ADDIS ABABA UNIVERSITY

COLLEGE OF MEDICE AND HEALTH SCIENCE

DEPARTMENT OF EMERGENCY MEDICINE

PREVALENCE AND ASSOCIATED FACTORS OF NEEDLE STICK

AND SHARP INJURIES AMONG NURSES WORKING IN TIKUR
ANBESA SPECIALIZED HOSPITAL, ADDIS ABABA, ETHIOPIA, 2018.

BY: BIKIS LIYEW (BSC)

A RESEARCH THESIS SUBMITTED TO GRADUATE STUDIES OF

ADDIS ABABA UNIVERSITY, COLLEGE OF MEDICINE AND
HEALTH SCIENCE, DEPARTMENT OF EMERGENCY MEDICINE
AND CRITICAL CARE IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTERS OF SCIENCE IN
EMERGENCY MEDICINE AND CRITICAL CARE NURSING.

JUNE, 2018
ADDIS ABABA, ETHIOPIA
 ADDIS ABABA UNIVERSITY
COLLEGE OF MEDICE AND HEALTH SCIENCES
DEPARTMENT OF EMERGENCY MEDICINE
PREVALENCE AND ASSOCIATED FACTORS OF NEEDLE STICK
AND SHARP INJURIES AMONG NURSES WORKING IN TIKUR
ANBESA SPECIALIZED HOSPITAL, ADDIS ABABA, ETHIOPIA, 2018
.
BY: BIKIS LIYEW (BSC)

ADVISORS:
DR. MENBEU SULTAN (MD, MPH, EMERGENCYPHSICIAN)
MRS. MEBRAT MICHEAL (BSC, MSC, LECTURER)

A RESEARCH THESIS SUBMITTED TO GRADUATE STUDIES OF

ADDIS ABABA UNIVERSITY, COLLEGE OF MEDICINE AND
HEALTH SCIENCE, DEPARTMENT OF EMERGENCY MEDICINE
AND CRITICAL CARE IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF MASTERS OF SCIENCE IN
EMERGENCY MEDICINE AND CRITICAL CARE NURSING.

JUNE, 2018
ADDISS ABABA, ETHIOPIA
 ADDIS ABABA UNIVERSITY
COLLAGE OF MEDICINE AND HEALTH SCIENCE
DEPARTMENTS OF EMERGENCY MEDICINE
MASTERS DEGREE IN EMERGENCY MEDICINE AND CRITICAL CARE
NURSING
BY: BIKIS LIYEW (BSC)
JUNE, 2018
Approved by Examining Board:
------------------------ ---------------------------------
Chairman, Department Of Graduate committee
1. Name…………………. Sign……
2 .Name…………………. Sign…
Advisors: 1. Mrs. Mebrat Micheal Sign……………
2. Dr. Menbeu sultan sig……………
Examiner
------------------------------ ---------------------------------------------

Examiner
------------------------------ -----------------------------------------------
I. ACKNOWLEDGMENT

The knowledge, experience and skill I gained from doing this thesis was highly life time
rewarding for me. For this, I am very indebted to the following scholars and organization.
First, and for most, I would like to express my grateful thank to my advisors Mrs. mebrat
Micheal and Dr.Menbeu sultan who actively participated and gave their invaluable
comments and concerns from the very inception of the proposal till end. My
acknowledgment also forwarded from root of my heart to Mesafint Abeje (MPH) and
Degefaye zelalemm (MSc) who closely advised me to accelerate my running through
completing the proposal preparation and thesis writing and reporting. I also express my
acknowledgement to staffs of Tikur Anbesa Hospital who participated in the study, data
collectors and also I would like to thank university of Gondar for supporting and
sponsoring me.
I am also very grateful and I would like to extend my heartfelt thanks and appreciation to
Addis Ababa University, College of Health Sciences, Department of emergency medicine
and critical care nursing for giving me this great opportunity.

i
II.TABLE OF CONTENT

I. ACKNOWLEDGMENT .................................................................................................. i

II.TABLE OF CONTENT .................................................................................................. ii

III. LIST OF TABLES ........................................................................................................ v

IV.LIST OF FIGURES ...................................................................................................... vi

ABBREVIATIONS .......................................................................................................... vii

ABSTRACT ..................................................................................................................... viii

CHAPTER ONE ................................................................................................................. 1

1. INTRODUCTION .......................................................................................................... 1

1.1. Background .............................................................................................................. 1

1.2. Statements of the problem ........................................................................................ 3
1.3. Significance of the study .......................................................................................... 5

CHAPTER TWO ................................................................................................................ 6

2. LITERATURE REVIEW ............................................................................................... 6

2.1. Prevalence of needle stick and sharp injury ............................................................. 6

2.2. Associated factors of needle stick and sharp injuries. ............................................ 11
2.3. Conceptual framework ........................................................................................... 14

CHAPTER THREE .......................................................................................................... 15

3. OBJECTIVES ............................................................................................................... 15

3.1. General objective.................................................................................................... 15

3.2. Specific objectives.................................................................................................. 15

CHAPTER FOUR ............................................................................................................. 16

4. METHODS AND MATERIALS .................................................................................. 16

4.1. Study area ............................................................................................................... 16

ii
 4.2. Study design and period ......................................................................................... 16
4.3. Population............................................................................................................... 16
4.3.1 Source population ............................................................................................. 16
4.3. 2.Study population .............................................................................................. 17
4.3.3. Sample population ........................................................................................... 17
4.4. Inclusion criteria and exclusion criteria ................................................................. 17
4.4.1. Inclusion criteria .............................................................................................. 17
4.4.2. Exclusion criteria ............................................................................................. 17
4.5. Variable of the study .............................................................................................. 17
4.5.1. Dependent variable .......................................................................................... 17
4.5.2. Independent variables ...................................................................................... 17
4.6. Sample size determination ..................................................................................... 18
4.7. Sampling procedures and techniques ..................................................................... 19
4.7.1. Sampling proportion of each ward in TASH ................................................... 19
4.8. Operational definition and definition of terms ....................................................... 20
4.9. Data collection tool and technique ......................................................................... 20
4.10. Data quality management ..................................................................................... 21
4.11. Data processing and analysis................................................................................ 21
4.12. Ethical consideration ............................................................................................ 21
4.13. Dissemination of results ....................................................................................... 22

CHAPTER FIVE .............................................................................................................. 23

5. RESULT ....................................................................................................................... 23

5.1. Socio demographic Characteristics of participants ................................................ 23

5.2. Prevalence and circumstances of needle sticks and sharp injuries......................... 24
5.3. Cross tabulation of Needle stick and sharp injury within the past 12 month. ........ 32
5.4. Factor associated with NSSI within the past 12 month .......................................... 34
5.4.1. Bi-variate and Multi-variate analysis .............................................................. 34
5.4.1.1. Bi-variate Analysis.................................................................................... 34
5.4.1.2. Multi-variate analysis................................................................................ 36

CHAPTER SIX ................................................................................................................. 38

iii
6. DISCUSSION ............................................................................................................... 38

CHAPTER SEVEN .......................................................................................................... 42

7. LIMITATION AND STRENGTH ............................................................................... 42

7.1 Strength of the study ............................................................................................... 42

7.1. Limitation of the study ........................................................................................... 42

CHAPTER EIGHT ........................................................................................................... 43

8. CONCLUSION AND RECOMMEDATION............................................................... 43

8.1. Conclusion.............................................................................................................. 43
8.2. Recommendation .................................................................................................... 44

9. REFERENCES ............................................................................................................. 45

10. ANNEXES .................................................................................................................. 50

Annex I: Participants Information and Consent Form .................................................. 50

Information sheet: ...................................................................................................... 50
Annex II: Questionnaire Check List.............................................................................. 51
Annex III. Assurance of Principal Investigator (declaration) ....................................... 57

iv
III. LIST OF TABLES

Table 1: Sample size determination, TASH, Addis Ababa, Ethiopia, and June, 2018. .... 18
Table 2: Distribution of socio-Demographic characteristics of nurses, TASH, Addis
Ababa, Ethiopia, June, 2018. ............................................................................... 23
Table 3: Frequency distribution of procedures at which exposure happened among the
exposed nurses during the last year working at TASH, Addis Ababa, Ethiopia,
June,2018. ............................................................................................................ 26
Table 4: Frequency distribution of procedure taken after exposure happened among the
exposed nurses during the last year working at TASH, Addis Ababa, Ethiopia,
June, 2018 ............................................................................................................ 27
Table 5: Showing working environment and Behavioral Characteristics of nurses working
in TASH, Addis Ababa, Ethiopia, June, 2018..................................................... 30
Table 6: Cross-tabulation of prevalence of NSSI within the past one year among nurses in
TASH, Addis Ababa, Ethiopia, June, 2018 (n = 268). ........................................ 32
Table 7: Bi-variate Logistic Regration Model Analysis of Factors Associated with NSSI;
TASH, Addis Ababa, June, 2018 ........................................................................ 34
Table 8: Logistic Regration Model Analysis of Factors Associated with NSSI; TASH,
Addis Ababa, June, 2018(n=268). ....................................................................... 37

