: Open Access                  The International Open Access                ...
Hashmi et al., Epidemiol 2012, 2:2              Epidemiology                                                              ...
Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, N...
Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, N...
Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, N...
Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, N...
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Prevalence of NSI among healthcare workers of Najran Saudi Arabia


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Prevalence of NSI in MCH Najran ASA

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Prevalence of NSI among healthcare workers of Najran Saudi Arabia

  1. 1. ISSN: 2161-1165 Epidemiology: Open Access The International Open Access Epidemiology Executive Editors Ann Marie Kimball University of Washington School of Medicine, WA Gordon Stephen Smith University of Maryland School of Medicine, MD Anthony Clifford Keech The University of Sydney, Australia Edward J. Trapido LSUHSC School of Public Health, LA James J. Collins Saginaw Valley State University Bay City, MichiganAvailable online at: OMICS Publishing Group ( T his article was originally published in a journal by OMICS Publishing Group, and the attached copy is provided by OMICS Publishing Group for the author’s benefit and for the benefit of the author’s institution, for commercial/research/educational use including without limitation use in instruction at your institution, sending it to specific colleagues that you know, and providing a copy to your institution’s administrator. All other uses, reproduction and distribution, including without limitation commercial reprints, selling or licensing copies or access, or posting on open internet sites, your personal or institution’s website or repository, are requested to cite properly. Digital Object Identifier:
  2. 2. Hashmi et al., Epidemiol 2012, 2:2 Epidemiology Open Access Research Article Research Article Open Access Open AccessPrevalence of Needle-stick and Sharps Injuries among HealthcareWorkers, Najran, Saudi ArabiaAnjum Hashmi*, Samer Abu Al Reesh and Lisa IndahInfection Control Specialist, Najran General Hospital, Najran, Saudi Arabia Abstract Introduction: An investigation estimates that needle-stick and sharps injuries affect about 3.5 million individuals on the global level. In healthcare workers nurses and physicians appear especially at risk. Objectives: To examine the epidemiology of occupational sharps injuries in Health care workers. Material and methods: It is retrospective cross-sectional study was carried out among the Health Care Workers of Maternity and Children’s Hospital, KSA from 1st January to 30th June 2012 with participation of 750 HCWs by Convenient sampling technique. Data entry and analysis was done on EPINetTM. Results: A total of 32 cases of sharps injuries occurred during the six months period. Nurses accounted 46.9%, constituting the largest group of the Health Care Workers. Most frequently site of occurrence was operating/recovery room 34.4%. 64.5% of injuries occurred “during use of device.” In 90.6% of cases injuring item was contaminated. 59.4% injuries occurred while wearing single pair of gloves, only 21.9% with double pair of gloves. Most common site of injury was the right hand. Conclusion: There can be serious consequences of needle stick injuries in hospitals as large proportion of injuries involves used needles and sharps if health care workers do not take appropriate measures of protection.Keywords: Prevalence; Needle-stick injuries; Occupational exposure; and new engineered devices, sharps disposal containers needed toCommunicable diseases; Health education; Hospitals infection control; prevent sharps injuries, and also prophylaxis after percutaneous injuryMedical waste disposal; Saudi Arabia [6]. Because of the environment in which HCWs work, many HCWs from physicians, surgeons, and nurses to housekeeping