PERCUTANEOUS I NJURI ES CORRELATES I N THE NURSI NG TEAM OF A BRAZI LI AN
TERTI ARY-CARE UNI VERSI TY HOSPI TAL
Silvia Rit a Marin da Silva Canini1 Suzana Alv es de Mor aes2 Elucir Gir3 I sabel Cr ist ina Mar t ins Fr eit as4
Canini SRMS, Moraes SA, Gir E, Freit as I CM. Percut aneous inj uries correlat es in t he nursing t eam of a brazilian t er t iar y - car e univ er sit y hospit al. Rev Lat ino- am Enfer m agem 2008 set em br o- out ubr o; 16( 5) : 818- 23.
The st udy aim s t o ident ify per cut aneous inj ur ies cor r elat es in t he nur sing t eam fr om a Br azilian t er t iar y - car e hospit al. A case- cont r ol st udy w as conduct ed fr om Januar y 2003 t o July 2004, including 200 cases and 200 cont r ols. Cases and cont r ols w er e pair ed by gender , pr ofessional cat egor y , and w or k sect ion. To ev aluat e t he r elat ion sh ip b et w een p ot en t ial r isk / p r ot ect iv e f act or s an d t h e ou t com e, od d s r at ios w er e est im at ed , u sin g m ult iv ar iat e logist ic r egr ession m et hods. The r esult s show n six pr edict or s of per cut aneous inj ur ies: “ r ecapping n eedles” ( OR 9 . 4 8 ; CI ( 9 5 % ) : 5 . 2 9 - 1 6 . 9 6 ) ; “ h ou r s w or k ed per w eek ≥ 5 0 h ou r s” ( OR 2 . 4 7 ; CI ( 9 5 % ) : 1 . 0 7 -5.67) ; “ year s in nur sing pr act ice ≤ 5 year s” ( OR 6.70; CI ( 95% ) : 2.42- 18.53) ; “ w or k shift in night ” ( OR 2.77; CI ( 95% ) : 1.35- 5.70) ; “ low self evaluat ion of risk” ( OR 10.19; CI ( 95% ) : 3.67- 28.32) and “ previous percut aneous inj uries” ( OR 3.14; CI ( 95% ) : 1.80- 5.48) . The result s support t he recom m endat ion of applying effect ive st rat egies t o pr ev ent per cut aneous inj ur ies in t he nur sing t eam w or king on t er t iar y - car e inst it ut ions.
DESCRI PTORS: needlest ick inj ur ies; r isk fact or s; nur sing, t eam ; accident s, occupat ional; analy t ic st udies
FACTORES ASOCI ADOS CON HERI DAS PERCUTÁNEAS EN EL EQUI PO DE ENFERMERÍ A DE
UN HOSPI TAL UNI VERSI TARI O DE NI VEL TERCI ARI O
La finalidad del est udio fue ident ificar fact ores asociados a los accident es percut áneos en el equipo de enferm ería de u n h ospit al t er ciar io. Un est u dio caso- con t r ol f u e con du cido en t r e en er o de 2 0 0 3 y j u lio de 2 0 0 4 , con selección de 200 casos y 200 cont r oles, em par ej ados según géner o, cat egor ía pr ofesional y sect or de t r abaj o. Las m edidas de asociación ut ilizadas fuer on las r azones de m om ios, est im ados m ediant e la r egr esión logíst ica m u lt iv ar iad a. Seis p r ed ict or es p ar a los accid en t es p er cu t án eos f u er on id en t if icad os: “ r een cap su lar agu j as” ( OR 9.48; CI ( 95% ) : 5.29- 16.96) ; “ j or nada sem anal ≥ 50 hor as” ( OR 2.47; CI ( 95% ) : 1.07- 5.67) ; “ ex per iencia en la enferm ería ≤ 5 años” ( OR 6.70; CI ( 95% ) : 2.42- 18.53) ; “ t rabaj ar en j ornada noct urna” ( OR 2.77; CI ( 95% ) : 1. 35- 5. 70) ; “ aut o- ev aluar com o baj o el r iesgo de accident es” ( OR 10. 19; CI ( 95% ) : 3. 67- 28. 32) y “ accident es percut áneos previos” ( OR 3.14; CI ( 95% ) : 1.80- 5.48) . Los result ados perm it en la recom endación de est rat egias efect iv as par a la pr ev ención de accident es per cut áneos en el equipo de enfer m er ía de hospit ales t er ciar ios.