v
IV.LIST OF FIGURES

Figure 1: Conceptual frame work literature review (18, 19, 48), Addis Ababa, Ethiopia,
June, 2018. ......................................................................................................... 14
Figure 2: Schematic presentation of the sampling procedure to select the study
participants, Addis Ababa, Ethiopia, 2017/2018. .............................................. 19
Figure 3: The prevalence of NSSI among nurses TASH, Addis Ababa, Ethiopia, June,
2018.................................................................................................................... 24
Figure 4 : Frequency distribution of causative tools of needle stick and sharp injuries
among exposed nurses during the last year working at TASH, Addis Ababa,
Ethiopia, June, 2018........................................................................................... 26
Figure 5: Frequency distribution of type of item causes NSSI among exposed nurses
during the last year working at TASH, Addis Ababa, Ethiopia, June, 2018. .... 27
Figure 6: Distribution of sharp collection box in clinical area of TASH, Addis, Ababa,
Ethiopia, June, 2018........................................................................................... 28
Figure 7: Percentage distribution of needle, syringe and sharp disposal system in TASH,
Addis Ababa, Ethiopia, and June 2018. ............................................................. 29

vi
 ABBREVIATIONS

AAU Addis Ababa University

AIDS Acquired Immune Deficiency
AOR Adjusted Odd Ratio
BSC Bachler of science
CHS College of health science
CI Confidence Interval
COR Crude Odd Ratio
GC Gregorian calendar
HBV Hepatitis B Virus
HCV Hepatitis C Virus
HCW Health Care Workers
HIV Human Immune Virus
MSC Master of Science
NSI Needle Stick Injury
NSSI Needle Stick and sharp Injury
SPSS Soft Ware Program for Social Science
TASH Tikur Anibesa Specialized Hospital
USA United States of America
WHO World Health Organization

vii
ABSTRACT

Background: Needle stick and sharp injuries are a significant risk to the health of nurses.
Every day Nurses face the possibility that they may injure themselves. Although many
injuries will have no adverse effect, the possibility of acquiring infections like hepatitis
C, hepatitis B and HIV can cause untold psychological harm. About twenty blood borne
pathogens can be transmitted through accidental needle stick and sharp injury, the
potential life threatening are Human Immunodeficiency Virus (HIV), hepatitis B virus
(HBV) and hepatitis C virus (HCV). Nurses are at risk of injuries caused by needle stick
and sharp instruments in hospitals.
Objective: The objective of this study was to assess the prevalence and associated factors
of needle stick and sharp injuries among nurses working in Tikur Anibesa Specialized
hospital, Addis Ababa, 2018.
Methods: Institutional based cross sectional study was conducted among 268 nurses
working in Tikur Anibesa Specialized Hospital from February 19 to march 31, 2018.
Stratified random sampling technique was used to select the study participants. Data was
collected by using a self-administered questioner. Bivariate and multivariate logistic
regression model was fitted to identify factors associated with needle stick and sharp
injury. An adjusted odds ratio with 95% confidence interval was computed to determine
the level of significance.
Result: The prevalence of needle stick and sharp injuries among nurses was 97(36.2%)
with 95% CI of 30.2% to 42.3%. Presence of contaminated needles and/or sharps
materials in the working area AOR=2.052(1.110, 3.791) and needle recapping after use
AOR=1.780(95% CI, 1.025, 3.091) were positively associated with needle stick/sharp
injury; while working in pediatrics ward AOR = 0.323(0.112, 0.930) and Being female
(AOR = 0.461(95% CI, 0.252, 0.845) showed negative association at p value of (p≤0.05).
Conclusion and recommendation: The proportion of needle stick/sharp injury was high
among nurses. The safety of nurses depends directly on the degree to which nurses can
identify and control the varied occupational hazards specific to jobs. Thus, working unit
specific safety precautions, safe working environment and appropriate needle and sharp
disposal improve nurses’ safety practice and thereby decrease the on job.
Key words: Needle sticks injury, Safe practice, Sharp injury, unsafe practice.

viii
 CHAPTER ONE

1. INTRODUCTION

1.1. Background

Needle stick and sharp injuries are wounds that are caused by sharps accidentally
puncture the skin. Sharps include needles, as well as items such as scalpels, razor blade,
lancets, retractors, scissors, pins, clamps, cutters, staples and glass item (1). About twenty
blood borne pathogens can be transmitted through accidental needle stick and sharp
injury, the potential life threatening are Human Immunodeficiency Virus (HIV), hepatitis
B virus (HBV) and hepatitis C virus (HCV). Moreover, HBV is highly contagious and
infects one out of three people (2). Risk factors that causes NSI are numerous as,
manipulating needles in patient line related work, recapping activity, passing devices,
handling specimens, clean-up or failure to dispose the needle in the puncture proof
containers. Every day while caring for patients, nurses are at risk to exposure to blood
borne pathogens potentially resulting in infections such as HIV or hepatitis B and C.
These exposures, while preventable, are often accepted as being a part of the job (3).
Needle stick and sharp injuries are a serious concern to all health care personnel and pose
a significant risk of transmission of occupational blood borne pathogens (4).

The Centers for Disease Control and Prevention (CDC) estimates that about 236,000 to
384,000 hospital workers sustain needle-sticks and sharp injuries, and nurses share 40%
of it (5). These injuries occur in a variety of procedures like during needle recapping,
operative procedures, blood collection, intravenous line administration, suturing,
checking blood sugar and poor sharp disposal system (6). Almost 90% of all the needle-
stick injuries which occurred in nurses of third world countries are due to lack of
knowledge, resources and training (7).

Among all health care personnel, nurses have the highest rate of needle stick and sharp
injury .In USA, It was estimated that the reported incidence of NSI among nurses is
currently 16.3 % (8). In United Kingdom, about (48%) of the nurses have reported an

1
incident at some point in their careers and (10%) had been stuck by a needle or sharp in
the last 12 months (9).
According to the World Health Organization (WHO) NSIs cause about (40%) of hepatitis
C and B infections and (2.5%) of HIV infections among healthcare providers worldwide
(10). In addition, direct costs for laboratory tests, including tests for hepatitis B serology,
HIV antibodies, and the test for anti-hepatitis C, also treatment for any condition. There
are also the burden associated with post-exposure prophylaxis and their work absences
(11).

According to US International Healthcare Worker Safety Center, injections and drawing

blood accounted for (23.6%) and (11.5%) of NSIs, respectively (12). So safety
engineered needle devices are recommended for these tasks (13).

Needle-stick injury among nurses varies according to work place, country, professional
level and procedures. For instance 39% of registered nurses in USA (14), 39.4% of
nurses in Iran (15), 62% nurses in Nigeria (16) and 32% of them in Ethiopia had
sustained needle-stick injury in 12 months period (17). Moreover, health care workers
practicing in poor countries such as Ethiopia are more exposed to human
immunodeficiency virus (HIV) and hepatitis B virus (HBV) following occupational
exposure, and are less likely to use post-exposure prophylaxis (PEP) than those working
in developed countries (18, 19).

2
1.2. Statements of the problem

Needle stick and sharp injury represent a major occupational hazard in the health care
industry, with professional nurses incurring a large proportion of the total burden
particularly with items that have been previously used on patients (20-22). In Turkey,
about four million people are estimated to be carriers of chronic HBV between 0% and
2% of the blood donor population were found to be HCV antibody positive. The numbers
of patients with HIV reported is relatively low rates have been increasing steadily in
recent years, whereas this number reached a total of 1325 in 2001. WHO reports that the
number of sharp and needle stick injuries per person among health care staff are 4 per
year in Africa, Western Mediterranean and Asia (23).

The risk of occupational infection is rises by a factor including the following: hospital
overcrowding lower ratio of HCWs to patients, limited awareness of the risks associated
with exposure, to blood, failure to implement standard precautions, inadequate supplies
of basic safety equipment, handles contaminated needles and other sharp instruments are
reuse. Developed countries recognized the importance of safety practice among HCWs
(24).

In the Health care sector, although nurses are more exposed to NSIs, many HCWs did not
have sufficient level of knowledge to protect themselves from injury and they did not
take the necessary precautions (22). Nurses are highly exposed to needle-stick and sharp
injuries. Such injuries transfer some pathogens such as (human immunodeficiency virus)
HIV, Hepatitis B virus (HBV), and Hepatitis C virus (HCV) (25). Approximately, 66000
cases of HBV, 1600 cases of HCV, and 1000 cases of HIV might occur worldwide
among healthcare workers through their exposure to needle-sticks. The spread of blood
borne viral diseases through sexual and vertical means is decreasing, while their
transmission by needle stick and sharp injuries are assumed to be increasing. They are
day to day medical hazards in health institution among nurses (26).

3
The burden of the problem is not only on individual health but also human resources,
economic and social destruction (27). Blood borne pathogens are generally considered
endemic in sub-Saharan Africa (26).

National data are unavailable for these blood borne infections in Ethiopia. However,
surveys in different parts of the country indicate the prevalence of HCV to be 0.9–5.8%
and estimates for HBV range from 4.7% to 14.4 % (28-31). Hence, the objective of the
present study was determining the prevalence of needle stick and sharp injuries and its
associated factors among nurses at Tikur Anibesa Specialized hospitals.

4
1.3. Significance of the study

There is a paucity of information in Ethiopia particularly in Tikur Anbesa Specialized

hospital describing occupational injuries by needle sticks and sharp injuries and
consequently exposures to blood and body Fluids and associated factors. In Ethiopia,
where primary health care services are covered by nurses, it is important to develop their
knowledge and practice on universal prequetion since the risk of contracting infections
following needle stick and sharp injuries are high in their day to day activities. Since I
have seen different literatures there is no single study on nurses rather than overall health
professionals in the study area and clinical attachment I observe needle stick and sharp
object injuries on nurses which is very dangerous and devastating in economical,
psychological and health of nurses and their families.

Credible evidence is paramount in designing strategies and in taking action-based

interventions. Such information would also be useful in identifying any gaps that might
need further attention in this implementation of infection-control practices for different
organizations and in providing feedback to these groups about improving safe practices.

