CHAPTER-1

INTRODUCTION

One of the best aspects of healthcare reform is it starts emphasis prevention

-Anne wojcicki

Globally there are 136 million workers in the health and social work sector ,

approximately 70% of whom are women. All these workers have the right to decent

work ,including protection of health and safety measures for protecting health workers and is

also fundamental for well functioning and reselient health systems ,quality of care and

maintaining a productive health workforce . Health workers faces a range of occupational risk

associated with biological , chemical, physical and psychosocial hazards affecting the safety of

both health workers and patients

The safety of nurses from workplace induced injuries and illness is important to

nurses themselves as well as to the patients they serve . The presence of healthy and well

rested nurses is critical to providing vigilant monitoring emphatic patient care and vigorous

advocacy . Aspects of direct care work that influence nurse safety will be discussed ,including

the impact of physical job demands such as patient lifting and awkward posture ,protective

devices to prevent needle stick , chemical , occupational exposure and potential for violence

Needle stick injuries are among the hazards and problems that can expose health

workers to infection . Hepatitis B and C and HIV are some of biological hazards threatening the
health of thousand of health care workers . The most common mode of transmission of these

disease is via needle stick injury

A needle stick injury is an accidental skin penetrating stab wound from a hollow

bore needle containing another person’s blood or body fluid . Health care workers including

dental professionals are at an occupational risk of exposure to blood born pathogens following

needle stick injuries and sharp injuries

The study of Kebede A Gerenesa H prevalence of needle stick injuries and it’s

associated factors among nurses working in public hospitals of Desssie town North East Ethiopia

, 2016 , the majority of nursing students training takes place in clinical setting where they learn

various nursing skills including injection techniques taking that samples and the monitoring

blood sugar level using under the supervision of instructor . However these nurses more

vulnerable to needle stick injury then experience due to inadequate knowledge and experience

in terms of handling needle and sharp objects in a clinical settings.

Based on literature review, Cheung k Ching , chang kkp , Hosc prevalence of and risk

factors for needle stick and sharp injuries among nursing students in Hong Kong , An j infect

control ( 2012) , the prevalence of needle stick injury among nursing students has varied

between 81% and 71%.

Our first aim is to preventing this problems is to gain on understanding of its exact

prevalence .Therefore the study aimed to estimate the pooled prevalence of needle stick injury

in nursing students all over the world .

 BACKGROUND OF THE STUDY

Need stick injuries constitute The greatest threat to nursing students During

clinical practise, Mainly because of accidental exposure to body fluids and infected blood,

needle stick injuries are the injuries that are caused by various type of needle such as

Hypothermic needles, blood collection needles, Intravenous cannula needles [1]

Study on global prevalence and device related cause of needle stick injuries

Among health care workers (2020) Showed that risk of Needle injury is due to various factors

like improper handling of needles ,work overload, recapping of needles lack of safer needle

devices ,sharp Disposals ,low Resources, lock of Proper training, immunisation rate , failure to

observe universal precautions [2]

Needle stick injuries can be Dangerous as they can transmit blood born pathogens

such as Hepatitis B , Hepatitis C and HIV . All these viruses can be acquired by a percutaneous

needle stick or splashing of blood on the mucosal surfaces of the body ( Arezzo 2015). While HIV

primarily affects immune system both Hepatitis B and C have a predilection for the liver . World

health organization estimated that 16000 cases of Hepatitis C (HCV),66000 cases of hepatitis B

( HBV) and 1000 cases of HIV might occur globally in the year 2000 among health care workers

through their exposure to needle stick injuries (3)

According to meningistu DA jolera ST(2016) half of the health care workers has

an NSI during their work time and one third had it the previous year . Nursing students appear

more vulnerable to NSI than health care professionals due to inadequate knowledge and

experience [4]
 In developing countries which have the highest global prevalence of HIV , the

prevalence of NSIs is also at the highest level . (5) it is thought that regardless of the experience

or nature of health care provision , the risk of the exposure to blood born infection of

healthcare workers through needle stick injury is a major cause of serious health consequences

and psychological stress[6]

Nurses who worked in a hospital with the lower staffing rate and high level of

emotional stressful events as a result of their jobs had a Significantly higher risk of needle stick

injuries[7]

Nursing students appear to be at a greater risk of suffering as a compared to

professional nurses , which is primarily due to the absence of medical capabilities . Universal

precautions are standard of practice aims to discover the spread of blood born diseases such as

the use of hand washing before and after procedure is advised ,as in the case of barriers such as

protective clothing, personal protective equipment’s when interacting with the blood or

others[8]

Safe injection practices while caring patients play a major role in safety of health care

workers and their health including nursing students [Abbottabad 2015].Needle pricks shop

injuries represent as significant hazards in professional nursing[Theresa Lawson 2015]

 CHAPTER II

Review of Literature

A research never conduct a study in an Intellectual vaccum studies are usually under taken with in the
content of an existing knowledge basis, researchers undertake a literature review to familarises them
with that knowledge basis.