personnel,Introduction laboratory technicians and waste handlers are at an increased risk of Needle-stick and Sharp Injuries (NSIs) are accidental skin accidental needle stick and sharps injuries [5]. Data from the EPInetTMpenetrating wounds caused by sharp instruments in a medical setting. system suggest that at an average hospital, workers incur approximatelyThey are defined as an accidental skin penetrating wound caused by 30 needle-stick injuries per 100 beds per year [7]. Standard precautionshollow-bore needles such as hypodermic needles, blood-collection are advocated for reducing the number of injuries caused by needles andneedles, Intra-venous (IV) catheter stylets, and needles used to connect sharp medical devices (“sharps injuries”), and also the effectiveness ofparts of IV delivery system, scalpels and broken glass. Healthcare gloves in preventing such injuries has not been established. The factorsWorkers (HCWs) face a high risk of an occupational exposure to blood, associated with gloving practices and identified associations betweenwhich can lead to the transmission of pathogens causing an infection gloving practices and sharps-injury risk. Gloves reduced injury riskand resulting in hazardous consequences for their health. Hepatitis in case-crossover analyses (Incidence Rate Ratio (IRR), 0.33 {95% CI,B, Hepatitis C, and Human Immunodeficiency Virus (HIV) are of 0.22-0.50}). In scrubbed individuals, involvement in an orthopedicutmost concern because they can cause significant morbidity or death. procedure was associated with double gloving at injury (OR, 13.7 {95%The common high risk situation of such an occupational exposure is CI, 4.55-41.3}); this gloving practice was associated with decreasedpercutaneous injury which is a high risk injury. injury risk (IRR, 0.20 {95% CI, 0.10-0.42}). Although the use of gloves reduces the risk of sharps injuries in health care, use among healthcare The frequency of such events has been estimated to be about 800,000 workers is inconsistent and may be influenced by risk perception andcases in the United State of America alone (EPInet TM1999 report) [1]. healthcare culture. Glove use should be emphasized as a key element ofAnother investigation estimates the rates of injuries on a global level multimodal sharps-injury reduction programs [8]. In 2007, Associationto affect about 3.5 million individuals [2]. Among healthcare workers of Preoperative Registered Nurses (AORN’s) recommended Practicesnurses and physicians appear especially at risk; [3] and an investigationamong American surgeons indicates that almost every surgeonexperienced at least one such injury during their training [4]. Causesof sharps injury include various factors like type and design of needle, *Corresponding author: Dr. Anjum Hashmi MPH, Infection Control Specialist, Najran General Hospital, Najran, Saudi Arabia, Tel: 00966549094925; E-mail:recapping activity, handling/transferring specimens, collision between anjumhashmi61@yahoo.comHCWs or sharps, during clean-up, manipulating needles in patient Received July 13, 2012; Accepted August 25, 2012; Published August 27, 2012line related work, passing/handling devices or failure to dispose of theneedle in puncture proof containers [5]. Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, Najran, Saudi Arabia. Epidemiol An American study shows inadvertent puncture during use, 2:117. doi:10.4172/2161-1165.1000117disassembly, or disposal of needles or sharp devices (called collectively, Copyright: © 2012 Hashmi A, et al. This is an open-access article distributed under“sharps”) which creates risk beyond a simple puncture. Thus incidence the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author andof sharps injury remains unacceptably high. Policy, practice, training source are credited. Epidemiol ISSN:2161-1165 Epidemiol an open access journal Volume 2 • Issue 2 • 1000117