Yet, there is no documented data identified in the area of prevalence and predictors of
needle stick and sharp injury among nurses working in Tikur Anbesa Specialized
Hospital. This research was intended to generate base line information on the possible
determinants of needle stick and sharp injuries and its prevalence. The reason why Tikur
Anbessa Specialized Hospital selected was that, this hospital is the largest referral
hospital in the country. It is also an institution where specialized clinical services that are
not available in other public or private institutions are rendered to the whole nation. Since
large number of Ethiopian population is served adequate staff number should be
available. Nurses are major part of health care delivery system by providing holistic care
for clients.

5
 CHAPTER TWO

2. LITERATURE REVIEW

2.1. Prevalence of needle stick and sharp injury

Study conducted in South Korea 70.4% of the hospital nurses had experienced needle
stick or sharp injuries in the previous year (32).

Study conducted in Pakistan 67% of nurses got needle stick injury during job. Almost all
99% nurses said that they didn’t report their injury because of no reporting system in
their hospital. Injection and needles (72%) are the most injury causing instrument and
majority of nurses (39%) sustained needle stick injuries more than once, while only
twenty five (11%) nurses sustained NSI once in their life. Two third (81%) of nurses
experienced NSI in ward or bedside whereas only few got NSI in Emergency Room (9%)
and Operation Theatre (6%). Needle is the most injury causing instrument (48%)
followed by ampoule (18%) and blade (1%). Almost all the nurses (99.3%) didn’t report
their injury to hospital administration (33).

A cross-sectional study was conducted among nurses in Thailand Regional Hospital

shows that the prevalence of SIs for the previous 12 months was 55.5%. 91.1% were with
blood. Needles (52.8%) were the main cause of SIs. The reporting rate of SIs to the
hospital was 23.8%. SIs had a significant association with each of marital status, work
duration, work department and preventive management (34).

In other study conducted in India shows that overall, every third nurse (33.3%) had
sustained needle stick injury at least once in the past. More than half (56%) of the NSI
incidents occurred while the nurses were recapping the needle, 10% of the incidences
occurred while passing needle and 10% while disposing the needle and or breaking. The
most common cause of NSI as perceived by nurses was lack of proper equipment for
disposal (50%) followed by increased workload (24%), carelessness (18%) and fatigue
(8%). More than half (58%) of the NSI involved a hollow bore needle, followed by I.V.
cannula (24%), suture needle (10%) and butterfly (8%). Fingers/thumb/index finger

6
together were the most common (65.3%) site of injury with almost third thirds of the total
incidents involving any of these areas followed by involvement of palm (18.4%) and
hand (10.2). In regard to the area where NSI occurred, nearly half (48%) of the total
incidents have occurred either in patient room (24%) or in emergency department (24%),
16% of the NSI have occurred in intensive/critical care units and only one NSI incident
(2%) has occurred in operating room/recovery room (35).

Study carried out in Nepal the prevalence of needle stick and sharp injuries among nurses
was 74% during the whole work duration and a study carried out in Saudi Arabia and Iran
were 74% and 39.4% respectively (36).

Study conducted in Tehran (Iran) shows that the prevalence of occupational exposure to
sharp tools of hospital waste was 41%. Most impressed by the syringe needle was 46.3%.
Working load and needle recapping were the main causes of the damage due to exposure
to the sharp objects, 26.8 and % 31.7 respectively (37).

Other study conducted in Iran Imam Hossein Hospital the case incidence of NSIs was
63.3%. 12.8% of nurses had not been vaccinated against hepatitis B virus (HBV). 92.1%
were hollow-borne needles and the main causes of percutaneous injuries with hollow-
bore needles were recapping (32.4%) and manipulating needles in patients (18.1%). The
majority 51.8% of injuries occurred after use and before disposal of the objects (38).
Study conducted In Jordanian showed that within the last 3 months, 67.6% of the nurses
reported having at least one NSI. Most of these injuries were caused by recapping
procedure, while working with syringe needles (39).

Study conducted in Sri Lanka, Colombo showed that the prevalence of NSIs was 43%. IV
cannulation was the most risky procedure (51%). Re-capping was seen in 24% of the
exposed group. Medical wards accounted for 78% of the NSIs (40).

Study carried out hospital of central India showed that the case incidence of NSIs was
31.78%. 63.64% were hypodermic needles and the main causes of percutaneous injuries

7
with hypodermic needles were during injecting drugs (38.4%) and handling sharp wastes
(32.9%) (41).

Study conducted in Imam Reza Hospital, Kermanshah, Iran showed that 73.3% of nurses
were exposed to sharp injuries at workplace. About 41.8% of cases occurred during the
first year of nursing. Major injuries were caused by needle-sticks (73.3%) and then IV
catheter (42.4%). About 43.5% of the observed injuries occurred while trying to recap the
needle-sticks. Also, 38.52% of injured nurses performed the tests after injury screening,
while 48.7% did nothing after being injured. This study showed that sharp injuries were
higher among female nurses regarding the relationship between demographic factors and
injuries, there was only a significant association between the sharp injuries and gender
(P=0.025) and the number of injuries was higher among female nurses (42).

In other study conducted among Nurses in a University Hospital, Shiraz, Iran the
prevalence of NSIs in the total of work experience and the last year was 76% and 54%,
respectively. Hollow-bore needles were the most common devices involved in the
injuries (85.5%).) and the most common activity leading to NSIs was recapping needles
(41.4%). A statistically significant relationship was found between the occurrence of
NSIs and sex, hours worked/week, and frequency of shifts/month (43).

study done by National surveillance for health care workers (NASH) of USA show that
59% of all sharp injuries were caused needles and according to a study done in Malaysia
hospitals nurses 27.2% NSSIs causes were recapping of syringes after use (35, 44).

A cross-sectional study conducted in South Africa 18.8% indicated that they had needle
stick injuries in the previous 12 months. Seventy eight point thee percent (78.3%) needle
stick injuries occurred in wards with syringe needles being the most common causative
device, while 28.9% occurred during recapping of needles. The majority of respondents
(90.1%) were aware of the hospital policy on needle stick injury. Although needle stick
injuries were prevalent at a low rate, only 50% were reported. It remains an important

8
workplace hazard that needs on-going attention such as training, as it could be the cause
for diseases, for example HIV and hepatitis B, among nurses (45).

Study conducted in Egypt, at zagazig University Hospitals the prevalence of needle stick
and sharp injuries among nurses was (74.57%) during the whole work duration, (72.8%)
of nurses exposed to needle stick while (39.4%) exposed to sharp injury and (36.86%)
exposed more than once. About the type of exposure, (47.78%) had needle stick and
(30.93%) had sharp injury while (22.88%) had more than one exposure. The most
frequent causative tools were hollow –bore needle (78.03%) followed by blade (27.27%)
then suture needle (23.48%). The most frequent procedures at which exposure happen
were needle recapping, injection and sample drawing (62.87%, 56.06% and 43.18%)
respectively. It was noticed that the frequency of exposure were high among nurses
working in emergency, surgery and internal medicine departments (78.04%, 71.05% and
63.26% respectively) (1).

A cross-sectional descriptive survey studded among Nigeria nurses showed that 40.2%
exposed NSSI in 12 month(16). 20% of sharp injury occurred while they were
administering injectable medicines and 35.3% of them identified needle recapping.
21.2% and 11% of the participants, breakage of medication ampoule and packing used
syringes and needles for disposal were identified respectively. Also, 87.6% of the
respondents experienced sharp injury at work while 12.4% did not. The causes of sharp
injury result from failure to follow recommended procedures through personal behavioral
risks such as safe handling and disposal of needle and syringes (46).

Study conducted in Southwest Ethiopia showed that prevalence of sharp injury among
nurses was found to be 58.8%. Of this syringe needle 58.8% and broken ampoule 43.3%
were the dominants. From the reported sharp injuries, 46.0% occurred when the needle
was used for an injection and 78 (41.7%) occurred during ampoule breaking. Out of those
nurses exposed to sharp injuries, 38.5% had experienced it twice (47).

9
Other cross-sectional Study conducted in Ethiopia, Jimma University Hospital shows that
the prevalence of needle tick injury was 39.3%. 37.3% reported due to needles recapping
and 37.7% were during sharp collection (48). In other studies done in Jimma zone public
hospitals prevalence of needle stick injuries was 39.3% (49).

Other studies done in Ethiopia, Bahir Dar, 66.6%(50).south west Ethiopia 58.8%(48) and
East Gojjam Zone Health Institutions, Sidama Zone and North western Ethiopia had
showed 23.5%, 22%, 32%and 31% respectively(51).in other studies done in Jimma zone
public hospitals prevalence of needle stick injuries was 39.3%.

10
2.2. Associated factors of needle stick and sharp injuries.

Study conducted in South Korea non-use of safety containers for disposal of sharps and
needles, less working experience as a registered nurse, poor work environments in
regards to staffing and resource adequacy and high emotional exhaustion significantly
increased risk for needle stick or sharp injuries. Working in perioperative units also
significantly increased the risk for such injuries but working in intensive care units,
psychiatry, and obstetrics wards showed a significantly lower risk than medical–surgical
wards. The occurrence of needle stick or sharp injuries of registered nurses was
associated with organizational characteristics as well as protective equipment and nurse
characteristics (32).