[Polit, 1995]

A literature review is an account of that has been published on a topic by accredited scholars and
researchers.

In this study reviews are Real categorised into:

Section A: Studies related to Incidence of needle stick injury

Section B: Studies related to Knowledge regarding needle stick injury

Section C: Studies related to prevention of needle stick injury

Section A: Studies related to Incidence of Needle stick injury

Across sectional study titled ``Incidence, knowledge, attitude and practice toward Needle
Stick Injury Among Health care workers in Abha city, saudhi Arabia´´published by Abdulla Alsabaani,
Norah speeds, Sarah saeed S in public health journal in 2022 February 14. The aim of the study was to
estimate.The incidence of needle stick injuries among health care worker during previous 12 months. A
structured questionare is used to called data. The study found that incidence of needle stick injuries
during previous 12 Months was 11.57% more than half (52-7%) are unreported. About 52.7% of needle
stick injuries occurred during using sharp devices and 42-91% injuries happened in patient room.

A crosssectional study titled‘‘occurrence and knowledge about needle stick injury in nursing
students published by Prasuna Sharma in 2015 April in northeast, India. The purpose of the study is to
measure the occurrence of needle stick injury along with past exposure measures and evaluation of
knowledge regarding needle stick injury among students. The sample size was 83. Self structured
question are is used to collect data. The Study found that the occurrence of needle stick injury during
their course was reported by 39.76% participants.It was also found that 54.54% of needle stick injury
were not reported. Among those exposed, only 15.15% student has took post exposure prophylaxis.

An article titled ``incidence of Needle Stick injury among, nursing students in Kathmandu,
Nepal published by Binita Kumaripaudel, kanchan kaski,in international journal of scientific and
technology in September 2013. The purpose of the study to determine the incidence of needle stick
injury among nursing students in Kathmandu. The sample size was 407. Self administered questionare
are used to collect data. The study found that 46.9% had have needle stick injury in the past and
44.7%experienced it more than one time. The over all incidence was found 5.82% person 1000 days
exposure.

Thus, After receiving the above literature, the investigator could identify the incidence of
needle stick injury. It widely reflects the significant needle stick injury experienced by health care
professionals especially nurses. Most of the studies are related to the knowledge regarding needle stick
injury. Most of the NSIs occured while recaping the needle.

Section B: Studies Related To Knowledge Regarding Needle Stick Injury

A cross sectional study titled ``Needle Stick and sharps injury in healthcare Students:
prevalence, Knowledge, atitude and practice published by Uma vasant Datas, Mamata Kamat,Mahesh
khaisnas in journal of Family Medicine and primary case in 2022 october 11. The purpose is to asses the
prevalence of needle stick injury and evaluate the knowledge, atitude and pratice regarding its
prevention and Management. The sample size 942 health care students in sangli, Maharashtra. A
structured questionare is uses to collect data. The study found that prevalence of needle stick and sharp
injury was found to be 25.2%. The students had adequate knowledge about prevention any management
of needle stick injury.

An article titled``prevalence, student nurses knowledge and practices of needle stick injuries
during clinical training: a cross sectional survey´´ published by mohammed Al gadise, cherry Ann c
Ballond in Al gadise BMC Nursing in 2021 october. The purpose of the study was to determine the
knowledge of the prevention guidelines of needle stick injury with a sample size of 167 students.
questionare is used to called data. The result showed of the participant 81.2% were females. The Mean
knowledge score was 6.6 cut of 10. The study demonstrates the student nurses have a moderate level of
knowledge about needle stick injury prevention measures.

An article titled ``Nursing student’s Knowledge regarding needle stick injury: Effectiveness of
structured teaching plan published by Rahul Stil, shivaleela p upashe in international journal of medical
and health research 11 2020 December 18. The purpose of the study to asses the knowledge regarding
needle stick injury among nursing students, conducted by Doyananda sagar university, Bengalur.A total
30 student nurses were recruited randomly. knowledge questionare is used to collect data. The Study
findings showed that 6 students (20%) har manegerate kronedie tousands needle shele casy. 24 Student
(80%) had moderate knowledge and none of them have adequate knowledge level regarding needle
stick injury.