  3. 3. Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, Najran, Saudi Arabia. Epidemiol 2:117. doi:10.4172/2161-1165.1000117 Page 2 of 5Task Force revised the “Recommended practices on prevention Ethical Considerationof transmissible infections in the preoperative practice setting” torecommend that health care practitioners should double-glove during Study was approved by ICC Ethical Board of Maternity andinvasive procedures. Previously, AORN had suggested that wearing Children’s Hospital (MCH) Najran, Saudi Arabia.two pairs of gloves might be indicated for some procedures. Research Material and Methodson the protective effects of double gloving provides compellingevidence that surgical personnel should double-glove during all This retrospective cross-sectional study was carried out among thesurgical procedures [9]. There can be serious consequences of needle HCWs (both males and females) of Maternity and Children’s Hospital,stick injuries in third world public hospitals as large proportion of a 200 bedded hospital of Najran Saudi Arabia. The study durationinjuries involves non-sterile used needles and health care workers do was six months i.e., from 1st January to 30th June 2012 involving 750not take appropriate measures of protection [10]. A Mongolian study HCWs by convenient sampling technique? The study group consistedconcludes that promotion of adequate working conditions, elimination of HCWs including doctors (consultants, specialists and residents),of excessive injection use, and adherence to universal precautions will nurses, allied health care staff, medical waste disposal personals andbe important for the future control of potential infections with blood- cleaners.borne pathogens due to occupational exposures to sharps [11]. Case definition of NSI in the present study included injuries caused The introduction of safety devices is one of the main starting points by sharps such as hypodermic needles, blood collection needles,for avoidance of needle-stick injuries, and acceptance among healthcare intravenous cannulas, suture needles, winged needle intravenous sets,workers is high. Further targets for preventive measures, such as needles used to connect parts of the intravenous delivery systems andtraining in safe working routines, are necessary for improvement of work conditions [12]. Engineered devices can significantly reducethe incidence of such injuries even cost analyses indicate that use of The HCWs were requested to report sharps injury incidents tothese devices will be cost-effective in the long term. But introduction the Infection Control Nurse when the incidents occurred. Those whoof such devices should accompanied with the necessary education were involved in the incidents were required to personally complete anand training, as part of a comprehensive sharps injury prevention and EPINetTM form which is translated in Arabic or with help of in-chargecontrol program [13]. A British study states that less number of NSIs nurse especially in case of cleaners due to their low education level.occurs when using safety syringes and to avoid NSIs, education plays Data was uploaded on EPInetTM website and finally analysis is done bya vital role particularly with effective implementation of the change to syringes with appropriate training [14]. Healthcare organizations Written consent had been obtained from the health care workerscan improve staff safety by investing wisely in educational programs who were involved in the study. To counter under reporting aspect ofregarding approaches to minimize NSIs risks. National Sheep Identification System (NSIs) Ministry of Health KSA In Saudi Arabia EPINetTM Needle Stick and Sharp-Object Injury issued a circular that any staff that becomes positive to HBV, HVC orReport have been compiled using the data from 21 facilities from HIV as a result of NSI his/her contract shall not be terminated.January 1st to March 31st, 2012. According to this report, nurses are theprimary injured staff, totaling 66.4%, as compared to 7.8% of which Resultsare physicians. The primary locations where these injuries occur are in A total of 32 cases of sharps injuries occurred during the six monthsthe patient room (48.9%), the Emergency Department (13.6%) and the period. Registered nurses accounted for 15 cases 46.9%, constitutingOperating/Recovery Room (11.5%). 