DESCRI PTORES: lesion es p or p in ch azo d e ag u j a; f act or es d e r iesg o; g r u p o d e en f er m er ía; accid en t es d e t r abaj o; epidem iología an alít ica
FATORES ASSOCI ADOS A ACI DENTES PERCUTÂNEOS NA EQUI PE DE ENFERMAGEM DE
UM HOSPI TAL UNI VERSI TÁRI O DE NÍ VEL TERCI ÁRI O
O est udo t eve por obj et ivo ident ificar fat or es associados aos acident es per cut âneos na equipe de enfer m agem de um hospit al t er ciár io. Um est udo caso- cont r ole foi conduzido ent r e j aneir o de 2003 a j ulho de 2004, com seleção de 200 casos e 200 cont roles, em parelhados segundo gênero, cat egoria profissional e set or de t rabalho. As m edidas de associação ut ilizadas foram os odds rat ios, est im ados por m eio da regressão logíst ica m ult ivariada. Seis pr edit or es par a os acident es per cut âneos for am ident ificados: “ r eencapar agulhas” ( OR 9 . 4 8 ; CI ( 9 5 % ) : 5.29- 16.96) ; “ j ornada sem anal ≥ 50 horas” ( OR 2.47; CI ( 95% ) : 1.07- 5.67) ; “ experiência na enferm agem ≤ 5 anos” ( OR 6.70; CI ( 95% ) : 2.42- 18.53) ; “ t rabalhar em j ornada not urna” ( OR 2.77; CI ( 95% ) : 1.35- 5.70) ; “ aut o-av aliar com o baix o o r isco de acident es” ( OR 10. 19; CI ( 95% ) : 3. 67- 28. 32) e “ acident es per cut âneos pr év ios” ( OR 3.14; CI ( 95% ) : 1.80- 5.48) . Os result ados perm it em a recom endação de est rat égias efet ivas para a prevenção de acident es per cut âneos na equipe de enfer m agem de hospit ais t er ciár ios.
DESCRI TORES: ferim ent os penet rant es produzidos por agulha; fat ores de risco; equipe de enferm agem ; acident es de t r abalho; epidem iologia analít ica
University of Sao Paulo at Ribeirao Preto College of Nursing, WHO Collaborating Center for Nursing Research Developm ent, Brazil:
I NTRODUCTI ON
O
c c u p a t i o n a l a c c i d e n t s w i t h b i o l o g i c a lm a t e r i a l a n d h e a l t h p r o f e s s i o n a l s h a v e g a i n e d
in cr easin g at t en t ion in t h e global r esear ch scen ar io
in t he last t w o decades because t hese pr ofessionals’
e x p o su r e t o b l o o d b o r n e p a t h o g e n s m a y l e a d t o
infect ions and, consequent ly, ser ious healt h dam age.
Occupat ional t ransm ission of hepat it is B ( HBV) and C
( HCV) an d Hu m an I m m u n od ef icien cy ( HI V) v ir u ses
am ong healt hcar e w or k er s is w ell docum ent ed( 1). The first case of occupat ional HI V infect ion( 2) o ccu r r e d i n En g l a n d i n 1 9 8 4 , a f t e r a n u r se w a s
accident ally cont am inat ed by a needlest ick wit h blood
of an infect ed pat ient . I n a w or ldw ide st udy on t he
dist ribut ion of occupat ional HI V infect ion cases am ong
healt h w or k er s( 3 ), 2 6 4 cases w er e iden t ified an d 9 4 ( 3 5 . 6 0 % ) r egist er ed unt il Sept em ber 1 9 9 7 , am ong
w hich, 52 ( 55.4% ) occurred in t he Unit ed St at es.
A st udy carried out in t he USA( 4) indicat es t hat 57 cases of occupat ional HI V infect ion were regist ered
unt il 2001, while 24 of t hese ( 42% ) occurred in nurses
aft er per cu t an eou s in j u r ies in v olv in g blood. Nu r sin g
inj ur ies r at es r elat ed t o needlest ick s ar e am ong t he
highest , and t hese pr ofessionals hav e also pr esent ed
t he highest HI V ser oconv er sion r at es.