An article titled “ A study to asses the knowledge of first years nursing students on Needle Stick
injuries at selected colleges of puducherry” published by sudha B and Ds. Selvanayaki in international
journal of research and Analytical Reviews in 2019 March 20. The purpose of the study is to asses the
level of knowledge on needle sick injury among first year nursing students. The sample size was 107 and
the study was conducted in vinayaka mission college of Nursing puducherry. Structured knowledge
questionares are used to collect data. The study found that 82.2% of the student had poor knowledge
and 16-82 had average level of knowledge and 0.3% student had good knowledge on needle stick
injuries.

An article titled ``Student nurses knowledge and prevalence of Needle stick injury in jordan
´´published by Mohammed suliman, Manas Alazzam,sami Aloush in Nurse education in today in January
2018. The purpose of the study to Measure Student nurses level of Knowledge about needle stick injury
with a sample size of 279 Students in jordan. The study used online survey composed of 22 questions.
Student nurses were recruited through facebook. The result was The mean score for the knowledge post
was 7 out of 10. The student nurses in Jordan have a moderate understanding of issues regarding needle
stick injury.

The studies stated above shows that lack of knowledge is the main reason for needle stick injuries.
The present study indicated a high incidence of needle stick injuries among nursing students with more
under reported cases and subjects were not aware of post exposure measures. The studies shows that
samples have moderate level of knowledge regarding needle stick injury.

Section C: study related to prevention of needle stick injures.

A descriptive cross-sectional study titled “Awareness in nursing students regarding prevention of

needle stick injuries: Prevention of needle stick injury” was conducted by
Shabbir.Janjua.S,Hanan.A,Afzal.M and Ali.A published in NURSEARCHER Journal of Nursing and
Midwifery Science. The study was aimed to aware nursing students regarding prevention of needle stick
injuries. This descriptive cross-sectional study was conducted at the Lahore School of Nursing, the
University of Lahore, Pakistan. The population of the study included 76 nursing students from 3 rd year
and 4th year. Sloven’s formula was used to get the sample size: n=N/(1+N€2) where ‘N’ denotes the
population, ‘e’ denotes the margin of error and ‘n’ denotes the sample size. Data were collected used
self administered questionnaire. The study result showed “Did you experience needle stick injury?”
49(64.5%) respond yes and 37(35.5%) respond no, “Did you reported the NSI event” 24 (31.6%) respond
yes and 52(68.4%) respond no, “NSI may lead to significant anxiety for the affected person “ 33(43.4%)
respond yes and 43(56.6%) respond no, “Do you know about needle safety device ?” 15(19.7%) respond
yes and 61(80.3%) respond no. The study showed that lack of awareness is one of the major factor for
needle stick injury.

A cross sectional study titled “knowledge and practice of needle stick injury Prevention among
nursing personnel in a teritary care teaching hospital in South India” was conducted by Muhammad and
Reddy.K.V, published in IP International Journal of Medical Microbiology and Topical Disease on 2020.
The sample size include 100 nursing staffs. Data were collected using structured questionnaire having
close ended and multiple choice questions. The study found that the result rate was 80%, incidence of
NSI was 45%, only 24% of the nurses were aware of the definition of NSI, about 90% of them was aware
about the infection transmitted, 85% of them are unaware of ‘no recapping ‘ technique of disposal, 90%
of them were aware of standard precautions. Overall knowledge is adequate among 65% nurses, only
35% nurses reported their NSI after incident,24% knew post prophylaxis, 98% of the reported NSI
incidents.

A cross sectional study titled “knowledge and practice of needle stick injury Prevention measures
among nurses of Sana’a city hospital in Yemen” was conducted by Gawad.M.A.Alwabr published in
Indian Journal of Health Sciences and Biomedical Research on November 2018. 259 samoles were
randomly selected from the staff nurses. A pre-test structured self administered questionnaire was used
for data collection. The result shows that 114(44%) respondents had poor knowledge of NSI prevention
measures, 75(29%) had a fair knowledge and 70(27%) had good knowledge. 198(76.5%) respondents
had a poor practice of NSI preventive measures, (8.9%) had fair practice and (14.7%)good practice. There
was a statistically significant association between the knowledge and practice. Among the respondents
48.6% was vaccinated against Hepatitis B. The study showed that the practices and knowledge of needle
stick injury preventive measures were low and occupational exposure to needle stick injury was a
common occurrence in the study sample.

