ACKNOWLEDGEMENTS

I extend my heartfelt gratitude to all those who have contributed to the successful
completion of this study on safe injection practices and the prevention of needle stick
injuries among healthcare providers in our community health center[CHC].

I would like to express my sincere appreciation to CHC Bhangel for granting permission to
conduct this study within their facility. Special thanks to Dr. Yatendra Singh[MOIC] for
providing valuable insights and support throughout the research process.

I am immensely thankful to the healthcare providers who participated in this study, willingly
sharing their experiences and perspectives .Their cooperation has been instrumental in the
collection of meaningful data.

I extend my thanks to my research advisors Mrs. Diksha Ma’am & Miss. Vaishali Singh
Ma’am for their guidance ,expertise and continuous support throughout the research
journey .Their constructive feedback and encouragement have been invaluable in shaping
the quality of this study .

I am grateful to the entire staff of labour room, examination room, emergency room and
immunization room at CHC Bhangel for their cooperation and assistance during data
collection .Their commitment to promoting safe injection practices has been evident and
inspiring.

Lastly, I want to acknowledge friends and guides for their unwavering support and
understanding during the research process.

This study would not have been possible without the collective efforts of all those
mentioned above. Thank you for being an integral part of endeavor.

MSC nursing 1st Year from PRAKASH INSTITUTE OF PHYSIOTHERAY,REHABILITATION &

ALLIED MEDICAL SCIENCES.

Feel free to customize the acknowledgements based on the specific individuals and
organizations involved in your study.
 INDEX
S.No. Topic Page No.
1. PROBLEM STATEMENT 3
2. OBJECTIVES 3
3. NEEDS 3
4. INTRODUCTION 5
5. METHODOLOGY 11
6. TOOLS 13
7. AUDIT ANALYSIS 16
8. RESULTS 19
9. CONCLUSION 20
10. REFERENCES 21
11. ANNEXURE 22

1. PROBLEM STATEMENT
A Study to assess safe injection and prevention of the
needle stick injury practices among health care providers in
CHC Bhangel.

2. OBJECTIVES
The primary objective of this study is to comprehensively assess the knowledge , attitudes
and practices related to safe injection and needle stick injury prevention among healthcare
providers in CHCs bhangel .Specific objectives includes:

 Assess the prevalence of needle stick injury among healthcare providers in CHCs.
 Identify factors contributing to unsafe injection practices and needle stick injuries
within CHCs.
 Explore the perceived barriers to implementing and sustaining best practices in
safe injections.

3.NEEDS
1. Firstly, needle stick injuries can lead to immediate health risks for healthcare
professionals , including the potential transmission of bloodborne pathogens. In
addition to the immediate health concerns, these injuries can result in long term
physical and emotional consequences , impacting the overall job satisfaction and
well-being of health care providers.
2. Secondly, the potential transmission of infections due to the needle stick injuries
poses a considerably risk to patient safe healthcare providers acting as potential
vectors for infections ,compromise the very essence of healthcare
delivery ,which is centred around the well -being and recovery of the patient
 therefore, understanding and addressing the factors contributing to needle stick
injury are paramount in uploading the quality and safety of patient care within
the CHC.
3. Safe injection practices are fundamental not only for well -being of healthcare
professionals but also for the overall integrity of the patient care .Needle stick
injuries represent a significant occupational hazard for healthcare providers and
can have far- reaching consequences.
4. Moreover, addressing safe injection practices aligns with broader goals of
preventing healthcare associated infections control measures . It is the
imperative to identify any gaps or challenges in the current practices to develop
targeted interventions that can be improve adherence to safety measures
protocols and reduce the incidence of needle stick injuries.
5. The need for this study arises from the critical importance of ensuring the safety
of healthcare providers in the administration of injections with CHC setting.
3. INTRODUCTION
Needle stick injuries (NSIs) are the injuries that are caused by needles such as hypodermic
needles, blood collection needles, intravenous stylets, and needles used to connect parts of
intravenous delivery systems.

