Introduction

Mushrooming of health care providing units ascends to biomedical waste generation and also the serious health consequences related to its inappropriate and inadequate handling.

Needlestick injuries (NSIs) are among the most common occupational hazards among healthcare workers (HCWs) worldwide. World Health Organization (WHO) estimated that NSIs cause HCV accounts for 16,000, HBV accounts for 66,000, and HIV accounts for 1,000 annually among Health Care Workers. Occupational exposure to needle stick injuries (NSIs) represents the most common sources of infection such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV).^[1] However, in spite of widespread alerts, it continues to be ill-reported and a topic of stigma and surreptitiousness. The current study encourages an informal qualitative tool to explore the adherence to measures against NSI in a tertiary care set up in Bhubaneswar.

Focus group discussions are qualitative exercises used to collect data through group interaction.^[2] This method is used more to elicit information about community problems but in this study, it was used to extract unbiased first-hand information on the subject in question, which was needle stick injuries.

Objectives

To gather information on knowledge and practices on NSI (prevention and management) among exposed health care workers, with specific reference to HIV infection.

To suggest recommendations to the work areas on the advocating of prevention and management of NSI.

Materials and Methods

On the eve of observance of World AIDS Day on 1^st December 2021, and as a part of an academic program, requisite Institutional permission was taken, and Focus group discussions (FGD) were conducted as per WHO norms.

The three key areas, whose workers were likely to be prone to NSI were chosen, i.e. Nursing station for Infection Control, Central Lab and Emergency/Casualty. A mix of preidentified nursing staff, lab technicians, and waste management staff participated in the exercise. Permission was taken from the head of institute and the departmental heads, being an academic exercise, ethics approval was waived off.

A predesigned pretested checklist was used to initiate a discussion among at least 10 workers (homogeneity with regards to the type of work i.e exposure to sharps and needles was maintained), with a team of faculty as facilitators. Questions were posed to the participants as per the checklist, by the facilitators in an informal manner and their responses were recorded, with their due consent. Utmost care was taken to avoid any prompting when a participant was speaking. Moreover, the speaker was gently diverted or asked another question if he/ she was deviating from the core topic. The timing of programme did not exceed 40 minutes. FGD was recorded in a template that included -the participants who spoke, participants who chose to keep quiet, the points generated, and any conflicts or discordance in the group. The entire exercise was audio-visually recorded and transcripted. The transcripts and infograms (proxy for sociograms for FGDs done in community settings) were analysed for final results.

Results

Overall the participants with maximum interaction in the exercise reflected a higher mean age (40-50 yrs) and higher years of work experience (mean 10 years; SD 2.5) in comparison to the nonrespondents. The infograms station-wise were used to derive inferences on the knowledge and practices among the groups involved in the exercise.

The infograms noted down during the exercise depicts the interaction of the participants.

1/11 participants (P10-WMS) had attended an educational awareness programme regarding NSI/HIV AIDS.

1/11 participants (P5-nurse) experienced NSI once and attributed the incident to recapping of needle.

1/11 participants (P5-nurse) had an idea about SOPs to be followed after encountering a NSI.

2/11 participants (P6, P8-nurses) had not received complete Hep B Vaccination and mentioned Covid as the reason for not completing their course.

3/11 (27.3%) participated in this discussion.

1/11 participants (P1-LT) had attended an training programme regarding NSI/HIV AIDS.

3/11 participants (P1, P4, P9-all LTs) experienced NSI multiple times and attributed the incident to high work load.

2/11 participants (P2, P3) had an idea about SOPs to be followed after encountering a NSI.

100% participants were completely vaccinated against Hep B.

3/11(27.3%) participated in the discussion.

1/11 participants (P8-nurse) had attended an educational programme regarding NSI/HIV AIDS and learnt about transmission, prevention and control.

2/11 participants (P8, P11-nurses) experienced NSI multiple times and attributed the incident to recapping of needle and lack of proper usage of PPE.

2/11 participants (P8, P11-nurses) had an idea about SOPs to be followed after encountering a NSI.

100% participants were completely vaccinated against Hep B.

4/11(36.3%) participated in discussion.

The Central Lab was found to be the most vulnerable site for NSIs, due to the increased workload and maximum reports of NSIs. The LT/Nurse were the most vulnerable group of workers to NSIs, as hinted by inputs. The nonresponse and lack of participation of BMW management staff in terms of occurrence and management of NSI, were the sentinel group identified for training on NSIs and management. NSI reported were mostly attributed to the practice of recapping of needles, despite proper usage of PPE.

Vaccination being inadequate among these active work sites also emerges as an area of concern. SOPs were not put up in any of the workstations. Use of PPE by the staff especially the BMW staff was erroneously reported.

Discussion

The above exercise is a simple projection of gaps in knowledge and practices and their influencers for needle stick injuries. Instead of taking a survey, wherein subjectivity refrains information, an informal discussion was done to elicit information and at the same time impart health education. In this study nearly 27% in all 3 groups reported a NSI, but the procedures to be done subsequent to that were unclear to all, akin to other studies wherein only 7%-15.6% workers knew what steps are to be done post-NSI.^[3], ^[4] Similarly, the prevalence of NSI were 8.4%, 11.57%, 20.1% & 35.1% by studies conducted at different hospitals.^[5], ^[6], ^[7], ^[8] Use of PPE was good among nurses and lab technicians (100%) but the knowledge of Post Exposure Prophylaxis (PEP) was only 88.5% in this study, while in studies in Tamil Nadu it was nearly 99.4%,^[9], ^[10] this could be because the high prevalence of AIDS in the city and state, for which sharing of equipment and PPE are restricted. Similarly, the knowledge about PPE was seen among 80.4% in a study conducted by Mponela MJ et al.^[8] Hepatitis B vaccination in this study is reported 100% among nurses and technicians but not among Biomedical waste management workers, even if their susceptibility is high. Similar findings are noted in a study done in dental premises.^[11] The vaccination status is satisfactory compared to other studies done by Batra V et al (49.6%),^[12] Byrd KK et al (63.4%).^[13]

Conclusion

The Focus Group Discussion conducted reflects the lack of awareness/educational exercises among the healthcare workers vulnerable to NSIs or similar themes of work place exposures and hazards, SOPs to be followed after a NSI, although available at the work place, was not followed and practiced. The theme of NSI is to be addressed adequately at the work level among health care providers.

Recommendations

Robust pre-orientation training, vaccination and refresher measures are advocated to identify and also tackle the burden of NSIs.

Registers reporting NSIs and its subsequent management to be encouraged to remove the taboos regarding the theme.

SOPs to be clearly put up at the work stations, practiced and reinforced by the workers regardless of their designation. The annual reports, accident reports, as required under BMW rules and regulations, should be submitted to the concerned authorities as per the standard format.

All the generators of biomedical waste should adopt universal precautions and appropriate safety measures while handling the bio‐medical waste.

Limitations

Single centric exercise, so the results cannot be generalised. FGD is not an ideal way out for knowing burden of NSI but here was done as the workers were closed groups and belonged to 1 center, hence recommendations could be robust. The homogeneity of the groups was maintained only regarding the workplace and exposure to NSI and not across the composition of the group.

Although the FGD was conducted as an experimental tool to seek out the ground level lacunae pertaining NSIs through an interactive and unbiased session, the presence of the area heads or seniors among the same cadre could have affected the responses.

Source of Funding

None.

Conflict of Interest

None.