89.3% of the sharp items involved the largest group of the HCWs. The incidents occurred most frequentlyin the injuries are contaminated. Most of the injuries occur during in the operating/recovery room which were 11 cases 34.4% (Figureinjections (17.9%), drawing of venous blood samples (17.2%), and 2). Twenty cases (64.5%) of the injuries occurred by needles duringsuturing (14.8%). 41.9% of the time the injuries occur during the use of use of device (Figure 3) (Table 1). In twenty nine cases 90.6% injuringthe sharp items, while 18.6% are injured after use, but before disposal. item was contaminated. Disposable syringe account for 11 cases 35.5%The principal devices causing the injuries are disposable syringes and next was suture needle which accounts for 9 cases 29%. 19 injuries(57.1%), 64.4% of the time they are not “safety devices”. Injuries (59.4%) occur while wearing single pair of gloves only 7 (21.9%) withprimarily occur to the hands of the staff. 68.3% of sharps penetrated double pair of gloves (Table 2). Most common site of NSI was rightwhen the staff wore a single pair of gloves, 26.9% wore no gloves at all,and 4.8% wore a double pair of gloves, which may have reduced theoverall penetration of the sharps [15]. IMMEDIATE CARE OF INJURY In our hospital we had a training program to reduce the numberof Needle-stick injuries and to increase the awareness of our staff,through comprehensive lecture on standard precaution which includesof hand hygiene, proper disposal of sharps, proper use of Personal Risk INCIDENCEProtective Equipment (PPE), use of double gloves in operating rooms, PLAN Reduction DOCUMENTATIONno recapping and if inevitable use of one hand scope method and staffimmunization. According to our NSIs management plan every staffshould be aware about their immunization status (Figure 1).Objectives MANGEMENTOF EXPOSED HCWS RISK ASSESMENT To examine the epidemiology of occupational sharps injuries of Figure 1: Maternity and Children’s Hospital NSI Management Plan.HCWs. Epidemiol ISSN:2161-1165 Epidemiol an open access journal Volume 2 • Issue 2 • 1000117
  4. 4. Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, Najran, Saudi Arabia. Epidemiol 2:117. doi:10.4172/2161-1165.1000117 Page 3 of 5 it is common for only a small proportion to be reported; and knowledge Where Injury Occurred about needle-stick injuries and possible infection from blood-borne 12 pathogens is often low and risks under-estimated. But these facts may provide useful information for planning measures to reduce sharps 10 10 injuries. In our study nurses accounted for 46.9% of cases, constituting the largest group of HCWs probably due to work load, this was also 8 8 endorsed by a Swiss study mentioning NSIs were more frequent among nurses (49.2%) and doctors performing invasive procedures 6 (36.9%) [14]. Association of Preoperative Registered Nurses (AORN’s) 5 Recommended Practices Task Force revised the “Recommended 4 4 practices on prevention of transmissible infections in the preoperative practice setting” to recommend that health care practitioners double- 2 2 2 glove during invasive procedures in 2007. Previously, AORN had 1 suggested that wearing two pairs of gloves might be indicated for 0 some procedures. Research on the protective effects of double gloving provides compelling evidence that surgical personnel should double- ea om d y om t it ar en er Un Ar Ro /W ov glove during all surgical procedures [10] An American study showed Ro rtm ty e ec m y ar e ili pa oo er ur /R lC Ut De liv ed tR om e/ a De the frequency of seeing blood on the hand after surgery was greater ic oc ic y n Ro nc rit tie rv Pr nd /C Se ge Pa g 10 ra in ve er 13 at1 bo si with single gloving than with double gloving [27]. A Pakistani study Em er n La te Op 3 In 16 5 4 Figure 2: Where Injury Occurred. also mentions