1. NSIs are very common and in many instances unavoidable among healthcare
providers when they are delivering patient care. In the healthcare sector, NSIs are
one of the most preventable occupational hazards among healthcare providers.
2. Centers for Disease Control (CDC) of the United States of America estimated that
exposure to blood and body fluids by sharps and NSIs affect around three million
health workers annually with an estimated occurrence of six million NSIs every year.
3. The occupational exposures to NSIs are considered to be much higher in the
developing world and much of the cases are not even reports.
4. It is expected that around 75% of the NSIs in developing countries are not reported.
Globally, there is gross under-reporting of NSI with the actual incidence of NSIs being
much higher than those reported.
5. Healthcare institutions must be careful not to interpret or understand the low
reporting rate as low rate of injury. Studies have shown that the NSIs that are
reported through the normal hospital reporting systems are underreported to the
extent of 10 times lower in many instances.
6. NSIs lead to a risk of developing various types of infections and healthcare providers
are always under serious threat. The main problem because of underreporting of
NSIs is that the people who are exposed could not be given postexposure
prophylaxis (PEP) at appropriate time to prevent the development of infection in the
person who has experienced NSI. For example, PEP for HIV is shown to be 80%
effective in preventing the development of the infection.
7. The risk of transmission of blood-borne infections, such as Human Immunodeficiency
Virus (HIV), Hepatitis B Virus(HBV), and Hepatitis C Virus(HCV), are common in NSIs,
and thus, safety practices and guidelines must be practiced by all healthcare
providers to protect themselves from infection.The risk of infection for different
 diseases varies highly. Due to NSI the risk of infection varies from 0.5% to 40% for
HIV and HBV infections, respectively.
8. There is evidence of best practices that should be followed to avoid NSIs. However,
the knowledge about them among the healthcare providers and their
implementation seems to be very less. Although published evidence recommend
that contaminated needles should not be recapped, but studies from developed
countries, such as the United States, showed that recapping of needles is occurring
commonly among the healthcare workers.
9. The Ministry of Health and Family Welfare of the Government of India recommends
that the healthcare providers must be made aware of the safety precautions that
must be followed for the prevention of NSIs. Adequate training to the healthcare
workers to handle the sharp objects is also equally vitals.In addition to provision of
information to healthcare providers and adequate training to them, effective
reporting systems should be placed in all healthcare facilities for early reporting of
cases and immediate actions to be taken to address the issue by providing adequate
PEP and treatment.
10. PEP can be initiated only if there is adequate and fast reporting of data. Some
institutions in India maintain a staff health services facilities , which registers all cases
of NSIs and holds a record for them and have safety protocols in place to manage
them and adequately monitor if the cases are being reduced. Safety protocols should
be always in place in all hospitals and healthcare facilities to prevent the risk of NSIs
and for the enforcement of safety precautions and immediate actions to be taken in
the case of any exposures. There are limited data about the prevalence and
attributes of NSIs in the different healthcare settings in CHC.
11. Healthcare providers included the physicians, staff nurses, operation theatre
personnel, and other support healthcare personnel. The study included both the full-
licensed physicians, nurses, other support personnel working in the hospital, and
also the medical, nursing, and other interns who were working under the supervisory
advice of a fully licensed medical provider. Data regarding injuries by needle stick
injuries including sharps such as cannulas, broken vials, splashes on cuts, and
mucous membranes by potentially infectious materials such as blood and other body
fluids were collected. For the study, NSI was defined as “any cut or prick to the
 respondents by a needle previously used on a patient is work related and sustained
within the hospital premises.” Data were entered into computer-based
spreadsheets.

SAFE INJECTION PRACTICES:

 Injection safety, or safe injection practices is a set of measures taken to perform

injections in an optimally safe manner for patients , healthcare personnel , &
others.
 Prevent transmission of infectious from:
 Patient to patient
 Patient to provider
 Provider to patient
 Prevent harms such as :needle stick injury.

STEPS OF SAFE INJECTION PRACTICES:

STEP 1: Clean work space.

STEP 2: Hand hygiene.
STEP 3: Sterile and new syringe and needle , with reuse prevention or injury
protection feature whenever possible.
STEP 4: Sterile vial of medication & diluent .
STEP 5: Skin infection.
STEP6: Appropriate collection of sharps .
STEP7: Appropriate waste management.

By following these simple steps, you take key actions to ensure the risks of unsafe injections
are avoided.