Study conducted in Tehran (Iran) shows that the relationship between occupational
exposure to hospital sharp tools and age, experience, education and place of work was
significant with P= 0.006, 0.017, 0.027 and 0.008 respectively. According to the
complications of sharp tools, reduction of sharp components requires regular training
courses for staff, proportion of the number of work shifts, strict implementation of
treatment protocols, modification of the current inaccuracy procedures, access to
adequate equipment’s and safe and an effective mechanism for reporting of occupational
accidents in all of the sectors (37)

Study conducted In Jordanian showed that the prevalence of NSI was found to be
significantly associated with age group (P<0.001), working experience (P<0.001), and
marital status (P<0.004) (39).

A cross-sectional study was conducted among Nurses in a Thailand Regional Hospital

shows that SIs had a significant association with each of marital status, work duration,
work department. A significant association between SIs and working duration (p=0.031)
was detected. The nurses who had been working from 1 to 20 years were about two times
more likely to have SIs than those working from 21 to 40 years. Less experienced nurses
were more likely to have SIs compared to more experienced nurses (34).

11
Study conducted in Sri Lanka, Colombo showed that there was a significant difference in
NSIs seen in maturity in age (p=0.015) and increase working experience (p=0.044) but no
difference was found with increased work load (p=0.765, increase number of working
hours per week, p=0.204) and participation in in-service training programs (p=0.592). A
significant 49% did not report the injury and the main reason were assumed less risk
(46%) (40).

Study conducted in Imam Reza Hospital, Kermanshah, Iran showed that sharp injuries
were higher among female nurses, there was only a significant association between the
sharp injuries and gender (P=0.025) and the number of injuries was higher among female
nurses (36).

In other study conducted among Nurses in a University Hospital, Shiraz, Iran showed that
a statistically significant relationship was found between the occurrence of NSIs and sex,
hours worked/week, and frequency of shifts/month (42).

Study conducted in Egypt, Zagazig University showed that there was no significant
association between gender with needle stick and sharp injury. However, the risk of
exposure decreases with increasing the duration of experience. And the risk of exposure
increased with the nurses with lower education, working in the emergency and surgery
departments; less experience and low education level were the most significant Predictors
of needle stick and sharp injuries among nurses. In another study conducted in Malaysia
showed that there was no significant association between gender with needle stick and
sharp injury (1).

Study conducted in Southwest Ethiopia showed that being male [AOR: 2.20, 95%
confidence interval (CI): 1.09, 4.4], being single (AOR: 2.26, 95% CI: 1.09, 4.69), and
having no training on infection prevention (AOR: 5.99, 95% CI: 3.14, 11.41) were
positively associated with needle stick/sharp injury; while working in chronic illness

12
follow-up clinic (AOR: 0.19, 95% CI: 0.05, 0.71) showed negative association at p value
of 0.05 (47).

13
2.3. Conceptual framework

The factors associated with needle stick and sharp injuries are classified as socio-
demographic factors like, sex, age, service year or experiences, marital status etc. work
related environmental factors like; injection practice, disposal of used sharps,
department, client flow, favorability of work place and etc. and behavioral factors are
like; education and training. The three factors are interrelated to affect one another. The
following figure shows the interrelation between sharp and needle stick injury (the
independent) variables in detail and it is adapted from Ethiopian nurse association.

Sociodemographic
factors Behavioral factors
NSSI
 Age  Training or
 Sex educations
 Working
experience
 Marital status
 Educational
status

Work related environment

 injection practice
 disposal of used sharps
 working departments
 flow of clients
 favorability of work place

Figure 1: Conceptual frame work literature review (18, 19, 48), Addis Ababa, Ethiopia,
June, 2018.

14
 CHAPTER THREE

3. OBJECTIVES

3.1. General objective

The objective of this study was to assess the prevalence and associated factors of needle
stick and sharp injuries among nurses working in Tikur Anibesa Specialized Hospital,
Addis Ababa, 2018.

3.2. Specific objectives

 To determine the prevalence of needle stick and sharp injuries among nurses working in
Tikur Anibesa Specialized Hospital, Addis Ababa, 2018.
 To identify associated factors of needle stick and sharp injuries among nurses working in
Tikur Anibesa Specialized Hospital, Addis Ababa, 2018.

15
CHAPTER FOUR

4. METHODS AND MATERIALS

4.1. Study area

The study was conducted in Tikur Anbessa Specialized Hospital which is found in Addis
Ababa (capital city of Ethiopia) in Lideta sub-city. According to Central Statistical
Agency of Ethiopia (CSA), as of 2013 the town of Addis Ababa has a total population of
3,130,673, of Which 1,478,890 are men and 1,624,783 women. It is the nation’s largest
and highest referral hospital. This hospital sees approximately 370,000 – 400,000 patients
a year but the exact number is not known. It has 700 beds. This is the largest teaching
hospital in Ethiopia. There are a total of 789 nurses in different qualification. The hospital
is planned and accommodated and facilitated with the outpatient department (OPD), has
seven x-ray, nine surgical and two diagnostic laboratory rooms. The hospital provides
medical services in the internal medicine, gynecological and obstetrics, surgical,
pediatrics and emergency departments. The hospital also have special units (Referral
clinics), those are Chest, Renal, Neurology, Cardiology, Dermatology And Sexually
Transmitted Diseases, Gastrointestinal, Infectious Diseases, Orthopedics, General
Surgical, Gynecologic and Obstetrics, Diabetic, Hematology And Medical Intensive Care
units (52).
4.2. Study design and period

An institutional based cross sectional study was conducted to assess prevalence and
associated factors needle stick and sharp injuries (NSI) from February 19 to March 31,
2018 G.C.
4.3. Population

4.3.1 Source population

All nurses who were working in Tikur Anibesa Specialized Hospital, Addis Ababa,
Ethiopia.

16
 4.3. 2.Study population

All nurses who were working in Tikur Anibesa Specialized Hospital, Addis Ababa,
Ethiopia, 2017/2018.
4.3.3. Sample population

All selected Nurses working in Tikur Anibesa Specialized Hospital at the time of data
collection Addis Ababa, Ethiopia, 2018.
4.4. Inclusion criteria and exclusion criteria

4.4.1. Inclusion criteria

 Nurses either males or females who were working at the same department or unit for at
least one year.
 All those registered nurses who were working in Tikur Anibesa Hospital of Addis Ababa
during study period involved in clinical work were included in the study.
4.4.2. Exclusion criteria

 The nursing personnel not involved in the direct management of the patients (e.g. nursing
managers, tutorial staff) were excluded.
 Those nurses who were students, retired, on sick or maternity leave was excluded from
the study.
4.5. Variable of the study

4.5.1. Dependent variable

 Needle sticks and sharp injury (NSSI)

4.5.2. Independent variables

 Unsafe injections (recapping, bending needle etc.)

 Unsafe clinical practices (inconsistence use of protective materials)
 not using the right equipment’s, not using the right sharp disposals)
 Background variables (socio-demographic characteristics of nurses.)
 Others like unsafe handling, using safety box, using incinerate or burring included here.
 Behavioral factors (training).

17
4.6. Sample size determination
The actual sample size for the study was determined using the formula for single
population proportion. To determine the initial sample size the following assumption was
been made: Where ni = initial sample size from finite population,
nf = final sample size from finite population
Z = the standard score (critical value) corresponding to 95% confidence level,
P = the proportion of nurses experiencing needle stick and sharp injuries in which taken,
from study done in Jimma university specialized hospital Taking the prevalence of NSTI
among nurses was 39.3%. So sample size can be calculated as follows
ni = (𝒁a/𝟐)2 𝑷(𝟏−𝑷)/𝒅𝟐 =(1.96)2×0.393(1-0.393)/(0.05)2=367 because of the total
population size of the study area are less than 10,000 we shall to apply the population
correction formula:
nf = ni/1+ni/N= 367/1+367/789= 250 samples + 10% non-response rate.
Totally =275 Samples.
Since I had taken prevalence of NSSI proportion in other studies I had considered factors
that are significantly associated with NSSI in different studies. The following four factors
identified and calculated by using double or two population proportions formula by using
epi info statcalc calculation. Where α = type I error (level of significant) ,Ɓ = Type two
error (1-B = power of the study), Power = the probability of getting a significant result,
f(Ɓ, α) = (Zα/2 + ZB)2 , When the Power = 80% and the level of significance is 5%.
Table 1: Sample size determination, TASH, Addis Ababa, Ethiopia, and June, 2018.
Factors Proportion AOR Sample size
Needle recapping after use P1=37.3%
P2=72.7% 0.26 128
Training on NSSI P1=48.7%
P2=16.4% 0.2 140
Working department P1=23.5%
P2=1.21% 0.58 95

Working experience P1=15.5%

P2=9.4% 0.947 985

18
So finally the sample size calculated in these factors the first three sample size (128,140
and 95) less than 275, then we didn’t take these, the last sample size (985) greater than
source population (789), so this also didn’t take. Finally 275 were taken as sample size.
4.7. Sampling procedures and techniques

Stratified random sampling technique was used to select the nurses. Hospitals
departments are classified into 5 main strata had nearly the same working conditions; 1)
Internal Medicine, 2) Pediatrics, 3) Surgical, 4) Outpatient Clinics, and 5) Emergency and
Intensive Care Departments. Proportional allocation will be taken from each stratum.
4.7.1. Sampling proportion of each ward in TASH

TASH

Emergency Surgical
Pediatrics OPD
and ICU departments
department department
department

Medical
departments

Total number of nurses in each department

115 120 206 218 130

Proportion to size allocation

N1=40 N2=42 N3=72 N4=76 N5=45

Simple random sampling

NF=275

Figure 2: Schematic presentation of the sampling procedure to select the study

participants, Addis Ababa, Ethiopia, 2017/2018.