almost 90% who received NSI were not wearing gloves or taking any other protective measures at the time of injury [21]. In our study most injuries 59.4% occur while wearing single pair of Original Purpose gloves only 21.9% with double pair of gloves thus our study validates these studies and also the AORN’s recommendations. In our study 16 96.9% items causing NSIs have no safety design. An Australian 14 14 study concluded introduction of self-retracting safety syringes and elimination of butterfly needles should reduce the current hollow-bore 12 NSI by more than 70% and almost halve the total incidence of NSI [28]. 10 A German study mentions that the rate of such injuries depends on the medical discipline. Implementation of safety devices will lead to an 8 improvement in medical staff’s health and safety [29]. A French study 6 also showed that passive (fully automatic) devices were associated 6 with the lowest NSI incidence rate. Among active devices, those with 4 4 a semiautomatic safety feature were significantly more effective than 3 2 those with a manually activated toppling shield, which in turn were 2 1 1 significantly more effective than those with a manually activated sliding 0 shield [30] (P<0.001). Saudi Arabian EPInetTM report 2012 which g e e k rin e us lin ib ic rt pl po tu cr st o m V ne Su es sa tI el or ta ec he ,d 11 d cu te oo nn er k/ si ub ic th bl co When Injury Occurred n st /s O io us er r To 15 la ct no ng cu je 5 ve in Fi us 25 IV 10 m a aw t0 tra in dr in n To n, io tio ct 7 20 je ec in j In 20 er2 th O 4 Needlestick-Reporting Period: All Records Figure 3: Original Purpose of Item. 15 Count 10hand. Source patients were identified in 27 cases (84.4%). 96.9% ofNSI causing items has no safety design (Table 3). Superficial injury 5 4with little or no bleeding occurred in 15 (46.9%) cases, moderate skin 3 2 1 1puncture with some bleeding also occurred in 15(46.9%) cases and only 02 (6.3%) cases had severe deep stick/cut with profuse bleeding. le e m e ib ed er l ur te sa cr ne in ed i o es of ta sp oc ed d n eDiscussion di co pr r, us us he re p l g a sa Ot fo te rin g o be -s in 14 sp Du ti pp , ul di se 2 ca m ru e re th a When we compared our study with other reports [16-26] there fte of le to ra hi in s ep W he m stwas no apparent difference in the characteristics of the NSIs. The 6 ite Ot n e ee 8 th tw ng Becircumstances of the injuries varied with the kinds of instruments. Due tti 3 pu leto the differences between studies, it is not possible to quantitatively hi W 10synthesize their results; nonetheless, some common themes emerge, Needlestick--Reporting Period: All Recordssuch as - needle-stick injuries are common; needle-stick injuries are Figure 4: When Injury Occurred.often under-reported and when levels of reporting have been examined, Epidemiol ISSN:2161-1165 Epidemiol an open access journal Volume 2 • Issue 2 • 1000117
  5. 5. Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, Najran, Saudi Arabia. Epidemiol 2:117. doi:10.4172/2161-1165.1000117 Page 4 of 5included our hospital also showed 64.4% of the time injuring item was VARIABLE NUMBER PERCENTAGEnot safety devices but in our hospital 96.9% injuries occurred by non SOURCE PATIENT IDENTIFIABLEsafety design item [7] so we can conclude that if the safety devices are Yes 27 84.4%provided injury rate would have been less, thus our study endorses the No 2 6.3%essentiality of safety devices. Unknown 3 9.4% "SAFETY DESIGN" NEEDLE / SHARPConclusions No 31 96.9% Needle-stick injuries are an important and continuing cause of Unknown 1 3.1%exposure to serious and fatal diseases among health care workers. LOCATION OF INJURYGreater collaborative efforts by all stakeholders are needed to prevent Foot 2 6.3%needle-stick injuries and the tragic consequences. Hand, left 13 40.6% Hand, right 17 53.1% Such efforts are best accomplished through a comprehensive Table 3: NSIs numbers and percentages respondent categories (n=32).VARIABLES NUMBER PERCENTAGE program that addresses institutional, behavioral, and