DO’s INJECTION PRACTICES:

 Prepare injections using aseptic technique in a clean area.

 Disinfect the rubber septum on a medication vial with alcohol before piercing.
 Do not use needles or syringes for more than one patient ( this include
manufactured prefilled syringes & other devices such as insulin pens).
  Medication containers (single & multidose vials, ampules ,bags) are entered with
a new needle & new syringes , even when withdrawing additional doses for the
same patient.
 Use single-dose vials for parenteral medications when possible.

DON’T USE INJECTION PRACTICE:

 Do not use single-dose medication vials, ampules, & bags or bottles of

intravenous solution for more than one patient.
 Do not combine the leftover contents of single-use vials for later use.
 Do not use fluid infusion or administration sets (e.g., IV bags, tubings,
connections) for more than one patient.

NEEDLE STICK INJURY:

 A needlestick injury is the penetration of the skin by a hypodermic needle or

other sharp object that has been in contact with blood, tissue or other body
fluids before the exposure. Even though the acute physiological effects of a
needlestick injury are generally negligible, these injuries can lead to transmission
of blood borne disease, placing those exposed at increased risk of infection from
disease-causing pathogens, such as the hepatitis virus(HBV), hepatitis C

virus (HCV), and human immunodeficiency virus (HIV).

Prevention:

 The first one is the use of tools that have been changed so that they are less likely to
lead to a sharps injury such as blunt or taper-point surgery needles and safety
engineered scalpels.Needleless connectors (NCs) were introduced in the 1990s to
reduce the risk of health care worker needlestick injuries.
 The second is to start using safe working practices such as the hands-free technique.
 The third line of prevention is increased personal protective equipment such as the
use of two pairs of gloves. In addition to these preventive
approaches,implementation measures are necessary because the measures are not
universally taken up.
Treatment: After a needlestick injury, certain procedures can minimize the risk of infection.
Lab tests of the recipient should be obtained for baseline studies, including HIV, acute
hepatitis panel (HAV IgM, HBsAg, HB core IgM, HCV) and for immunized individuals ,HB
surface antibody . Unless already known, the infectious status of the source needs to be
determined. Unless the source is known to be negative for HBV, HCV, and HIV, Post
exposure Prophylaxis (PEP) should be initiated, ideally within one hour of the injury.

STEPS FOR PEP:-

1. Assess nature of exposure.

2. Assess HIV status of source of exposure
3. PEP Evaluation
4. PEP Regimens – Drugs and Dosage for PEP.
5. Follow up.

MILD EXPOSURE:-

 Mucous membrane/ non-intact skin with small volumes.

 E.g. ; a superficial wound (erosion of the epidermis) with a plain or low calibre
needle or contact with the eyes or mucous membranes , subcutaneous injections
following small – bore needles.

MODERATE EXPOSURE:-

 Mucous membrane / non-intact skin with large volumes or Percutaneous superficial

exposure with solid needle .
 E.g. , a cut or needle stick injury penetrating gloves.

SEVERE EXPOSURE:-

 Percutaneous with large volume.

 E.g., an accident with a high calibre needle (>=18G) visibly contaminated with blood ;
a deep wound (haemorrhage wound and/ or very painful) ; transmission of a
significant volume of blood ; an accident with material that has previously been used
intravenously or intra-arterially.
 POST EXPOSURE PROPHYLAXIS [PEP] EXPLOSION

TABLE 1.1:- Post Exposure Prophylaxis[PEP] Explosion

Exposure STATUS OF SOURCE

HIV + Asymptomatic HIV + Clinically HIV StatusUnknown

Asymptomatic
Mild Consider 2 Drug PEP Start 2 Drug PEP Usually No PEP or
Consider 2 Drug PEP
Moderate Start 2 Drug PEP Start 3 Drug PEP Same As Above

Severe Same as Above Same As Above Same As Above

DOSAGES OF THE DRUG FOR PEP

MEDICATION 2 DRUG REGIMEN 3 DRUG REGIMEN

Zidovudine(AZT) 300mg Twice a day 300mg Twice a day
Lamivudine(3TC) 150 mg Twice a day 150 Twice a day
Protease Inhibitors 1st choice Lopinavir / Ritonavir -
400/100mg twice a day OR
800/200mg once daily with
meals.
2nd choice Nelfinavir(NLF): 1250mg
twice a day OR 750 mg
three times a day with
empty stomach.
3rd choice Indinavir (IND)800mg
every 8 hour & drink 6-8
litres of water every day.