A pre-experimenral study titled “Effectiveness of structured teaching program regarding

prevention of needle stick injury among nursing students in selected college of nursing Noida was
conducted by Lavanya Nandan,Shilpa Katoch published in Indian Council of Holistic Nursing in 2019. 30
samples were selected and data collection was done through questionnaire. Study results showed that
the mean post-test score (10.166) with the mean difference of 4.567. Therefore the structured teaching
program was an effective method for improving knowledge on the prevention of needle stick injury.

A quasi experimental study titled “Prevention of needle stick and sharp objects Injuries among
internship nursing students during their clinical exposure: An educational program at Assiut University
Hospital, Egypt was conducted by Zanb Abd-Ellatif,Fathya Rdi, Heba Abdul Mowla on April 2018 and
published on IOSR Journal of Nursing and Health Science. The study was aimed to assess the effect of
educational program on knowledge and practice of internship nursing students towards practice of
needle stick injury. 76 samples were selected and data were collected using questionnaire and
observational checklist. Result of the study showed that. Result of the study showed that the subject’s
knowledge regarding needle stick injuries in post program is better than program. There is a highly
significant statistical difference between subject’s knowledge & performance regarding precautions to be
taken before, during and after needle stick injuries from pre to post program.

A quasi experimental study was conducted on 2017 to assess the effectiveness of self instructional
module on prevention of needle stick injury among nursing personnel between the age group of 21 to 35
years. Sample size was 50 satff nurses selected randomly from Sri Ramakrishna Hospital, Coimbatore. 20
questions were administered and time provided to answer were around 30 minutes. The result shows
that the mean value of pre-test was 18.18 and post-test was 26.94 with the mean difference was 17.09.
The result shows that the nurses has improvement in the level of knowledge after the self instructional
module.

The studies stated above shows that lack of occurrence is one of the major factor for needle stick
injury. Self instructional modules occur effective in terms of exchange the knowledge regarding the
prevention of needle stick injury among health personnel.

SUMMARY

This chapter deals with the literature of review categorised under three sections. In section A:
Studies related to Needle Stick Injuries; numerous studies state that, there are various circumstances
where needle stick injury was occurred. In section B: Studies related to knowledge regarding needle stick
injury; it shows that lack of adequate knowledge is one of the major cause of needle stick injuries. And in
section C: Studies related to prevention of needle stick injury; it focused on providing educational
programs or self instructional modules helps to improve the knowledge regarding the prevention of
needle stick injuries

CONCLUSION

The above literature review give brief idea about need of the study for identifying the effectiveness
of self instructional module in Prevention of needle stick injury among nursing students. The review also
helped the investigator in selection of suitable design, sample size, tools and techniques for the study.
Thus overall theses reviews facilitated the investigator in planning the methodology for the present
study.

CHAPTER 3

RESEARCH METHODOLOGY

“ Methodology should not be a fixed track to a fixed destination but a conversation about everything
that could be made of happening “

- jc jones

Introduction

Research methodology involves specific procedure or technique used to identify, selecte, process, and
analyze information about a topic. In a research paper, the methodology section allows the reader the
reader to critically evaluate a study’s overall validity and reliability. A research methodology is an outline
of how a given piece of research is carried out

This chapter deals with the methodology followed by investigator to assess the knowledge regarding
needle stick injury among BSc nursing students in upasana college of nursing ,kollam

“Methodology is the complete structure of resey study ;the size and sample method, the practices and
technique utilized to collect data, and the process to analyze data

_ Bowling ( 2002)
Research approach

A research approach is a plan and procedure that consist of broad assumptions to a detailed method of
data collection, analysis and interpretation. Therefore, it is based on the nature of research problem, the
approach of data analysis or reasoning. The three common approaches for conducting research are
quantitative, qualitative and mixed methy

In this study, the investigators used a quantitative research approach to asses the knowledge regarding
needle stick injury

Research design

The research design is the plan specifying specifyings and procedures of collecting and analyzing the
needed information in a research study. Research design is the researcher’s overall plan for answering
research questions or testing the hypothesis. The research design incorporates some of the most
important methodology decision that researcher makes