19
4.8. Operational definition and definition of terms

Needle Stick Injury: - Is a percutaneous piercing wound typically set by a needle point,
but possibly also by other sharp instrument or objects.
Sharp: Any object that can penetrate the skin including, but not limited to needles,
scalpels, broken glass.
Sharp injury: An exposure event occurring when any sharp object penetrates the skin.
This term is interchangeable with ‘’ percutaneous injury.’’
Safe injection:-An injection that does not harm the recipient, does not expose the health
care worker to any avoidable risk and does not result in waste that is dangerous for the
community.
Unsafe practice: An injection that expose health care worker at risk of HBV,HCV, and
HIV infection through percutaneous injury or contact of mucus membrane or non-intact
skin with blood, tissue, or other body fluids that are potential infectious
Safe: Clean and no potential contamination of any sharps, syringe and needle with blood
or other body fluids.
Risky: Dirty and potential contamination of any sharps, syringe and needle with blood or
other body fluids.
Hallow-bore needle: Needle (e.g.’ hypodermic needle, phlebotomy needle) with a lumen
though which material (e.g., medication and blood) can flow.
4.9. Data collection tool and technique

Quantitative data collection tool were a questionnaire informed by literature review and
adapted from the WHO / ICN tool kit injection safety and the experience of the research
done by Ethiopian Nurse Association. The data was collected using self-administered
questionnaire. Data was collected by three BSc Nurses and supervised by two MSc
nurses and one EMCCN principal investigator. Training was given by principal
investigator for two days for data collectors and supervisors. Data were collected in Tikur
Anibesa Specialized Hospital by introducing themselves, explaining the aim of the study
and by agreed up on consent.

20
4.10. Data quality management

Data assurance were applied from the very beginning by review prior study and adopted
from WHO/ICN, CDC tool kit, and pretest was by taking 5% of the study sample in
Minilick hospitals and close monitoring of the activity of data collectors and supervisors
by principal supervisor. The collected was checked for completeness, accuracy and
clarity. Codes were given to the questionnaire and participant during data collection so
that any identified errors could get traced back using the codes. Each filled questionnaire
were checked and re-viewed for completeness by supervisor and principal investigator;
the necessary feedback was given to the data collectors in the next morning.
4.11. Data processing and analysis

Data clean up and cross-checking were done before analysis. Data was checked, coded,
completed questionnaires were given identification numbers and entered to epi info
version 7.2.2 then it was exported to SPSS version 23 for analysis. Both descriptive and
analytical statistical procedures were utilized. Descriptive statistics like percentage,
mean, median and standard deviation were used for the presentation of socio-
demographic data and prevalence of needle stick and sharp injury. Tables were also used
for data presentation. Cross tabulation and chi square test were used. A binary outcome
variable indicating “have you had any sharp and needle stick injury since last year?” The
response was coded as “yes” and “no” and it was used as the dependent variable .Binary
logistic regression was used to identify associated factors of needle stick and sharp injury
among nurses working in Tikur Anbesa Hospital. All explanatory variables with p-value
of < 0.2 from bivariate logistic regression model was fitted in to the multivariate logistic
regression model to control the possible effect of confounders and finally the variables
which had been independent association with needle stick and sharp injury was identified
on the basis of OR, with 95%CI and p-value less than 0.05. The variables were entered in
the multivariate model using the Backward Stepwise regression method. Model fitness
was checked by using Hosmer and Lemeshow goodness of a fit test.
4.12. Ethical consideration

Ethical clearance was applied from Ethical Review Board of Addis Ababa University,
collage of medicine and health science, departments of emergency medicine and critical

21
care. Approval for the study area was obtained from Addis Ababa University, college of
medicine and health science. An informed consent was obtained from participants who
were signed or gave verbal consent to fill the questionnaires are allowed to do so. Nurses
whom refused to participate in the survey were not force to participate in the study. Each
study subject was informed about the objective of the study and confidentiality of the
information which they were given. In addition, they were told that they have full right to
withdraw from the study at any time if they feel that uncomfortable. A letter of
cooperation was written by TASH to conduct this research in the hospital.
4.13. Dissemination of results

The findings of this study will be presented and submitted to Department of emergency
medicine and critical care nursing, College of Medicine and Health Sciences, Addis
Ababa University. In addition, it will be used as a reference for other researchers
interested in these topics. It will be presented in different seminars and attempts will also
be made for presentation in National / International Science of conference and for public
in peer reviewed journal. Furthermore, the finding will be presented on appropriate
seminars, conferences and workshops and will be published with scientific journals.

22
CHAPTER FIVE

5. RESULT

5.1. Socio demographic Characteristics of participants

A total of 268 hospital nurses responded fully to the self-administered questionnaire

providing a response rate of 97.5%. From the total respondents 191 (71.3%) were female
nurses. 115 (42.9%) were between age of 25-30 with the mean age of 29.97 years
(SD±5.68 years). One hundred eighty seven (69.8%) were Orthodox Christians. In the
marital status condition of nurse, more than half 158 (58.9%) were single followed by
married which accounts 89 (33.2%). one hundred ninety eight (73.9%) nurses have work
experience of less than five years with the mean work experience of 5.08 year (SD±5.883
years). Majority to the study participants 202 (75.4%) were BSC nurses by educational
status (table 2)
Table 2: Distribution of socio-Demographic characteristics of nurses, TASH, Addis
Ababa, Ethiopia, June, 2018.
Variables Characteristics Frequency(N=268) Percentage (%)
Age <25 59 22.0
25-30 115 42.9
>30 94 35.1
Total 268 100
Sex Male 77 28.7
Female 191 71.3
Total 268 100
Religion Orthodox 187 69.8
protestant 40 14.9
Muslim 35 13.1
catholic 6 2.2
total 268 100

23
Marital status Single 158 59.0
Married 89 33.2
Divorced 9 3.4
widowed 12 4.5
total 268 100
Educational status Diploma 31 11.6
BSC 202 75.4
MSC 35 13.1
Total 268 100
Work experiences <5 198 73.9
5-10 41 15.3
>10 29 10.8
Total 268 100
working Emergency & 38 14.2
departments ICU
Medical 72 26.9
Surgical 45 16.8
OPD 73 27.2
Pediatrics 40 14.9
Total 268 100
5.2. Prevalence and circumstances of needle sticks and sharp injuries

The prevalence (occurrence) of needle stick and sharp injury to nurses in TASH was
97(36.2 %) with 95% CI of 30.2% to 42.3%.

Figure 3: The prevalence of NSSI among nurses TASH, Addis Ababa, Ethiopia, June,
2018.

24
From the total of respondents who had experienced NSSI in the last 12 months prior to
the study, (49.5%) were exposed once, while 27.8%, 14.4% and 8.2 were exposed two,
three, four and above times per year respectively. But out of total respondents who had
experienced NSSI in the last year 58.8% of nurses exposed in the last one month prior to
the study, while 6.2% exposed two times and none of the respondents exposed three,
four and above per month. Nearly one half of (46.2%) the injuries occurred in ICU unit.
Other injuries occurred in surgical ward (44.4%), medical (39.9%), emergency (36%),
OPD (35.6%) and pediatrics (20%).
Regarding parts of the body injured accounted by finger was 72.2% followed by hand
15.5% and 7.2%,7.2%, 6.2% were arm, thigh and palm respectively. The degree or
severity of injury accounted by slight skin penetration was 53.6% and followed by
superficial and deep were 33% and 18.6% respectively among injuries. On the other hand
77.3% of nurses inflicted self after injury happen and the other 14.4% and 12.4% of
nurses inflicted by another staff and non-compliant patient respectively.

Regarding the practice of nurses on job, 44% of the respondents had recapped needles
after use at least once during their work time. From those (69.5%) of the needles were
recapped using one hand recapping, where us nearly one third (30.5%) of needles were
recapped using two hand recapping. Among those nurses exposed NSSI ,workload
(61.9%), fatigue(7.2%) and lack of proper equipment disposal(35.1%) were perceived
causes of NSSI.64.5% of nurse know in which department or room they report and 71.3%
nurses were responded that safety box available at right working places.
The study result Revealed that most frequent causative tools of needle stick and sharp
injuries among exposed nurses was needle (87.6%) followed by blade (9.3%) then lancet
(5.2%) (figure 4).

25
100
87.6
90
80
70
60
50
40
30
20
9.3
10 5.2 3.1
0
needle blade lancet sciscors

Figure 4 : Frequency distribution of causative tools of needle stick and sharp injuries
among exposed nurses during the last year working at TASH, Addis Ababa, Ethiopia,
June, 2018.
This study result represented that the most frequent procedures at which exposure happen
were injection, Sample drawing, operation (38.1%, 24.7% and 16.5%) respectively.
Table 3: Frequency distribution of procedures at which exposure happened among the
exposed nurses during the last year working at TASH, Addis Ababa, Ethiopia, June,2018.
Procedures N=97 Percent (%)*
Injection 37 38.1
Suturing wound 12 12.4
Sample drawing 24 24.7
Operation 16 16.5
Needle recapping 10 10.3
Sharp disposal 6 6.2
Cleaning and sterilization of 12 12.4
instruments
Failing of tools 2 2.1

26
The frequency distribution of procedure taken after exposure showed that 51.5% used
antiseptic after exposure while 45.4% let blood to flow. Regarding vaccination, only
(2.1%) took the vaccine while no one reporting the incident after exposure.
Table 4: Frequency distribution of procedure taken after exposure happened among the
exposed nurses during the last year working at TASH, Addis Ababa, Ethiopia, June, 2018
Action taken n=97 %*
Let blood to flow 11 11.3
Wash with water 50 51.5
Use with antiseptic 44 45.4
Lab investigation 2 2.1
Vaccination 2 2.1
Seroprophylaxis 9 9.3
* Each of the percentages does not add up to 100% because respondents could choose
several responses which could be more than one reason

100%
90%
80%
70%
60%
74.2
5.2
3.1

10.3
3.1

50%
12.4
2.1

40%
30%
20%
10%
0%
syringe
suture
hollow bore
glasses
IV cannula
insulin
scalpe blade

Figure 5: Frequency distribution of type of item causes NSSI among exposed nurses
during the last year working at TASH, Addis Ababa, Ethiopia, June, 2018.