Table 1.2:-Dosages of the drug for PEP

4. METHODOLOGY

STUDY DESIGNS:

 This study will employ a cross-sectional research design to assess the safe infection
practices and prevention of needle stick injuries among healthcare providers at
community health centres.
 Cross-sectional research allows for the collection of data at a single point in time ,
providing a snapshot of the current practices and factors influencing safe infection
procedures.

SAMPLING:

 The study will use a stratified random sampling technique different healthcare
departments within the CHC Bhangel.
 Stratification will be based on departments such as-

Labour room nurses ,Pharmacy, Immunization,Emergency room ,etc.

 A proportionate number of participants will be randomly selected from each

stream.

PARTICIPANTS:

 Healthcare providers including nurses, physicians,pharmacistsand other relevant

staff involved in the administrations of injections will be invited to participate in the
study . Informed consent will be obtained from each participants gain qualitative
insights into the challenges and perceptions related to safe injection practices .The
analysis will be employed to identify recurring theories.

SIGNIFICANCE:

 This research aims to provide valuable insights into current practices ,identify areas
for improvement and c0ntribute to the development of targeted interventions , to
enhance safe infection practices and prevent needle stick injuries among healthcare
providers in the CHCs.
DATA COLLECTION:

 A structured questionnaire will be developed based on established safe injection

guidelines and will include questions related to awareness, adherence to protocols ,
availability and utilization of safety engineered devices and experiences with needle
stick injuries .The questionarie will be pre-tested for reliability and validity.

DATA ANALYSIS:

 Quantitative data will be analysed studies statistical software .Descriptive statistics

such as :- frequencies ,percentages and means will be used to summarize
demographics characteristics and key variables , inferential statistics , such as :-chi-
square tests, are logistic regression , will be applied to identify associations between
variables.

QUALITATIVE COMPONENT :

 In-depth interviews or focus group discussions will be conducted with a subset of

participant to gain qualitative insights into the challenges and perception related to
safe injection practices.

SETTING OF THE STUDY:

 The study will be conducted in Community Health Centre [CHC] Bhangel ,focusing
on the different department such as:-Emergency room, immunization room, labour
room, examination room.
8.TOOLS
To assess injection and needle stick injuries practices among healthcare providers ,we can
use the following tools ass a checklist:-

Name and Designation of the employee:-

Date-

Department-

CHECKLIST OF SAFE INJECTIONS PRACTICES

Practice If answer is No, document

Injection Safety plan for remediation
Performed?

Proper hand hygiene, using alcohol-based Yes

hand rub or soap and water, is performed No
prior to preparing and administering
medications.

Injections are prepared using aseptic

technique in a clean area free from Yes
contamination or contact with blood, body No
fluids, or contaminated equipment.

Needles and syringes are used for only one

patient (this includes manufactured Yes
prefilled syringes and cartridge devices such No
as insulin pens).

The rubber septum on a medication vial is Yes

disinfected with alcohol prior to piercing. No
Medication vials are entered with a new
needle and a new syringe, even when Yes
obtaining additional doses for the same No
patient.

Single-dose or single-use medication vials,

Yes
ampules, and bags or bottles of intravenous
No
solution are used for only one patient.

Medication administration tubing and Yes

connectors are used for only one patient. No
Multi-dose vials are dated by healthcare
when they are first opened and discarded
within 28 days unless the manufacturer
Yes
specifies a different (shorter or longer) date
for that opened vial.
No

Note: This is different from the expiration

date printed on the vial.

Multi-dose vials are dedicated to individual Yes

patients whenever possible. No
Yes
No

Multi-dose vials to be used for more than

one patient are kept in a centralized
medication area and do not enter the
immediate patient treatment area (e.g.,
operating room, patient room/cubicle).

Note: If multi-dose vials enter the

immediate patient treatment area, they
should be dedicated for single-patient use
and discarded immediately after use.