Am on g t h e f ou r cases of occu p at ion al HI V
infect ion ident ified t o dat e( 5) in Br azil, only one w as published in a scient ific j ournal and confirm ed by t he
Min ist r y of Healt h in 1 9 9 9 , in d icat in g t h e n eed t o
im plem en t an ef f ect iv e epidem iological su r v eillan ce
sy st em for occupat ional accident s.
Th e Ce n t e r s f o r D i s e a s e Co n t r o l ( CD C)
p u b lish ed a g u id e w it h r ecom m en d at ion s in 1 9 8 7 ,
cal l ed u n i v er sal p r ecau t i o n s, ai m ed at p r ev en t i n g
occu pat ion al ex posu r e t o bloodbor n e pat h ogen s. I n
1 9 9 6( 6 ) , t h ese g u id elin es w er e r ev ised an d called “ st an dar d pr ecau t ion s”.
St andard and t ransm ission- based precaut ions
were int roduced in t he universit y hospit al in 1997, as
w r it t en g u id elin es w er e lar g ely sp r ead t h r ou g h t h e
H o s p i t a l a n d n u r s e s f r o m t h e I n f e c t i o n Co n t r o l
Com m it t ee con du ct ed n u m er ou s t r ain in g session s.
Consider ing t hat only a few epidem iological
st udies t o evaluat e correlat es t o percut aneous inj uries
have been conduct ed in Brazil, t he present st udy aim s
t o ident ify risk/ prot ect ive fact ors for out com es in t he
n u r sin g t eam of a t er t iar y - car e u n iv er sit y h ospit al,
aft er adj ust ing for confounding fact or s.
METHODS
Set t ing: The t er t iar y - car e univ er sit y hospit al
i s a n 8 0 0 b e d - si ze d t e a ch i n g h o sp i t a l l o ca t e d i n
Ribeirão Pret o and is t he second larger school hospit al
fr om t he Sao Paulo St at e Univer sit y, Brazil.
Case- Cont rol St udy: A case- cont rol st udy was
co n d u ct e d t o i d e n t i f y r i sk / p r o t e ct i v e f a ct o r s f o r
per cut aneous inj ur ies. An incident case w as defined
as any nur sing w or k er w ho r egist er ed per cut aneous
i n j u r i es a t t h e Hea l t h Pr o f essi o n a l Acci d en t Ca r e
Ou t p at ien t Clin ic f r om 0 1 / 0 1 / 2 0 0 3 t o 0 7 / 3 0 / 2 0 0 4 ,
w h e n t h e sa m p l e si ze w a s co m p l e t e d . Th i s ca se
id en t if icat ion sou r ce w as ch osen b ecau se a r ecen t
st udy in t he sam e inst it ut ion( 7) had revealed t hat about 3 0 % of t h e t r u e cases ar e n ot r eg ist er ed w h en a
t r a d i t i o n a l so u r ce o f d a t a i s t a k e n i n t o a cco u n t .
Workers who did not regist er any percut aneous inj ury
du r in g t h e 2 4 m on t h s pr ev iou s t o t h e dat e of t h eir
r espect iv e case or du r in g t h e dat a collect ion per iod
were considered cont rols. They were select ed t hrough
a t able of r an dom n u m ber s. To obt ain a f r equ en cy
pairing, cases and cont rols were paired in t he design,
accor ding t o gender, pr ofessional cat egor y, and w or k
unit . Dur ing t he dat a collect ion per iod, four cont r ols
b e ca m e ca se s, t h u s t h e y w e r e r e p l a ce d b y n e w
cont rols, according t o t he st udy definit ion of cont rols.
The sam ple size was calculat ed t o det ect odds
r at io ≥ 2. 0, consider ing a 5% of t y pe I and 20% of
t ype I I errors( 8), which result ed in a sam ple com posed b y 1 5 3 ca se s a n d 1 5 3 co n t r o l s. Th e r e se a r ch e r s
decided t o select 200 cases and 200 cont r ols, w hich
in cr eased t h e st at ist ical p ow er t o 9 0 % . Dat a w er e
c o l l e c t e d t h r o u g h i n d i v i d u a l i n t e r v i e w s . I t w a s
est ablished t hat cases’ and cont rols’ int erviews should
o ccu r so o n a f t e r t h e i d e n t i f i ca t i o n o f ca se s, n o t
ex ceed in g 1 5 d ay s af t er t h e case’s accid en t d at e.