27
In this study result those factors contributed to NSSI were excess client 35.7% followed
by shortage of glove 29.6% and the rest suturing 17.35%, shortage of sharp collection
box 13.3%,during emergency situation 5.1%), recapping of used needle 8.2% and
removing of used needle12.2%. In another way from the total respondents 193(72%) of
nurses observe needle stick and sharp injury on nurses. From this 101(52.3%) NSSI occur
by abrupt movement of patients during clinical practice, followed by unsafe sharp
collection 51(26.4%) and the rest two handed recapping and carelessness (negligence) of
nurses, 37(19.2%), 18(9.3)] respectively.
In this study from 268 participants 180(67.2%) of nurses says that there was sharp
collection box in the clinical area.

115
puncture proof, 2.7

110
open container, 6.1

105
liquid proof, 5.5

100

safty box, 98.3

95

90
sharp collection
box

Figure 6: Distribution of sharp collection box in clinical area of TASH, Addis, Ababa,
Ethiopia, June, 2018.

28
In this study from 268 study participants 188(70.1%) of nurses had seen over filled sharp
collection containers in the clinical area were us 50(18.7%) and 30(11.2%) had seen torn,
needle seen the hole and dirty syringe inside it respectively.

47.4 50
39.9 40
30
20
2.98 4.5 10
5.2
0
dumping

burial in pit

open dumping

protected incineration

open incineration
Figure 7: Percentage distribution of needle, syringe and sharp disposal system in TASH,
Addis Ababa, Ethiopia, and June 2018.

29
Regarding the injection environment, 187(69.8%) staffs responded that their injection
environments were unsafe. From the total respondents, one hundred forty six (54.5%) had
got of site and onsite training on infection prevention prior to the study (table 5).
Table 5: Showing working environment and Behavioral Characteristics of nurses working
in TASH, Addis Ababa, Ethiopia, June, 2018.
Variable Response Frequency (N=268) Percentage
Training Yes 146 54.5
No 122 45.5
Total 268 100
IP committee Yes 197 73.5
No 71 26.5
Total 268 100
PEP Yes 150 56
No 118 44
Total 268 100
HBV vaccination Yes 174 64.9
No 94 35.1
Total 268 100
Department report Yes 173 64.6
when NSSI occur No 95 35.4
Total 268 100
recapping of needle Yes 118 44.0
after use No 150 56.0
Total 268 100
Observe any NSSI on Yes 193 72
nurses No 75 28
Total 268 100
Sharp collection box Yes 180 67.2
No 88 32.8
Total 268 100
Injection equipment Sterilized and reused 21 7.8

30
 Single use 233 86.9
auto disposable 14 5.2
Total 268 100
Recommended Yes 192 71.6
practice to prevent No 76 28.4
NSSI Total 268 100
Dirty sharps in Yes 184 68.7
working places No 84 31.3
Total 268 100
Injection environment Safe 81 30.2
Unsafe 187 69.8
Total 268 100

31
5.3. Cross tabulation of Needle stick and sharp injury within the past 12
month.
Generally, male respondents reported high prevalence of NSSI than female counterparts;
for 50.6% male-compared to 30.4% female-respondents from those who had NSSI 1 year
prior to the study (χ2=8.917, p= 0.003). Respondents who recapping needle after use
were higher occurrence of NSSI (44.8%) compared with not recapping needle after use
(29.3) χ2 = 6.285, p = 0.012).The occurrence of NSSI was higher in males (50.3%)
compared with female (30.4%). This difference was statistically significant. The highest
prevalence of NSSI was observed among nurses who practiced needle recap after use
(44.9%) compared to those who do not have history of recap (29.3%). This difference
was statistically significant. There is also statistically significant difference of NSSI
among those who had seen dirty sharps in working places and those who did not seen.
Neither the age nor marital status or the training, work experience and working
departments had a significant effect on the prevalence of NSSI of the respondents.
Table 6: Cross-tabulation of prevalence of NSSI within the past one year among nurses in
TASH, Addis Ababa, Ethiopia, June, 2018 (n = 268).
Variables Characteristics Frequency of NSSI in past one year
YES (%) No (%) χ2 p-value
Age <25 21(35.6) 38(64.4)
25-30 41(35.7%) 74(64.3) 0.068 0.967
>30 35(37.2) 59(62.8)
Sex Male 39(50.6) 38(49.4) 8.917 0.003*
Female 58(30.4) 133(69.6)
Marital status Single 53(33.5) 105(66.5)
Married 35(39.3) 54(60.7) 1.270 0.736
Divorced 4(44.4) 5(55.6)
Widowed 5(41.7) 7(58.3)
Educational status Diploma 6(19.4) 25(80.6) 0.026*
BSC 73(36.1) 129(63.9) 7.324
MSC 18(51.4) 17(48.6)
Total

32
Work experiences <5 71(35.9) 127(64.1)
5-10 12(29.3) 29(70.7) 2.694 0.260
>10 14(48.3) 15(51.7)
working Emergency 9(36.0) 16(64.0)
departments ICU 6(46.2) 7(53.8)
Medical 28(38.9) 44(61.1) 6.664 0.247
Surgical 20(44.4) 25(55.6)
OPD 26(35.6) 47(64.4)
Pediatrics 8(20.0) 32(80)

Training Yes 60(41.1) 86(58.90 2.887 0.089

No 37(30.3) 85(69.7)
IP committee Yes 76(38.6) 121(61.4) 1.462 0.227
No 21(29.6) 50(70.4)
HBV vaccination Yes 69(39.7) 171(63.8) 2.164 0.141
No 28(29.8) 66(70.2)
recapping of needle Yes 53(44.9) 65(55.1) 6.285 0.012*
after use No 44(29.3) 106(70.7)

Dirty sharps in Yes 75(40.8) 109(59.2) 4.689 0.030*

working places No 22(26.20 62(73.8)
Injection Safe 32(39.5) 49(60.5) 0.365 0.546
environment Unsafe 65(34.8) 122(65.2)
*significant at p≤0.05

33
5.4. Factor associated with NSSI within the past 12 month

5.4.1. Bi-variate and Multi-variate analysis

5.4.1.1. Bi-variate Analysis

As described in table below the regration analysis of socio-demographic, NSSI

circumstances on bivariate logistic regration showed that sex, COR =0.425(95%
CI,0.247,0.731), educational status, COR = 0.227 (0.075, 0.688), current working
department, COR = 0.313 (95% CL, 0.118, 0.8270) , dirty sharps in working places,
COR =1.939( 95% CI, 1.098,3.423), and needle recapping COR=1.964(95%
CI,1.185,3.255) have association with NSSI (Table 7).
Table 7: Bi-variate Logistic Regration Model Analysis of Factors Associated with NSSI;
TASH, Addis Ababa, June, 2018
Variables Category NSSI COR(95% CI) p-value
YES NO
Age <25 21 38 0.32(0.473,1.834) 0.838
25-30 41 74 0.934(0.530,1.645) 0.813
>30 35 59 1
Sex Male 39 38 1 0.002**
Female 58 133 0.425(0.247,0.731
Marital status Single 53 105 0.707(0.214,2.3330 0.569
Married 35 54 0.907(0.267,3.7086) 0.876
Divorced 4 5 1.120(0.196,6.414) 0.899
Widowed 5 7 1
Educational BSC 73 129 0.5349(0.260,1.101) 0.089*
status Diploma 6 25 0.227(0.075,0.688) 0.009**
MSC 18 17 1
Working Emergency 9 16 0.703(0.257,1.923) 0.493
department ICU 6 7 1.071(0.310,3.6980) 0.913
Medical 28 44 0.795(0.374,1.6930) 0.553
Surgical 20 5 1
OPD 26 47 0.691(0.324,1.476) 0.340

34
 Pediatrics 8 32 0.313(0.118,0.8270 0.019**
Training Yes 60 86 1.603(0.965,2.6630 0.069*
No 37 85 1
Working <5 71 127 0.599(0.273,1.312) 0.200*
experiences 5-10 12 29 0.44390.164,1.195) 0.108*
>10 14 15 1
Dirty sharps Yes 75 109 1.939(1.098,3.423) 0.022**
in working No 22 62 1
places
IP committee Yes 70 80 1.495(0.833,2.6840 0.1778*
No 27 91 1
Safety box at Yes 70 121 1.071(0.616,1.862) 0.808
right places No 27 50 1
Universal Yes 72 120 1.224(0.699,2.144) 0.480
prequetion No 25 51 1
Sharp Yes 66 114 1.065(0.625,1.812) 0.818
collection No 31 57 1
box
Needle Yes 53 65 1.964(1.185,3.255) 0.009**
recapping No 44 106 1
Injection Safe 32 49 1
environments Unsafe 65 122 0.816(0.477,1.397) 0.458
* Significant at p≤0.2, ** significant at p≤0.05

35
5.4.1.2. Multi-variate analysis

In the logistic multi variate analysis sex, current working department, dirty sharps in
working places and needle recapping are statistically significant with the occurrence of
needle stick and sharp injury. But, working experiences and status of infection
prevention committee had not showed any significant association. On bi-variate analysis
respondents being diploma in educational status were 77% less likely risk of experiencing
injury compared to their counterparts. But this was not significant after controlling other
variables in multivariable analysis.
In multivariate analysis the odds of needle stick and sharp injury was 54% less likely in
female nurses than male nurses (AOR = 0.461 (95% CI, 0.252, 0.845). Those who
worked in the pediatric ward were 68 % less likely to get injured by needle stick and
sharp objects than those who worked in surgical ward. AOR = 0.323 (0.112, 0.930). The
risk of NSSI were 1.78 times higher in nurses who had recapping needle after use than
those nurses had not recapping needle after use; AOR=1.780 (95% CI,1.025,3.091).The
total model was significant (p=<0.001). All the value of the standard error in the model
(0.127) was below 5 which indicated no multi-collinearity among variables. The result of
the Hosmer and lemshow test (p=0.791) indicated the goodness of fit of the model. The
Nagelkerke R Square shows that about 50% of the variation in the outcome variable
(NSSI) is unexplained by this logistic model (Table 8).