Yes
Recapping of needle
No
Do not use proper bio-medical waste Yes
management No

We will collect data with different department of CHC bhangel [emergency room, labour
room, examination room , immunization room ].from 19. Feb.2024 to 22.Feb. 2024.
9.AUDIT ANALYSIS

Name and Designation of the employee: -NOT SIGNIFY

Date-19.Feb.2024 TO 22.Feb.2024

Department-Examination room, Immunization room, Emergency room, Labour room

Bench Total Score Percentage

S.No. Observation Point Mark Score Obtained (%)

Proper hand hygiene, using

alcohol-based hand rub or
soap and water, is performed
prior to preparing and
1 administering medications. 8 2 25%

Injections are prepared using

aseptic technique in a clean
area free from contamination
or contact with blood, body
fluids, or contaminated
2 equipment. 8 1 12.5%

Needles and syringes are

used for only one patient
(this includes manufactured
prefilled syringes and
cartridge devices such as
3 insulin pens). 8 7 87.5%
 The rubber septum on a
medication vial is disinfected
4 with alcohol prior to piercing. 8 0 0%

Medication vials are entered

with a new needle and a new
syringe, even when obtaining
additional doses for the same
5 patient. 8 2 25%

Single-dose or single-use
medication vials, ampules,
and bags or bottles of
intravenous solution are used
6 for only one patient. 8 6 75%

Medication administration
tubing and connectors are
7 used for only one patient. 8 8 100%

Multi-dose vials are dated by

healthcare when they are
first opened and discarded
within 28 days unless the
manufacturer specifies a
different (shorter or longer)
date for that opened vial.

Note: This is different from the

8 expiration date printed on the vial. 8 1 12.5%
 Multi-dose vials are dedicated
to individual patients
whenever possible.

8 0 0%

8 0 0%

Multi-dose vials to be used

10 for more than one patient are

kept in a centralized
medication area and do not
enter the immediate patient
treatment area (e.g.,
operating room, patient
room/cubicle).

11. Recapping of the needle 8 6 75%

Do not use proper bio-

12. medical waste management . 8 2 25%

Total Score =96

Total Score Obtained= 35

Total Percentage= 36.4%

10.RESULTS
The results of our study showed that around 36.45% of the total healthcare providers were
exposed to needle stick injury at work .In CHC bhangel.

 Proper hand hygiene,using alcohol based hand rub or soap water is performed prior
to preparing & administrating medications (25%).
 Injections are prepared using aseptic technique in a clean area free from
contamination or contact with blood , body fluids or contaminated equipment
(12.5%).
 Needles and syringe are used for only one patient (87.5%)
 Rubber septum on a medication vial is infected with alcohol prior to piercing (0%
 Medication vials are entered with a new needle& a new syringe ,even when
obtaining additional doses for the same patient (25%)
 Single dose or single use medication vials, ampules & bags or bottles of intravenous
solution are used for only one patient (75%)
 Medication administration tubing and connectors are used for only one patient
(100%)
 Multi-dose vials are dated by healthcare when they are first opened & discarded
within 28days unless the manufacturer specifies a different (shorter or longer)date
for that opened vial (12.5%)
 Multi-dose vials are dedicated to individual patient whenever possible (0%)
 Multi-dose vials to be used for more than one patient are kept in a centralised
medication area & do not enter the immediate patient treatment area(0%)
 Recapping of the needle (75%)
 do not use proper bio-medical waste management(25%).
11.CONCLUSION
The study aimed to assess injection practices and needle stick injury prevention among
health care providers with different department of CHC bhangel [emergency room, labour
room, examination room , immunization room ].

However, a notable a portion still engaged in risky behaviours such as recapping needles or
improper disposal , potentially exposing themselves to needle stick injuries , do not prepare
a injection with a proper aseptic techniques in a clean area free from contamination or
contact with blood .

Despite the presence of safety measures and guidelines , the study identified gaps in
knowledge and awareness among some healthcare providers , emphasizing the need for
and promoting a culture of safety ,could contribute to reduce the incidence of needle stick
injuries.