Appr opr iat e infor m ed consent w as obt ained fr om all
t h e p ar t icip an t s w h o sig n ed a Con sen t For m . Th e
p r oj ect w as ap p r ov ed b y t h e Et h ical Com m it t ee of
t he inst it ut ion w here t he st udy w as carried out .
Dat a analysis: Aft er t he collect ion phase, dat a
w er e subm it t ed t o double t y ping t o t est for ex t er nal
c o n s i s t e n c y. Th e d a t a b a s e w a s f o r m a t t e d a n d
an aly zed in St at ist ical Pack ag e f or Social Scien ces
sof t w ar e, v er sion 1 0 . 0 . Dat a an aly sis in clu d ed t h e
f ollow in g p h ases: a) ch ar act er izat ion of t h e st u d y
p o p u l a t i o n a c c o r d i n g t o p o t e n t i a l c o r r e l a t e s
( descr ipt iv e ph ase) an d b) calcu lat ion of t h e ef f ect
confidence int ervals, using crude and adj ust ed logist ic
r egression m odels( 9). The st at ist ical m odeling pr ocess w as dev eloped in t he follow ing st ages: 1. univ ar iat e
m odels w er e built t ak ing int o account t hat v ar iables
w it h p- values ≤ 0.25 ( Wald t est s) should be included
in su bsequ en t m odels, an d 2 . t o com pose t h e f in al
m odel, researchers kept variables wit h p- values ≤ 0.05
on Wald t est s or variables t hat , when excluded, would
ch an ge t h e odds r at ios of t h e v ar iables in clu ded in
t he m odels by m ore t han 10%( 10).Variables wit h m ore t han t wo cat egories were t reat ed as dum m y variables,
including one independent variable for every t en st udy
cases ( 1 0 : 1 r at io) , as r ecom m en ded( 1 1 ). Con dit ion al and uncondit ional logist ic regression m odels were run
and t he result s were sim ilar. Thus, t aking int o account
t he incr eased st at ist ical pow er, t he r esult s pr esent ed
h e r e a r e t h o se r e l a t e d t o u n co n d i t i o n a l l o g i st i c
r eg r ession .
RESULTS
Table 1 show s t he dist r ibut ion of cases and
cont rols according t o t im e bet ween t he accident dat es
in cases and int er v iew dat es. The r esult s show t hat
m ore t han 80% of t he int erview s w ere held bet w een
6 an d 1 0 d ay s af t er t h e case’s accid en t d at e. Tw o
cases and four cont r ols w er e int er v iew ed 16 and 60
days, because t he cases had suffered inj uries t he day
j ust before t heir vacat ion had st art ed, and four cont rols
had t o be random ly chosen in order t o replace t hose
w ho becam e cases dur ing t he st udy.
Table 1 - Dist ribut ion of cases ( n = 200) and cont rols
( n = 2 0 0 ) , acco r d i n g t o t i m e b et w een t h e case’s
accident dat e and t he int erviews dat e. Ribeirão Pret o,
2 0 0 4
) s y a d ( e m i
T Cases Control
º
N % Nº %
≤05 49 24.50 48 24.00
0 1 | -| 6
0 126 63.00 122 61.00
5 1 | -| 1
1 23 11.50 26 13.00
0 6 | -| 6
1 02 1.00 04 2.00
l a t o
T 200 100.00 200 100.00
The char act er ist ics of cases and cont r ols ar e
present ed in Table 2 according t o pot ent ial correlat es.
Ca s e s ’ a n d c o n t r o l s ’ d i s t r i b u t i o n a r e s i m i l a r,
consider ing age, gender and pr ofessional cat egor ies.