36
Table 8: Logistic Regration Model Analysis of Factors Associated with NSSI; TASH,
Addis Ababa, June, 2018(n=268).
Variables Category NSSI AOR(95%CI) P-value

Yes NO
Sex Male 39 38 1
Female 58 133 0.461(0.252,0.845) 0.012*
Emergency 9 16 0.670(0.226,1.984) 0.469
Working ICU 6 7 0.8464(0.214,3.487) 0.838
departments Medical 28 44 0.666(0.288,1.542) 0.343
OPD 26 47 0.711(0.299,1.692) 0.441

Pediatrics 8 32 0.323(0.112,0.930) 0.036*

Surgical 20 25 1

Dirty sharp in Yes 75 109 2.052(1.110,3.791) 0.022*

working places No 22 62 1
Work experiences <5 71 127 1.413(0.520,3.839) 0.498
5-10 12 29 0.602(0.202,1.795) 0.363
>10 14 15 1
IP Committee Yes 70 89 1.702(0.878,3.299) 0.116
No 27 91 1
Needle recapping Yes 53 65 1.780(1.025,3.091) 0.041*
No 44 106 1
Training Yes 60 86 0.753(0.429,1.323 0.324
No 37 85 1

37
 CHAPTER SIX

6. DISCUSSION

In this study the prevalence of nurse who sustains NSSI in the las 12 month was found to
be 36.2% with 95% CI of 30.2% to 42.3%. This is in line(comparable) with the studies
done in Ethiopia; Jima University hospital which showed 39.3% (53), Sidama Zone
(32%) , North western Ethiopia (31%) (51), India (33.3%) (35), central India (31.8%)
(41) and Tehran (41%) (37). But the prevalence in this study is lower than the figure from
an earlier studies in south west Ethiopia 58.8% (48), sri lanka (43%) (40), Thailand
regional hospital (55.5%) (34) and Iran shiraz university hospital (54%) (43). However,
this result is much lower when compared with study done in Ethiopia, Bahir Dar, 66.6%
(50),south Korea (74.4%) (32), Pakistan (67%) (33), Nepal (74%) (36), Iran imam
Hussein hospital (63.3%) (38), Jordan (67.6) (39), Iran imam reza hospital (73.3%) (42).
This difference might be related to the fact that the above studies were conducted by
mixing all types of health professionals from hospitals, health centers and clinics, socio-
demographic/economic status, and cultural characteristics of study participants, sampling
method and sample size. The other possible reason might be related to work load and the
availability of resources as well as the work environment and related to different time of
recall periods.

In this study the prevalence of NSSI were higher as compared to other studies like East
Gojam Zone Health Institutions (22%) (51) and South Africa(18.8%) (45). It could be
due to the difference in the study health facility set ups, so that the number of screening,
diagnostic, follow up and other intervention procedures that use needles and medical
sharp materials were less in health centers and even the year of the study. But whatever is
the difference in the proportion of needle stick and sharp injury, nurses are at much
higher risk to acquire blood borne pathogens such as HIV and other infectious diseases
through needle stick and sharp injuries.

In this study majority of injuries was slight skin penetration (53.1%) while (32.7%) was
superficial, Regarding causative tools, the most frequent causative tools were needle

38
(86.3%). The present study revealed 51% exposed nurses used wash with water after
exposure while 44.9% of them with antiseptic solution. This was lower than study
conducted in Egypt, zigzag university who reported that severity of penetration of needle
stick and sharp injuries during the last year among nurses were superficial (74.24%) and
the most procedure exposed nurses were injection and withdrawal of blood (56.06% and
43.18%) respectively and procedure taken after exposure showed that, all exposed Nurses
used antiseptic after exposure while half of them let blood to flow (1). But This result is
higher than study done by JUH for nurses shows that needle 25.6%, surgical blade 23.2%
(53). This result is also higher than study done by National surveillance for health care
workers (NASH) of USA show that 59% of all sharp injuries were caused needles and
study conducted in India showed that 71% the needles involved in the NSSIs injury were
needles(35, 54). This variation might be due to different time of recall period.

The study revealed that syringe needle was a major cause of the injuries (74.2%). It is
much higher as compared to the study done in Tehran (Iran) (46.3%) (37) and south west
Ethiopia (58.8) (47). However, it is consistent with a study done in South Africa (78.3%)
(45). This implies that nurses who had been injured by NSSI might be due to
inappropriate needle handling practices. It might be also due to majority of the
procedures done for the patients require syringe needles that may put nurses under risk of
injuries.

Regarding the frequency of injury, 49.5 % of the respondents had experienced injuries at
least once in a year. This is a little bit higher than as compared to the study done in India
(33.3%) (35). But whatever the difference of the proportions of NSSI, nurses might
practice needle recapping after use which may put them under risk of injury. For instance,
the prevalence of needle recapping after use in this study was 44 % and of these nearly
one third (30.5%) was recapping using two hands. The practice of recapping is higher to
the studies in Nigeria(46) (35.3%) and Northern Ethiopia (34.7%) (51).

In this study Injection 37.7% and blood withdrawal 24.5% were the major clinical
activities that lead to NSSIs in this study. Study conducted in Saud Arabia, showed that

39
most of the injuries occur during injections 31.8% and drawing of venous blood samples
17.2% (55) And study conducted in India showed that the commonest clinical activities
to cause NSSIS in that study were, 55% blood withdrawal, 20.3% suturing, 11.7%
vaccination and recapping needles after use was 66.3% and according to a study done in
Malaysia hospitals nurses 27.2% NSSIs causes were recapping of syringes after use (44).
In this study 64.9% nurses were vaccinated against Hepatitis B. This result is higher than
a study done in Jimma hospitals showed that 1.76% of the study subjects were vaccinated
for hepatitis B vaccine (53) And study conducted Egypt showed that only (6.81%) were
vaccinated for hepatitis B (1).This variation may be due to the presence of the vaccine in
TASH.

Regarding to factors found to be associated with high prevalence of NSSIs. From those
factors being female was significantly associated with NSSI; the odds of needle stick and
sharp injury was 54% less likely in female nurses than male nurses (AOR = 0.461(95%
CI, 0.252, 0.845). This is consistent with the report from south western Ethiopia (47). The
possible explanations might be men are less likely to use universal precautions but further
studies are warranted to identify exposure differences. Those who worked in the pediatric
ward were 68 % less likely to get injured by needle stick and sharp objects than those
who worked in surgical ward: AOR = 0.323(0.112, 0.930). This is also may be due to
more advanced procedures and manipulation of syringe and sharp materials were done in
surgical ward. Respondents who practiced needle recapping were 1.78 times more likely
to experience injury than who did not recap needles after use: AOR=1.780(95% CI,
1.025, and 3.091). Recapping needles after use was positively associated With NSSI in
previous studies Jimma zone (49).

Taking training on infection prevention was not found to be statistically significant on

multivariable analysis in this study. Similarly, this finding goes in line with previous
findings study in Bahir Dar, in which training for workers seem to be not necessarily
brought about protection from injury exposure. The reason for this may be: (i)
Knowledge gained may not necessarily be transferred into practice of preventive
measures or knowledge received may not be sufficient. (ii) Those who participated on the

40
infection prevention training may be other workers who are working as administrators
rather as nurses working in clinical area (i.e. the training missed the personnel under risk
of injury). (iii) The training might be given after the workers sustained the injury. (iv)
The provided training may be more of theoretical than practical. Lastly, the sample size
might not sufficient enough to detect the differences.

Current Working Unit/department/, sex, presence of contaminated needle and sharps

materials in the working area and needle recapping had significant association with the
occurrence of sharp and needle stick injury in nurses; AOR = 0.323(0.112,0.930), (AOR
= 0.461(95% CI,0.252, 0.845), AOR=2.052(1.110,3.791) and AOR=1.780(95%
CI,1.025,3.091) respectively (p<0.05). This result is almost different with study
conducted in East Gojjam Zone Health Institutions health care workers which showed the
following results: sex of the worker, infection prevention and safety information access
and getting training on infection prevention showed a significant association with the
occurrence of needle stick and sharp injuries in health care workers (56).This difference
may be related to difference of the setups they use (standard precaution guidelines) and
mixing all types of health professionals from health centers.