device-relatedJOB CATEGORY factors that contribute to the occurrence of needle-stick injuries inDoctor (Specialist/Consultant) 3 9.4% health care workers. Critical to this effort is the elimination of needleDoctor (Resident) 7 21.9% bearing devices where safe and effective alternatives are available andNurse 15 46.9% the development, evaluation, and use of needle devices with safetySurgery attendant 4 12.5% features.Technologist (Non lab) 1 3.1%Laundry Worker 2 6.3% LimitationsWHERE INJURY OCCURED This study has several potential limitations, primarily because itPatient Room/Ward 8 25.0% was a retrospective review of surveillance data and the number of casesEmergency Department 4 12.5% was relatively small. Reporting bias may have resulted in health careIntensive/critical Care Unit 5 15.6% workers preferentially reported exposure that they believed was moreOperating Room/Recovery 10 31.3% likely to result in HBV, HBC and HIV.Procedure Room 1 3.1%Service/Utility Area 2 6.3% AcknowledgmentLabor and Delivery Room 2 6.3% Our heartiest acknowledgment to Hospital Director MCH Najran KSA andWHEN INJURY OCCURED Director General of Infection Control Najran Region KSA.During use of item 20 64.5% ReferencesBetween steps of a multi-step procedure 4 12.9% 1. Chalupa S, Markkanen PK, Galligan CJ, Quinn MM (2008) Needlestick andWhile recapping a used needle 1 3.2% Sharps Injury Prevention: Are We Reaching Our Goals? AAACN Viewpoint.Other after use, before disposal 3 9.7% 2. Prüss-Ustün A, Rapiti E, Hutin Y (2005) Estimation of the global burden ofWhile putting the item into the disposal 1 3.2% disease attributable to contaminated sharps injuries among health-carecontainer workers. Am J Ind Med 48: 482-490.Other, describe 2 6.5% 3. Exposure prevention information network data reports. University of Virginia: Table 1: NSIs numbers and percentages respondent categories (n=32). International Health Care Worker Safety Center. EPINet (1999)VARIABLE NUMBER PERCENTAGE 4. Makary MA, Al-Attar A, Holzmueller CG, Sexton JB, Syin D, et al. (2007) Needle-stick injuries among surgeons in training. N Engl J Med 356: 2693-WAS THE SHARP ITEM CONTAMINATED 2639.Contaminated 29 90.6% 5. Wilburn SQ (2004) Needle sticks and sharps injury prevention. Online J IssuesUncontaminated 1 3.1% Nurs 30: 5.Unknown 2 6.3% 6. Zanni GR, Wick JY (2007) Preventing needle-stick injuries. Consult Pharm 22:TYPE OF DEVICE CAUSING INJURY 400-402.Syringe, disposable 11 35.55Syringe, blood gas 1 3.2% 7. EpinetTM (1999) Exposure prevention information network data reports. University of Virginia, International Health Care Worker Safety Center.Syringe, other type 1 3.2%IV catheter 3 9.7% 8. Kinlin LM, Mittleman MA, Harris AD, Rubin MA, Fisman DN (2010) Use of gloves and reduction of risk of injury caused by needles or sharp medicalNeedle/holder vacuum tube blood collection 1 3.2% devices in healthcare workers: results from a case-crossover study. InfectNeedle, unattached hypodermic 2 6.5% Control Hosp Epidemiol 31: 908-917.Needle, describe 1 3.2% 9. Thomas-Copeland J (2009) Do surgical personnel really need to double-glove.Suture Needle 9 29.0% AORN J 89: 322-328.Scalpel, reusable 1 3.2% 10. Aslam M, Taj T, Ali A, Mirza W, Ali H, et al. (2010) Needle-stick injuries amongScalpel, disposable 1 3.2% health care workers of public sector tertiary care hospitals of Karachi. J CollSHARP ITEM PENETRATED Physicians Surg Pak 20: 150-153.Single pair of gloves 19 59.4% 11. Kakizaki M, Ikeda N, Ali M, Enkhtuya B, Tsolmon M, et al. (2011) Needle-stickDouble pair of gloves 7 21.9% and sharps injuries among health care workers at public tertiary hospitals in anNo gloves 6 18.8% urban community in Mongolia. BMC Res Notes 4: 184. Table 2: NSIs numbers and percentages respondent categories (n=32). 12. Wicker S, Ludwig AM, Gottschalk R, Rabenau HF (2008) Needle-stick injuries Epidemiol ISSN:2161-1165 Epidemiol an open access journal Volume 2 • Issue 2 • 1000117