The m ain differ ences bet w een t hem w er e r elat ed t o
r ecappin g n eedles; y ear s in n u r sin g pr act ice; h ou r s
w or k ed p er w eek ; t r ain in g; self - ev alu at ion of r isk,
a n d p r e v i o u s p e r c u t a n e o u s i n j u r i e s. A t o t a l o f
2 1 . 0 % o f c a s e s a n d 9 . 5 % o f c o n t r o l s h a d
p r o f e s s i o n a l n u r s i n g e x p e r i e n c e ≤ 5 y e a r s . I n
gen er al, cases w or k ed lon ger h ou r s per w eek t h an
con t r ols. Relat ed t o self - ev alu at ion of acciden t r isk ,
7 6 . 5 % of con t r ols self - classif ied t h eir r isk as “ h igh
r i sk ”, a g a i n st 3 3 . 5 % o f ca se s. Pr e v i o u s i n j u r i e s
o ccu r r e d m o r e f r e q u e n t l y a m o n g ca se s ( 6 0 . 5 % )
t h an am on g con t r ols ( 2 7 . 0 % ) .
Ta b l e 2 – Ch a r a ct e r i st i cs o f ca se s a n d co n t r o l s,
acco r d i n g t o p o t en t i al p r ed i ct o r s o f p er cu t an eo u s
inj ur ies. Ribeir ão Pr et o, 2004
s e l b a i r a V s e s a
C Controls
º
N % Nº %
s e l d e e N g n i p p a c e R s e
Y 132 66.0 29 14.5
o
N 68 34.0 171 85.5
r e d n e G e l a m e
F 170 85.00 170 85.00
e l a
M 30 15.00 30 15.00
) s r a e y ( e g A 9 2 | -| 0
2 52 26.00 32 16.00
9 3 | -| 0
3 83 41.50 83 41.50
9 4 | -| 0
4 57 28.50 70 35.00
≥50 08 4.00 15 7.50
) s r a e y ( n o it a c u d E 1 1
< 28 14.00 20 10.00
≥11 172 86.00 180 90.00
y r o g e t a C l a n o i s s e f o r P e s r u
N 51 25.50 51 25.50
s n a i c i n h c e T e s r u
N 18 9.00 18 9.00
s e d i A e s r u
N 131 65.50 131 65.50
e c it c a r P g n i s r u N n i s r a e Y
≤05 42 21.00 19 9.50
0 1 | -| 6
0 66 33.00 52 26.00
0 2 | -| 1
1 67 33.50 89 44.50
≥21 25 12.50 40 20.00
k e e W r e p d e k r o w s r u o H
≤39 75 37.50 107 53.50
9 4 | -| 0
4 85 42.50 77 38.50
≥50 40 20.00 16 8.00
t f i h S k r o W y a
D 74 37.00 72 36.00
t h g i
N 51 25.50 34 17.00
d e x i
M 75 37.50 94 47.00
g n i n i a r T s e
Y 123 61.50 155 77.50
o
N 77 38.50 45 22.50
k s i r f o n o it a u l a v e -fl e S h g i
H 67 33.50 153 76.50
e t a i d e m r e t n
I 94 47.00 39 19.50
w o
L 39 19.50 08 4.00
s e i r u j n i s u o e n a t u c r e p s u o i v e r P s e
Y 121 60.50 54 27.00
o
Cr u d e od d s r at ios an d con f id en ce in t er v als
( 95% ) are shown in Table 3. At t he phase of analysis,
r ecappin g n eedles h ad m aj or odds r at io m agn it u de
( O R= 1 1 . 4 4 ; CI ( 9 5 % ) : 7 . 0 0 - 1 8 . 6 9 ) , a n d w i t h
except ion of work shift ing t he odds rat io for variables
cl a ssi f i e d a s m o r e t h a n t w o ca t e g o r i e s ( d u m m y
v ar iables) indicat ed som e lev el of linear t r end.