41
 CHAPTER SEVEN

7. LIMITATION AND STRENGTH

7.1 Strength of the study

Since the study was conducted among randomly selected nurses it might be generalized
to all nurses who had direct contact with patients or equipment’s used on patients
working in the study hospital.
7.1. Limitation of the study

 Some staffs couldn’t remember that they sustained needle stick and sharp injuries within
the past 12 months, some respondents were not sure their information kept secrets and
nurses was recruited during their lunch time and not comfortable to answer freely. Since
participants have been asked a one year exposure experience, there might be recall bias.
 Since the study was based on self-reported data in estimating the prevalence of NSSI
exposure; a common threat to the validity of the self-report that can lead to information
bias such as social desirability and recall bias.
 In addition, a cross-sectional study by its nature cannot establish definitive cause and
effect relationship to identify the risk factors.

42
CHAPTER EIGHT

8. CONCLUSION AND RECOMMEDATION

8.1. Conclusion

This study revealed that more than one third of study participants had needle stick and/or
sharp injury at least once in the previous 12 months. The proportion of needle stick and
sharp injury in the last one year was found to be high.
In general this study revealed that no single factor accounted for the occurrence of NSSIs.
Presence of contaminated needles and/or sharps materials in the working area and needle
recapping after use were positively associated with needle stick/sharp injury; while
working in pediatrics ward and being female showed negative association.

43
 8.2. Recommendation

Based on the findings of this study the following recommendations forwarded to MOH
Ethiopia, Addis Ababa City Administration Health Bureau, TASH Managers and TASH
nursing professionals to reduce the occurrence of NSSIs and the consequences of NSSIs
among nurses working in TASH:
 TASH Hospital administrates and nursing service directors: Strengthened regular
provision of information on infection prevention and safety to nurses at all levels to
creating safe working environment for nurses. Continuous monitoring of the work place
safety and appropriate sharp disposal system.
 TASH Nurse Professionals: Practice proper use of safety box and personal protective
equipment during handing needle and sharp. Nurses involved in safe segregation and
disposal of all sharps items immediately in marked containers.
 Health policy makers: Formulate strategies to improve the working condition for
nursing professionals and increase their adherence to universal precautions.
 MOH: continuous monitoring of the work place safety should be ensured by MOH.
 Addis Ababa City Administration Health Bureau: Regular reporting, follow up and
evaluation of occupational injury exposure among nurses need to be introduced.
 NGO: Creating awareness to nursing professionals on safety practices of injection.

44
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35. Kaushik A, Sarin J. Prevalence of Needlestick Injuries and Its Related Factors
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50. Lulie Walle EA, Medihanit etal.ww. Factors associated with needle stick and sharp
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49
10. ANNEXES
Annex I: Participants Information and Consent Form
Information sheet:
This questionnaire was designed to investigate the prevalence and factors associated of
needle stick and sharp injury sustained by nurses in Tikur Anibesa Specialized Hospital
in Addis Ababa. It were look in to the following details back ground information,
prevalence, associated factors and circumstances surround ding needle stick injuries.
There was no risk to take part in the survey, all information were confidential. Their
name was not kept in the form. Their participation in the survey was voluntary: They
were not obliged to participate and may discontinue at any time. Moreover, this research
thesis was approved by Ethical review board of AAU and college of health science,
department of emergency medicine.
Consent Form
Hello! Good morning/afternoon? My name is ----------------- I am here today to collect
data on the Assessment of prevalence and associated factors of needle stick and sharp
injuries among nurses in Tikur Anibesa Specialized Hospital. The objective of this
questionnaire was to assess prevalence and associated factors of needle stick and sharps
injuries among nurses in Tikur Anibesa Specialized Hospital. Your correct and genuine
response or answer to the questions can make the study achieve its goal. Therefore, you
are kindly requested to respond very voluntary with patience. The questionnaire may take
10 to 15 minutes. We assure you that this study is surely confidential, thus writing your
name is not needed. Are you willing to participate in answering the questionnaire?
Yes! Go to the next page.
No! Thank them and interrupt to take response.
Sign of the consenting interview ………………………………………
Supervisor’s name ………………………………………………….
Sign ……………………………

50
 Annex II: Questionnaire Check List
I. Sociodemographic characteristics
No. Questions Choices Skip
101 Age in years?
102 Sex? 1) Male
2) Female
103 Level of education? 1) diploma nurse
2) BSC nurse
3) MSC nurse
104 Marital 1) Single
status 2) married
3) divorced/separated
4) widowed
105 Religion 1) Orthodox
2) Muslim
3) Protestant
4) Other(specify)----------------------
Experience in
years
106 Current working 1) Emergency
Department 2) OPD
3) Pediatrics
4) medical
5) surgical
6) ICU
107 Is there any infection prevention 1) Yes
committee? 2) No

108 Have you ever been vaccinated 1) Yes

for HBV? 2) No

51
II. Information on needle stick injury and sharp injury (NSSI)
201 Type of injection equipment 1) Sterilized and reused.
(syringe and needle) used in the 2) Single Use
facilities 3) Auto disposable
4) Other (specify) ……………
202 Have you had any sharp and 1) yes
needle stick injury since last 2) No
year?

203 perceived causes of NSI by

1) Workload
nurses 2) Fatigue
3) Lack of proper equipment for disposal
4) Any other (carelessness)
204 How much sharp (needle) injury 1) One time
have you sustained since last 12 2) Two times
months? 3) Three times
4) Four and above
205 How much sharp (needle) injury 1) One time
have you sustained since last 1 2) Two times
months? 3) Three times
4) Four and above
206 In your most recent needle stick 1) Syringe needle
injury, What type of item caused 2) Suture needle
your injury? 3) Butterfly needle
4) Hollow bore needle
4) Glasses item
5) IV cannula
6) Insulin needle

52
 7) Scalpel blade
8) Other Sharp…………….
207 Type of injury you sustained? 1) Deep injury
2) Slight skin penetration
3) Superficial
4) Others (specify)…………….
208 Causative tools of NSI and sharp
1) Needle
injury during the last year? 2) Blade
3) Scissors
4) Lancet
5) Others
209 What parts of the where injured 1) Hand
2) Thigh
3) Finger
4) Palm
5) Arm
2010 How was the injury inflicted 1) Self
2) Another staff
3) Non-compliant patient
4) Other, specify………………
2012 Which Procedure exposed for
1) Injection
NSI and sharp injury 2) Suturing wound
3) Sample drawing
4) Operation
5) Needle recapping
6) Sharp disposal
7) Cleaning and sterilization of ins
8) Failing of tools
9) Others
2013 What actions taken after
1) Left blood to flow
exposure happened during NSI
2) Wash with water

53
 and sharp injury in the last year?3) Use antiseptic
4) Lab investigation
5) Vaccination
6) Seroprophylaxis
7) Reporting
2014 Do you know which unit / 1) yes
Department or room you may 2) No
report if you exposed or
sustained sharp or needle injury?

2015 In your last NSI, you sustained 1) Excess clients,

or observed which of the 2) Shortage of gloves
following factors contributed to 3) Shortage of sharp box
NSI? 4) Emergency Situation
5) Recapping of used needle
6) Removing of used needle
7) Attempting to bend the needle
8) After drawing the blood
9) Lack of training
10) During injection
11) During suturing
12) During securing IV line
13) Other( specify)----------------
2016 Have you had on site or off site 1) Yes
training on infection prevention? 2) No

2017 Is there any active post sharp 1) Yes

exposure management system in 2) No
your facility

2018 Did you recapping needle after 1) Yes

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 use? 2) No
2019 How did recapping of the needle 1) Single handed
occurring? 2) Two handed

2020 Have you observed any needle 1) Yes

stick injury on nurses? 2) No

2021 How did the needle stick injury 1) Abrupt movements of the patient/s
occur? 2) Two handed recapping
3) Unsafe sharp collection
4) Carelessness/ negligence
5) Other(specify)-----------------
2022 How is the injection 1) Clean and no potential contamination of
environment? syringes and needled with blood or other
body fluids
2) Dirty and potential contamination of
syringes and needles with blood or other body
flu-ids.
3) Comments
2023 Are there any needle, syringes, 1) Yes
and sharp collection box in the 2) No
room?

2024 Type of needle, syringes and 1) Safety box

sharp collection box? ( you can 2) Liquid proof
select more than one) 3) Open container
4) Puncture proof
5) Others (specify) ……………
2025 Have you ever seen sharp 1) Over filled
container ( can select more than 2) Torn and needle seen through the hole
one) 3) Empty or few dirty syringes and needle

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 inside it
4) Others (specify)
2026 Have ever seen any dirty needles 1) Yes
and sharps in place where they 2) No
expose nurses to needle stick
injuries.

2027 How are needles, syringes, and 1) Open incineration

sharps disposed In your facility 2) Protected incineration
3) Open dumping
4) Burial in a pit
5) Dumping
6) Other (specify) ………………
2028 Is there a list of recommended 1) Yes
practices to prevent NSI in your 2) No
work place? Ex. Universal
Precaution?

2029 Are there safety box available at 1) Yes

your work point as long as your 2) No
hand stretch

2030 What suggestion do you have for

1) Change the attitude of nurses on safety
preventing needle stick injury injection
(NSI) and Sharp injury 2) Education and training for nurses
3) Change perception of nurses on risk of NSI
and sharp injury.
4) Others specify

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Annex III. Assurance of Principal Investigator (declaration)
The undersigned, declare that this thesis is my original work and has not been presented
for degree in this or any other university, and all sources of materials used for this thesis
have been fully acknowledged.
Name of the student: BIKIS LIYEW (BSc)
Date_________ Signature _____________
Place: Addis Ababa
Date of submission: June, 2018
Address: +251932731964, [email protected]

Advisors: Dr. Menbeu sultan

Signature: ______ Date_______

Mr. Mebrat Micheal

Signature: ______ Date_______

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