Injection Practices in Clinics in Karachi

Injection practices among practitioners in private medical clinics of Karachi, PakistanAuthors of study:M.Tahir Yousafzai1, Nighat Nisar2, M.FaazilKakakhel3, Majid Hafeez Qadri41, R. Khalil 5 and S.M. Hazara 6

Presenter:Mahmood Ahmed2nd year, III-semester

Faculty:Dr . Mubashir Zafar

*Mahmood Ahmed 2nd Year MSN Semester III

Mahmood Ahmed 2nd Year MSN Semester III

OBJECTIVESIntroduction

Methodology

Results

Discussion

Conclusion*Mahmood Ahmed 2nd Year MSN Semester III


IntroductionThe risk of blood borne infection among Health Care Workers is due to poor health care practices about workplace safety conditions, the lack of safety devices and personal protective equipment and poor compliance with universal precautions.WHO estimates, 40%65% of hepatitis B and C virus among health-care workers of developing world due to occupational sharps injuries.*Mahmood Ahmed 2nd Year MSN Semester III


Conti:Main causes are not using personal protective equipment such as gloves, goggles, masks, gowns and poor compliance with universal precautions e.g. hand washing, recapping needles, proper disposal of sharpsThe culture of using injections is more common by the practitioners in private clinics.



LiteratureLimited literature on the prevalence of sharps injuries in Pakistan and neighbouring countriesIndia reported a higher prevalence (63%)Studies from Iran and Ethiopia found prevalence of sharps injury 26.3% and 29.1% respectively.In Malaysia reported sharp injury was 23.5%In the Dominican Republic found 22.3%In the Untied States of America, reported 9%



Objective of study:

The aim of this study was to determine the frequency and determinants of sharps injuries among practitioners working in private health care clinics in slum areas of Karachi.*Mahmood Ahmed 2nd Year MSN Semester III


Methodology:Study design : A cross-sectional study was carried out during May to July 2006Study setting: Landhi town, Karachi, Majeed, Bilal, Muslimabad, Muzafarabad and Sherpao colonies of Karachi East. Most people are factory workers.Target population: 317 practitioners working in private health care clinics located in the given areas.



Methodology:Inclusion / exclusion criteria: Practitioners who had work experience of at least 1 year in the given clinic private practice. Government dispensaries, Social security institute not included and Practitioners having experience less than 1 year Sampling strategy Purposive sampling techniqueSample size calculation: Initial survey was done to list of private health care practitioners 407 397 selected ,317 consented (79.8%) practitioners*Mahmood Ahmed 2nd Year MSN Semester III


Methodology:Data collection tool: A structured, pre-tested questionnaire in the English language was used for data collection from all the eligible practitioners who consented to participate in the studyData collection plan: Practitioners were given 1-week to complete the questionnaires and collected . Some practitioners were given more 3 days.



Ethical considerationThe study was approved by the ethics committee of Baqai Medical University.consents were taken from participants in the study



Data analysis:Software Statistical Package for Social Sciences (SPSS) version 19 was used for data analysisPercentage for categorical and mean with standard deviation (SD) for continuous scale variables were calculated. Prevalence with 95% confidence interval (CI) of at least 1 sharps injury in the last 12 months



Data analysis:Crude and adjusted odds ratios (OR) for predictors of sharps injury were calculated using multivariable logistic regression analysisHosmer and Lemeshow goodness-of-fit test was used to evaluate the model adequacy. *Mahmood Ahmed 2nd Year MSN Semester III


Results:Table 1 Descriptive characteristics of practitioners in private medical clinics in Landhi town, Karachi (n = 317) Demographic variablesEthnicityPashtu 110 34.7Panjabi & others 130 41.0Urdu speaking 77 24.3Age in years [mean (SD)] 37.6 (11.1)Sex [no., %]Male 277 87.4Female 40 12.6Years of work experience [mean (SD)] 11.9 (9.0)Years of schooling10 40 12.612 160 50.514 82 25.916 35 11.0Professional qualifications [no., %]MBBS 25 7.9Registered nurse 39 12.3Dispenser diploma or others 225 71.0No professional qualifications 28 8.8Hepatitis B complete vaccination [no., %] 67 21.1%



Results:*Mahmood Ahmed 2nd Year MSN Semester III


Results:Table 2 Distribution of reasons for injury among practitioners in private medical clinics in Landhi town, Karachi who suffered at least 1 sharps injury in the previous 12 months (n = 85) Variable No. %Object of sharps injurySyringe needle 50 58.8Stitching needle 15 17.6Surgical blade 10 11.8Drip-set needle 10 11.8What led to sharps injuryNeedle recapping 40 47.0Patient movement 15 17.6Changing of needle 20 23.5During discarding in the waste bin 10 11.8Lighting in clinic at time of injuryFluorescent lamp 15 17.6Regular light bulb 20 23.5Rechargeable emergency light 30 35.3Candle 20 23.5*Mahmood Ahmed 2nd Year MSN Semester III


Results:Table 3 Distribution of determinants of sharps injury among practitioners in private medical clinics in Landhi town, KarachiVariable Sharps injury OR (95% CI) P-value Yes No No. % No. % Total 85 26.8 232 73.2Years of work experience< 5 30 46.2 35 53.8 5.7 (2.513.2) 510 25 36.8 43 63.2 3.8 (1.78.9) < 0.0011015 18 21.2 67 78.8 1.8 (0.84.2)15+ 13 13.0 87 87.0 1 Years of schooling1012 75 37.5 125 62.5 6.4 (3.013.9) < 0.0011416 10 8.5 107 91.5 1No. of injections administered per day< 30 1 10.0 90 90.0 1 < 0.001> 30 75 34.6 142 65.4 4.7 (2.210.3)No. of patients per day< 20 7 7.1 91 92.9 1 < 0.001> 20 78 35.6 141 64.4 7.2 (3.017.8)Use of disposable syringe for each injectionYes 6 7.5 74 92.5 1 < 0.001No 79 33.3 158 66.7 6.2 (2.516.5)Needle recapping after useYes 81 29.2 196 70.8 3.7 (1.212.7) < 0.017No 4 10.0 36 90.0 1*Mahmood Ahmed 2nd Year MSN Semester III


Discussion:Frequency of sharps injuries was high among practitioners working in private clinicsUnsafe and inadequate practices of reusing syringes, needle recapping, using multi-dose vials, unavailability of sharps disposal containers and disposal of sharps in community waste binshigher in hospitals than immunization clinics b/c immunization staff received ongoing training on universal precautions. *Mahmood Ahmed 2nd Year MSN Semester III


Discussion:Practitioners not vaccinated against hepatitis B are at more high risk of occupational infection with HCV and HBV .Practitioners not professionally qualified are more at risk due to lack of Knowledge and practice of multiple use of one syringe.*Mahmood Ahmed 2nd Year MSN Semester III


Conclusion:Study highlights the value of HBV immunization for all practitioners. NEED For surveillance systems for needle stick/sharps injuries.Appropriate facilities for ongoing training of practitioners, refresher courses and availability of personal protective equipment.Awareness about single-use disposable syringes for each patient Training sessions for all HCW in private clinics on practising universal precautions Medical and Nursing associations enhance awareness about safe injection practices to avoid transmission risk of bloodborne infections by health care practitioners.*Mahmood Ahmed 2nd Year MSN Semester III


Reference:Yousafzai MT et al. (2013), Injection practices among practitioners in private medical clinics of Karachi, Pakistan Vol. 19 No. 6: 570-5. Eastern Mediterranean Health Journal *Mahmood Ahmed 2nd Year MSN Semester III


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Injection Practices in Clinics in Karachi

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