In conclusions, while there is commendable adherence to injection practices among

healthcare providers in CHC Bhangel ,addressing the identified gaps through continuous
education and reinforcement of safety measures is crucial for further minimizing the risk of
needle stick injuries in the healthcare settings.
11.REFERENCES

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436289/#:~:text=Around
%2065%25%20of%20%20health,precautions%20and%20treatment%20after
%20NSIs.
2. https://images.app.goo.gl/4SSTkAMaaYYsqpeAA
3. https://www.slideshare.net /shivanagu/safe-injection-practices-injection-safety
4. https://en.n.wikipedia.org /wiki /Needlestick_injury
5. https://www.slideshare.net/anjalatatchi /safe-injection-practices-as-per-nabhpptx
6. https://www.slideshare.net/AnshuYadav31/needle-stick-injury-120057439
12.ANNEXURE

ANNEXURE

Name & designation of the employee:

Date:

Department:

CHECK LIST OF SAFE INJECTION PRACTICES

Practice If answer is No, document

Injection Safety plan for remediation
Performed?

Proper hand hygiene, using alcohol-based hand

Yes
rub or soap and water, is performed prior to
preparing and administering medications.
No

Injections are prepared using aseptic technique

in a clean area free from contamination or Yes
contact with blood, body fluids, or No
contaminated equipment.

Needles and syringes are used for only one Yes

patient (this includes manufactured prefilled
No
syringes and cartridge devices such as insulin
pens).

The rubber septum on a medication vial is Yes

disinfected with alcohol prior to piercing.
No
Medication vials are entered with a new needle
Yes
and a new syringe, even when obtaining
additional doses for the same patient.
No

Single-dose or single-use medication vials,

Yes
ampules, and bags or bottles of intravenous
solution are used for only one patient.
No

Medication administration tubing and Yes

connectors are used for only one patient. No
Multi-dose vials are dated by healthcare when
they are first opened and discarded within 28
days unless the manufacturer specifies a
Yes
different (shorter or longer) date for that
No
opened vial.

Note: This is different from the expiration date printed on

the vial.

Yes
Multi-dose vials are dedicated to individual
No
patients whenever possible.

Multi-dose vials to be used for more than one Yes

patient are kept in a centralized medication
No
area and do not enter the immediate patient
treatment area (e.g., operating room, patient
room/cubicle).

Note: If multi-dose vials enter the immediate patient

treatment area, they should be dedicated for single-
patient use and discarded immediately after use.

Yes
Recapping of the needle

No

Do not use proper bio-medical waste

management. Yes
No

Name and Designation of the employee: -NOT SIGNIFY

Date-19.Feb.2024 TO 22.Feb.2024

Department-Examination room, Immunization room, Emergency room, Labour room

S.No. Observation Point Bench Total Score Percentage

 Mark Score Obtained (%)

Proper hand hygiene, using

alcohol-based hand rub or
soap and water, is performed
prior to preparing and
1 administering medications. 8 2 25%

Injections are prepared using

aseptic technique in a clean
area free from contamination
or contact with blood, body
fluids, or contaminated
2 equipment. 8 1 12.5%

Needles and syringes are

used for only one patient
(this includes manufactured
prefilled syringes and
cartridge devices such as
3 insulin pens). 8 7 87.5%

The rubber septum on a

medication vial is disinfected
4 with alcohol prior to piercing. 8 0 0%

Medication vials are entered

with a new needle and a new
syringe, even when obtaining
additional doses for the same
5 patient. 8 2 25%

Single-dose or single-use
medication vials, ampules,
and bags or bottles of
intravenous solution are used
6 for only one patient. 8 6 75%
 Medication administration
tubing and connectors are
7 used for only one patient. 8 8 100%

Multi-dose vials are dated by

healthcare when they are
first opened and discarded
within 28 days unless the
manufacturer specifies a
different (shorter or longer)
date for that opened vial.

Note: This is different from the

8 expiration date printed on the vial. 8 1 12.5%

Multi-dose vials are dedicated

to individual patients
9 whenever possible. 8 0 0%

8 0 0%

Multi-dose vials to be used

10 for more than one patient are

kept in a centralized
medication area and do not
enter the immediate patient
treatment area (e.g.,
operating room, patient
room/cubicle).

11. Recapping of the needle 8 6 75%

Do not use proper bio-

medical waste management.
12. 8 2 25%
Total Score = 96

Total Score Obtained= 35

Total Percentage= 36.45%