Table 3 – Unadj ust ed odds rat io and 95% confidence
int er v als ( CI ) accor ding t o t he select ed v ar iables t o
b e in clu d ed in m u lt iv ar iat e m od els. Rib eir ão Pr et o,
2 0 0 4
s e l b a i r a
V OddsRatios(crude) CI(95%)
s e l d e e N g n i p p a c e R s e
Y 11.44 7.00-18.69
o N 1 ) s r a e y ( e g A 9 2 | -| 0
2 3.04 1.16-7.99
9 3 | -| 0
3 1.87 0.75-4.66
9 4 | -| 0
4 1.52 0.60-3.85
≥50 1
) s r a e y ( n o it a c u d E 1 1
< 1.46 0.79-2.69
≥11 1
e c it c a r P g n i s r u N n i s r a e Y
≤05 3.54 1.69-7.39
0 1 | -| 6
0 2.03 1.09-3.77
0 2 | -| 1
1 1.20 0.67-2.18
≥21 1
k e e W r e p d e k r o w s r u o H
≤39 1
9 4 | -| 0
4 1.91 1.10-3.29
≥50 2.91 1.20-7.03
t f i h S k r o W y a D 1 t h g i
N 1.88 1.10-3.19
d e x i
M 1.28 0.82-2.01
g n i n i a r T o
N 2.15 1.39-3.33
s e Y 1 k s i r f o n o it a u l a v e -fl e S h g i H 1 e t a i d e m r e t n
I 5.50 3.43-8.81
w o
L 11.13 4.93-25.09
s e i r u j n i s u o e n a t u c r e p s u o i v e r P s e
Y 4.14 2.71-6.31
o
N 1
Mult ivariat e analysis ( final m odels) confirm ed
t he independent effect of recapping needles ( OR= 9.48;
CI ( 95% ) : 5.29- 16.69) relat ed t o percut aneous inj uries,
as w ell as t h e in depen den t ef f ect of f iv e cor r elat es
based on t he adopt ed crit eria t o com pose t he m odel:
y ear s of n u r sin g pr act ice, h ou r s w or k ed per w eek;
w o r k sh i f t; se l f e v a l u a t i o n o f r i sk, a n d p r e v i o u s
per cut aneous inj ur ies ( Table 4) .
Table 4 – Adj u st ed odds r at io an d 9 5 % con f iden ce
in t er v als ( CI ) accor din g t o per cu t an eou s cor r elat es
( final m odel) . Ribeir ão Pr et o, 2004
s e l b a i r a
V OddsRatios ) d e t s u j d a
( CI(95%)
s e l d e e N g n i p p a c e R s e
Y 9.48 5.29-16.96
o N 1 e c it c a r P g n i s r u N n i s r a e Y
≤05 6.70 2.42-18.53
0 1 | -| 6
0 4.10 1.68-9.96
0 2 | -| 1
1 1.89 0.82-4.34
≥21 1
k e e W r e p d e k r o w s r u o H
≤39 1
9 4 | -| 0
4 1.29 0.71-2.36
≥50 2.47 1.07-5.67
t f i h S k r o W y a D 1 t h g i
N 2.77 1.35-5.70
d e x i
M 2.32 1.22-4.41
k s i r f o n o it a u l a v e -fl e S h g i H 1 e t a i d e m r e t n
I 4.88 2.69-8.79
w o
L 10.19 3.67-28.32
s e i r u j n i s u o e n a t u c r e p s u o i v e r P s e
Y 3.14 1.80-5.48
o
N 1
DI SCUSSI ON
Th e st u d y r esu lt s r ev ealed t h at “ r ecap p in g
n eed les” w as con sid er ed an im p or t an t p r ed ict or of
per cut aneous inj ur ies in nur sing pr ofessionals. Som e
aut hors( 12) have found t hat t he frequent m anipulat ion of hollow - bor e needles is consider ed a r isk fact or for
p er cu t an eou s accid en t s ( OR= 1 . 0 2 ; CI ( 9 5 % ) : 1 . 0 1
-1.03) am ong healt h professionals, while not recapping
n eed les w as id en t if ied as a p r ot ect iv e f act or ( OR=
0 . 7 4 ; CI ( 9 5 % ) : 0 . 6 0 - 0 . 9 1 ) , a f t er a d j u st m en t f o r
p o t en t i al co n f o u n d i n g v ar i ab l es. An o t h er st u d y( 1 3 ) sh o w e d t h a t t h e ch a n ce s o f n e e d l e st i ck i n j u r i e s
increase 3.63 t im es in nurses who oft en recap needles
(≥ 1 0 t im es/ d ay ) com p ar ed t o t h ose w h o n ev er or
r ar ely r ecap needles ( 0 - 2 t im es/ day ) .
