s12199-019-0807-7.pdf

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s12199-019-0807-7.pdf

School
Buraq Institute of Higher Studies, Peshawar*
*We are not endorsed by this school
Course
A EN ENGLISH LI
Pages
10
Upload Date
Feb 9, 2024
Uploaded by MasterWalrus1888 on coursehero.com
REVIEW ARTICLE Open Access Prevalence of needlestick injury among healthcare workers in Ethiopia: a systematic review and meta-analysis Teshiwal Deress Yazie * , Kasaw Adane Chufa and Mekonnen Girma Tebeje Abstract Background: Health facilities can provide diagnostic, curative, and prognostic services for the community. While providing services, healthcare workers can be exposed to needlestick injuries that can transmit pathogenic organisms through body fluids. Objective: The aim was to establish the pooled prevalence of needlestick injuries among healthcare workers in Ethiopia. Methods: This systematic review and meta-analysis was conducted according to PRISMA guidelines. Articles were searched from Google Scholar, PubMed, Science Direct, and Scopus databases using a combination of keywords and Boolean functions. All the searched articles were imported into the EndNote X9 software, and then, duplicate data files were removed. Article screening and data extraction were done independently by two authors. Data manipulation and analyses were done using STATA version 15.1 software. Results: The analysis of 23 full-text articles showed that the prevalence of the 12-month and lifetime needlestick injuries among the primary studies ranged from 13.2 to 55.1% and 18.6 to 63.6%, respectively. The pooled prevalence of needlestick injuries among the Ethiopian healthcare workers was 28.8% (95% CI 23.0 - 34.5) and 43.6% (95% CI 35.3 - 52.0) for the 12 months and lifetime, respectively. Conclusions: The pooled prevalence of needlestick injuries among Ethiopian healthcare workers was high. Therefore, efforts should be implemented to reduce the occurrence of injuries. Adequate protective equipment and safety-engineered devices should be supplied for the healthcare workers. It could be more effective to reduce the factors contributing to increased exposures through the allocation of adequate numbers of the healthcare workforce and implementing in-service training. Keywords: Needlestick injury, Percutaneous exposure, Occupational exposure, Healthcare worker, Ethiopia Background Healthcare facilities (HCFs) can provide diagnostic, prevent- ive, curative, and prognostic services for the community. However, while they are providing services, healthcare workers (HCWs) are exposed to blood and body fluids through occupational sharps, splashes, and needlestick injuries [ 1 , 2 ]. Particularly, there is a potential exposure among doctors, nurses, laboratory professionals, and bio- medical waste management staff to blood-borne pathogens worldwide [ 3 - 5 ]. Needlestick injuries (NSIs) are the most common workplace-related health hazards responsible for the transmission of blood-borne pathogens [ 6 , 7 ] among the HCWs where safety measures have not already been estab- lished [ 2 ]. Needles caused accidental penetration of the skin [ 2 , 8 - 11 ]. Injuries mostly happen during needle recapping, operative procedures, blood sample collection, intravenous line administration, and poor waste disposal practices [ 12 ]. Following NSIs, more than 20 blood-borne pathogens can be transmitted through body fluids [ 11 , 13 ]. However, the most common diseases that can be potentially transmitted through body fluids are HIV, HBV, and HCV [ 11 ]. © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated. * Correspondence: [email protected] ; [email protected] Unit of Quality Assurance and Laboratory Management, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia Environmental Health and Preventive Medicine Yazie et al. Environmental Health and Preventive Medicine (2019) 24:52 https://doi.org/10.1186/s12199-019-0807-7
Though currently the exact incidence of NSIs is believed to be underreported [ 14 ], the World Health Organization (WHO) reported as 3 million HCWs were exposed to blood-borne viruses each year globally. From this, 2 million, 900,000, and 300,000 were contributed to HBV, HCV, and HIV, respectively, and the majority (90%) happened in the developing countries [ 15 , 16 ]. The high incidence of NSIs associated with blood-borne infections among developing countries is mainly attributed due to the high disease prevalence and lack of proper personal protective devices [ 17 , 18 ]. The risk of acquiring HBV, HCV, and HIV infections from the sharp exposure when the source patient is positive can range from 2 to 40%, 3 to 10%, and 0.2 to 0.5%, respectively [ 19 , 20 ]. In addition, HBV can survive up to a week under optimal conditions and has been detected from the discarded needles [ 21 ]. The morbidity and mortality associated with occupational hazards are impacting the health and productivity of the health workers [ 22 ] through high cost, health consequences, emotional distress, and missing working days [ 23 , 24 ]. Cur- rently, there is no review conducted with respect to the estimation of NSI prevalence in Ethiopia. Therefore, the aim of this systematic review and meta-analysis was to estimate the pooled prevalence of NSIs among the healthcare workers in Ethiopia. Methods Setting Ethiopia is a highly populated country in the Horn of Africa. Though, currently, the exact number of the population is unknown, during 2012, it was predicted to be 84,320,987 [ 25 ]. Due to rapid population growth, the number of health facilities is increasing [ 26 , 27 ]. Currently, the healthcare management is grouped into primary, secondary, and tertiary levels. During 2011, there were a total of 22,792 health facilities in the