In this study, a quantitative descriptive survey design is used which facilitates the investigator to assess
the knowledge regarding needle stick injury with a view to develop say – instructional module
TO assess the knowledge regarding needle stick injury among BSc nursing students with a view to develop
sey -instructional module

Research approach and design quantitative description survey design

Preparation and validation of tool

Setting Upasana College of Nursing Kollam

Sampling technique ; non probability convenient sampling

Tool for data collection

Demographic data, sey -structured questionnaire to asses knowledge regarding needle stick injury

Technique for data collection

Data analysis

Data interpretation conclusion

Development and validation of self instructional module

Dessimination of research finding

 CHAPTER 6
DISCUSSION SUMMARY AND CONCLUSION
DISCUSSION
In the present study 40% of samples were in the age group of 20-22 years and 60% of samples
were in 22-24 years. 93.3% of students were females & 6.7% were males. 56.6% of students
belongs to Hindu relegion, 16.6% of students belongs to Muslim. 26.6% of students belongs to
Christian. 73.3% of sample completed III doses of hepetitis B vaccine and 23.3% samples
completed 2 nd dose of Hepatitis B vaccine. 3.3% sample completed 1 st dose of Hepatitis B.
86.6% of students gets NSI and 13.3% of students who not get NSI
A descriptive study to assess the level of knowledge about NSI and to examine its
prevalence and post exposure measures in Jordan. The samples of the study was 279 nursing
students and instrument consist of 22 survey question. Study reveals that characteristics of
respondants were 71% of females & 26.2% exposure to knowledge. 86.3%have average
knowledge &13.7% have poor knowledge
Distribution of samples according to knowledge score
In the present study 13.3% of the sample had knowledge and 86.6% had average knowledge
regarding needle stick injuary
Association between the knowledge score and selected demographic variables
In the study, finding shows that there are significant a.sociation between the knowledge score
and demographic variables such as age, sex, relegion, status of Hepatitis B immunization,
incidence of needle stick injury. Here the

Summary
Neddle stick injury is an accidental skin penetrating swab wound from a hollow bore needle
containing another peraon blood or body fluid. Health care workers are very much prone to cause
infection like hep B & hep C, Hiv. So, they should have adequate knowledge regarding needle
stick injuary. The aim of the study to “ assess the knowledge regarding needle stick injury among
forth year BSC nursing students in upasana college of nursing Kollam and to find out the
association between knowledge score & selected demographic variables. 30 forth year BSC
nursing students from upasana college of nursing kollam were selected by convenient sampling
technique. After obtaining conscent from them questionnaire was given to them then the data
collected were analyzed using descriptive and inferential statistics technique. Result which
revealed that students have (13.3%)below average knowledge and (86.6%) have average
knowledge regarding needle stick injury and there was a significant association between the
knowledge score and demographic variables such as age, sex, relegion, status of hepatitis B
immunization, incidence of needle stick injury
Conclusion
Bsc nursing students had adequate knowledge regarding needle stick injury
There was significant association between the knowledge score and demographic variables such
as age, sex, relegion, status of Hepatitis B immunization, incidence of needle stick injury

Nursing Implication

The findings of the study have implications of nursing practice,nursing education,nursing

administration and nursing research

Nursing practice

Prepare Bsc nursing students and teach them how to prevent needle stick injuries.

Health information can be imparted through pamplet,lecturer etc

As health professionals,the nurses who are in the hospital and community setting have a major

responsibility regarding needle stick injuries.

Nursing Education

It is very important for nursing students in understanding about needle stick injuries.
The structured knowledge question used in the study should be employed by teachers to refine

their knowledge about needle stick injuries.

Provide good education to the teachers can improve their knowledge on how to prevent the

spread of needle stick injury.

Nursing Administration

Nurse as an administer has a role in planning for protocols to prevent needle stick injury.

Administrator can also take intiative in impacting health education through different teaching

methods

Nursing Research

Research investigator can use the methodology as reference material to provide a venue for

further studies in this area.

Research Studies should be done on practicing newer methods of health teaching, focusing on

interest, quality and cost effective.

Limitations
The study was confined to specific group of students the structured knowledge questionnaire

was used to collect the data which restricted the respondent in providing adequate information

regarding the prevention of needle stick injury.

The findings of the study would be generalized only to that population who fulfilled the criteria

in this study.

Recommendation

A similar study can be replicated with a small sample in order to generalize the data.

A study can be conducted to assess the knowledge on preventing of needle stick injuries among

nursing students.

The study can be conducted to assess the knowledge on prevention of needle stick injury

among nursing students.