Desp it e t h e n u r sin g p r of ession als f r om t h e
h ospit al w h er e t h e st u dy w as car r ied ou t h ad been
t r a i n e d o n s t a n d a r d p r e c a u t i o n s a n d a c c i d e n t s
prevent ion, m any of t hem adm it t ed, during int erviews,
t o r eca p n eed l es. Th i s i n f o r m a t i o n i n d i ca t es t h a t
st r at eg ies em p loy ed sh ou ld b e r ev iew ed f or f u t u r e
t r ain in gs.
So m e i n h e r e n t l i m i t a t i o n s r e l a t e d t o t h e
a) t he st udy was conduct ed at a large t ert iary hospit al,
which m ay lim it t he generalizat ion of t hese result s t o
o t h er Heal t h I n st i t u t i o n s; b ) al t h o u g h t h e Heal t h
Professional Accident Care Out pat ient Clinic had good
sensit iv it y for case’s det ect ion, ot her w ay s t o select
cases, such as t hose in a nest ed case cont rol design,
could have result ed in higher sensit ivit y levels t o det ect
t r u e cases.
On t he ot her hand, t he select ion of r ecent ly
d i ag n o sed cases an d f ace- t o - f ace i n t er v i ew s w i t h
cases an d con t r ols ar e con sider ed st r en gt h s, w h ich
con t r ibu t ed t o accu r at e com par ison s in case- con t r ol
st udies. Fur t her m or e, all int er v iew s w er e car r ied out
by t h e sam e in t er v iew er w h o spen t sim ilar am ou n t
t im e w it h bot h groups. Alt hough individual int erview s
a r e m o r e t i m e - c o n s u m i n g a n d e x p e n s i v e , t h i s
t echnique w as chosen in or der t o guar ant ee cont r ol
of infor m at ion qualit y. The r eliabilit y of t he t est and
re- t est quest ions relat ed t o precaut ions correlat es was
close t o 100% ( dat a not shown) .
I n a case- cont rol st udy held in a com m unit y
base, t he aut hor s( 14) concluded t hat int er v iew s r esult in b et t er q u alit y of in f or m at ion ab ou t occu p at ion al
ex posur e t han m ail quest ionnair es, being consider ed
as t he gold st andard for dat a collect ion when t his kind
of ex posur e is consider ed.
I n t his st udy, t he lower t he num ber of years
in t he nursing pract ice t he higher t he odds rat io relat ed
t o t h e ou t com e. Th ese r esu lt s ar e cor r obor at ed by
lit erat ure( 15), as shown by an analysis of percut aneous inj ur y pr edict or s in w hich nur ses w it h less t han fiv e
y ear s of clin ical ex per ien ce h ad gr eat er ch an ces of
su f f er in g t h ose in j u r ies ( OR= 1 . 4 8 ; I C ( 9 5 % ) : 1 . 0 6
-2 . -2 0 ) . I n a ca se - co n t r o l st u d y co n d u ct e d a m o n g
vet erinarians( 16), t he aut hor s found t hat pr ofessionals who had five years or less of professional experience
h a d g r e a t e r c h a n c e s o f s u f f e r i n g o c c u p a t i o n a l
accid en t s, af t er ad j u st m en t f or som e con f ou n d in g
fact ors ( OR= 3.1; I C( 95% ) : 1.4- 6.8) . I t is t hought t hat
m o r e e x p e r i e n c e d p r o f e s s i o n a l s , w h o a r e
consequent ly bet t er t rained t o m anipulat e piercing and
cut t ing m at erial, m ay be less suscept ible t o t his kind
of accident .
A lon g w or k w eek en t ailed gr eat er ch an ces
of producing t he out com e, which m ay result from t he
worker’s longer exposure t o risk sit uat ions, apart from
t h e f act t h at lon g w or k d ay s can p r od u ce f at ig u e,
increasing t he risk of inj ury( 17). I n t his st udy, working
50 or m ore hours per week increased t he chances of
needlest ick inj ur ies ( OR= 2 . 4 7 ; CI ( 9 5 % ) : 1 . 0 7 - 5 . 6 7 )
and sim ilar r esult s w er e found for t hose w or k ing in
m ixed or in night shift s, as com pared t o t hose working
only in r egular daily shift s.