  6. 6. Citation: Hashmi A, Al Reesh SA, Indah L (2012) Prevalence of Needle-stick and Sharps Injuries among Healthcare Workers, Najran, Saudi Arabia. Epidemiol 2:117. doi:10.4172/2161-1165.1000117 Page 5 of 5 among health care workers: occupational hazard or avoidable hazard? Wien 22. Alzahrani AJ, Vallely PJ, Klapper PE (2000) Needlestick injuries and hepatitis Klin Wochenschr 120: 486-492. B virus vaccination in health care workers. Commun Dis Public Health 2000; 3: 217-218.13. Tan L, Hawk JC 3rd, Sterling ML (2001) Report of the Council on Scientific Affairs: preventing needle-stick injuries in health care settings. Arch Intern Med 23. Varma M, Mehta G (2000) Needle sticks injuries among medical students. J 161: 929-936. Indian Med Assoc 98: 436-438.14. Gaballah K, Warbuton D, Sihmbly K, Renton T (2012) Needle-stick injuries 24. Ippolito G, Puro V, Petrosillo N, De Carli G (1999) Surveillance of occupational among dental students: risk factors and recommendations for prevention. exposure to blood borne pathogens in health care workers: The Italian national Libyan J Med. experience. Euro Surveill 4: 33-36.15. Alysia Giani (2012) EPINet™ Report: Needle Stick Injury Incidents Are High. 25. Resnic F, Noerdlinger MA (1995) Occupational exposure among medical SAFE: 6 students and house staff at a New York City medical center. Arch Intern Med 155: 75-80.16. Memish ZA, Almuneef M, Dillon J (2002) Epidemiology of needle-stick and sharps injuries in a tertiary care center in Saudi Arabia. Am J Infect Control 26. Kermode M, Jolley D, Langkham B, Thomas M, Crofts N (2005) Occupational 30: 234-241. exposure to blood and risk of blood borne virus infection among health care workers in rural North Indian settings. Am J Infect Control 33: 34-41.17. Newsom DH, Kiwanuka JP (2002) Needle-stick injuries in an Ugandan teaching Hospital. Ann Trop Med Parasitol 96: 517-522. 27. Korniewicz D, El-Masri M (2012) Exploring the benefits of double gloving during surgery. AORN J 95: 328-336.18. Shiao J, Guo L, McLaws ML (2002) Estimation of the risk of blood pathogens to health care workers after a needle stick injury in Taiwan. Am J Infect Control 28. Whitby RM, McLaws ML (2002) Hollow-bore needle stick injuries in a tertiary 30: 15-20. teaching hospital: epidemiology, education and engineering. Med J Aust 177: 418-422.19. Abu-Gad HA, Al-Turki KA (2001) Some epidemiological aspects of needle stick injuries among the hospital health care workers: Eastern province. Saudi 29. Wicker S, Jung J, Allwinn R, Gottschalk R, Rabenau HF (2008) Prevalence Arabia. Eur J Epidemiol 17: 401-407. and prevention of needle-stick injuries among health care workers in a German university hospital. Int Arch Occup Environ Health 81: 347-354.20. Karstaedt AS, Pantanowitz L (2001) Occupational exposure of interns to blood in an area of high HIV seroprevalence. S Afr Med J 91: 57-61. 30. Tosini W, Ciotti C, Goyer F, Lolom I, L’Hériteau F, et al. (2010) Needle-stick injury rates according to different types of safety-engineered devices: results of21. Puro V, DeCarli G, Petrosillo N, Ippolito G (2001) Risk of exposure to blood a French multicenter study. Infect Control Hosp Epidemiol 31: 402-407. borne infection for Italian Health Care Workers, by job category and work area. Infect Control Hosp Epidemiol 22: 206-210. Submit your next manuscript and get advantages of OMICS Group submissions Unique features: • User friendly/feasible website-translation of your paper to 50 world’s leading languages • Audio Version of published paper • Digital articles to share and explore Special features: • 200 Open Access Journals • 15,000 editorial team • 21 days rapid review process • Quality and quick editorial, review and publication processing • Indexing at PubMed (partial), Scopus, DOAJ, EBSCO, Index Copernicus and Google Scholar etc • Sharing Option: Social Networking Enabled • Authors, Reviewers and Editors rewarded with online Scientific Credits • Better discount for your subsequent articles Submit your manuscript at: Epidemiol ISSN:2161-1165 Epidemiol an open access journal Volume 2 • Issue 2 • 1000117