country. From this, hospitals, health centers, health posts, and private clinics accounted for 125, 2999, 15,668, and 4000, respectively [ 28 ]. The health posts and health centers provided basic health services to the community, and an estimated 3000 - 5000 and 40000 popu- lation, respectively, is allocated for them. Similarly, primary hospitals serve about 60000 - 10000 population. General and specialized hospitals cover a wide catchment area, and they provide specialized and referral services for about 1 - 5 million population [ 29 ]. Currently, with the rapid increment of HCFs, the ratio of the healthcare worker task force to the health facilities is becoming quite inadequate [ 30 ]. Article searching strategy Literature search, selection, data extraction, and reporting of the results were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 31 ]. Online electronic databases including Google Scholar, PubMed, Science Direct, and Scopus were searched using a combination of keywords and Boolean functions: (1) (needle injur* OR needlestick injur* OR percutaneous injur* OR occupation* exposure OR accident* exposure OR Body fluid* exposure OR accidental occupational exposure OR Occupational hazard*) (2) (health care worker* OR health worker* OR health staff OR medical personnel OR health personnel) (3) Ethiopia 1 AND 2 AND 3 Eligibility criteria Articles were included in the study only if they reported the 12-month, lifetime, or both prevalence of NSIs. Primary full-text articles published in English from the Ethiopian settings were the inclusion criteria thereby excluding letters to editors, short communications, and review articles. In addition, the aggregate report of needlestick and sharps injuries were excluded from the study. Study selection and data extraction All the searched articles were imported into the EndNote version X9 software, and then, duplicate files were removed. Two investigators (TD and MG) independently screened articles by their title, abstract, and full-text to identify potentially eligible studies according to the predetermined inclusion criteria, and then, the screened articles were com- piled together from the two reviewers. The data extraction form was prepared in Microsoft Excel Spreadsheet. Data were extracted from the full-text articles by two reviewers (TD and KA) independently. The data extraction form includes the name of the first author, year of publication, setting (region of the country), study group, sample size, number of needlestick injuries, 12 months prevalence, and lifetime prevalence. Any discrepancy between the two data extractors was resolved by discussion. Statistical analysis The extracted data were categorized into 12 months and lifetime needlestick injury and entered into the STATA version 15.1 separately. The prevalence estimates were conducted using the metaprop program. Proportions of exposure (p) and the corresponding standard errors (se) were calculated using p = r/n and se = p(1 p)/n, re- spectively. However, to normalize the distribution, study level estimates were logit transformed using logitp = ln[p/(1-p)], and the corresponding standard error (se) of logit event estimates se = 1/r + 1/(n-r) was calculated. In situations with high across study heterogeneity, the use of random effects models is recommended [ 32 ]. The DerSimonian and Laird method is the most common Yazie et al. Environmental Health and Preventive Medicine (2019) 24:52 Page 2 of 10
method for using a random effects model for the meta- analysis [ 33 ]. The presence of heterogeneity among the studies was checked using the I 2 test statistics. The I 2 statistics estimates the presence of observed difference between studies due to heterogeneity, and it can range from 0 to 100%. A value of 0% indicates the absence of heterogeneity whereas 100% indicates the presence of significant heterogeneity. The 25%, 50%, and 75% values represent low, medium, and high heterogeneity between studies, respectively [ 34 ]. In addition, a p value of less than 0.05 is used to declare heterogeneity [ 35 ]. In this meta-analysis, in both 12 months and lifetime prevalence estimates of NSIs, the I 2 values were found to be high (> 75%). Since this value is a definite indicator of signifi- cant heterogeneity, the analysis was conducted using a random effects model with 95% CI as opposed to the fixed effects model to adjust the observed variability among the studies. Moreover, the sources of heterogen- eity were assessed through subgroup analysis, sensitivity analysis, and meta-regression. Finally, small study effects and publication bias were analyzed through visual inspection of the funnel plots and objectively using Egger ' s test. All the data manipulations and analysis were performed using the STATA version 15.1 software. Quality assessment The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) quality assessment tool for the prevalence studies [ 36 ]. The evaluation criteria included nine parameters: (1) appropriate sampling frame, (2) proper sampling technique, (3) adequate sample size, (4) study subject and setting description, (5) sufficient data analysis, (6) use of valid methods for the identified conditions, (7) valid measurement for all participants, (8) using appropriate statistical analysis, and (9) adequate response rate. Two reviewers (TD and MG) assessed the quality of included studies. Finally, studies were categorized into high risk of bias and low risk of bias using 50% as a cutoff value. Articles with a score of 50% were considered as a low risk of bias. Fig. 1 The PRISMA flow diagram showing the study selection process Yazie et al. Environmental Health and Preventive Medicine (2019) 24:52 Page 3 of 10
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