St u d ies on n eed lest ick an d sh ar p in j u r ies,
in v olv in g n u r sin g p r of ession als, also h av e r ep or t ed
t hat t he chances of being v ict im ized by t his k ind of
inj uries are higher in m ixed shift s( 18).
I n t his st udy, t he nur sing w or ker s w ho
self-ev aluat ed t he r isk of suffer ing per cut aneous inj ur ies
as “ low” and “ int erm ediat e” in t heir work had great er
chances of suffer ing inj ur ies com par ed t o t hose w ho
evaluat ed t heir work sit uat ion as “ high risk”. Divergent
result s in a case- cont rol st udy were report ed, showing
t h a t l o w r i sk p e r ce p t i o n w a s co n si d e r e d t o b e a
prot ect ive fact or for occupat ional inj uries( 16). I t should be t aken int o considerat ion t hat t he percept ion of risk
relat ed t o t he vet erinarian pract ice, very dist inct from
nur sing pr act ice, m ight be an ex planat ion for t hese
report ed result s. Despit e of being subj ect ive, t he
self-evaluat ion of occupat ional risks can be a useful guide
i n d e c i s i o n m a k i n g r e l a t e d t o a d o p t i o n o f s a f e
p r act ices.
The occur r ence of needlest ick inj ur ies is not
only or exclusively a m at t er of t he individually relat ed
risk/ prot ect ive fact ors. Those inj uries are also heavily
influenced by t he environm ent in which t he worker is
inser t ed as w ell as by t he or ganizat ional st r uct ur e in
t h e i n st i t u t i o n , w h i ch sh o u l d p r o v i d e a p p r o p r i a t e
c o n d i t i o n s t o i m p l e m e n t t h e r e c o m m e n d e d a n d
ack n ow ledgef saf et y m easu r es f or t h eir em ploy ees.
I t is known t hat t radit ional t raining program s t ransm it
in f or m at ion b u t d oes n ot alw ay s en t ice b eh av ior al
c h a n g e s . On e o f t h e g r e a t c h a l l e n g e s i n t h e
o c c u p a t i o n a l i n j u r i e s a r e a i s t o m a k e w o r k e r s
per ceiv e r isk sit uat ions and conv ince t hem t o adopt
safe behav ior s in t heir daily pr act ice.
A r e v i e w( 1 9 ) t h a t a i m e d t o a n a l y z e t h e s c i e n t i f i c p r o d u c t i o n o n p e r c u t a n e o u s a c c i d e n t s
p u b lish ed b et w een 1 9 8 5 an d 2 0 0 0 ev id en ced t h at
m o s t s t u d i e s i n t h i s k n o w l e d g e a r e a a r e
d e s c r i p t i v e . Po t e n t i a l c a u s e s f o r t h i s k i n d o f
acci d en t s r el at ed t o w o r k co n d i t i o n s o r i n d i v i d u al
b e h a v i o r h a v e b e e n a p p o i n t e d , p a r t i c u l a r l y
em er gen cy sit u at ion s, lack of pr of ession al t r ain in g,
w o r k o v er l o ad an d l ack o f ad h er en ce t o st an d ar d
Despit e t he lack of inform at ion from analyt ical
st u d i es a n d a i m i n g t o i n v est i g a t e a sso ci a t i o n s o f
p ot en t ial p r ed ict or s of p er cu t an eos accid en t s, t h is
st u d y p r e se n t s t h e i m p o r t a n t r o l e o f si x f a ct o r s
associat ed t o t h e issu e. Fu r t h er r esear ch based on
a n a l y t i ca l m e t h o d o l o g y, l i k e ca se co n t r o l s, co u l d
cor r obor at e t h ese fin din gs.
Fin ally, it is r ecom m en d ed t o t er t iar y - car e
i n s t i t u t i o n s t o o v e r c o m e l i m i t s i m p o s e d b y
c o n v e n t i o n a l h e a l t h p r o m o t i o n a n d p r e v e n t i o n
m e a s u r e s , c o n s i d e r i n g t h e i m p l e m e n t a t i o n o f
e f f e c t i v e a n d r a t i o n a l p r o g r a m s b a s e d o n
m a n a g e m e n t o f i n d e p e n d e n t p r e d i c t o r s o f
p e r cu t a n e o u s i n j u r i e s.
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