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Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 475-478

Assessment of safe injection practices and disposal methods among nursing personnel at health care centres of Hoskote - Rural Bengaluru, India

Department of Public Dentistry, The Oxford Dental College and Hospital, Bengaluru, Karnataka, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Nikhitha Raghunath
Department of Public Dentistry, Room No 5, The Oxford Dental College and Hospital, Bommanahalli, Hosur Road, Bengaluru - 560 068, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2319-5932.171191

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Introduction: Unsafe injection practices are commonplace in developing country health settings. These unsafe practices predispose the health care workers to various risks and also facilitate transmission of an array of diseases to the health care professionals and the community. Aim: To assess safe injection practices and disposal methods among nursing personnel at health care centres. Materials and Methods: A hospital based cross-sectional study was conducted among 86 nurses at health care centres of rural Bengaluru. Data were collected using a 20 item questionnaire. Along with demographic details questions regarding knowledge, practices, and disposal methods were included. Data were subjected to descriptive analysis. Results: The study population consisted of 89.5% female nurses and 10.5% were males. Among them only 46.5% were protected by hepatitis B vaccination. During the last 12 months 25.6% nurses had accidental needlestick injury (NSI). The subjects who practiced squeezing out blood at the puncture site and washed their hands immediately after NSI were 51.2%. A total of 82.6% of the subjects were of the opinion that human immunodeficiency virus/AIDS was the only disease transmitted by unsafe injection. Regarding the methods of disposal of used needles and syringes in their hospital 89.5% had no information of the same. Conclusions: There is a great disparity between the ideal and practiced methods among the nursing personnel. There is an immediate need to reinforce the importance of safe practices periodically through training and motivation on safe injection practices and its disposal.

Keywords: Biomedical waste disposal, injection practices, needlestick injuries, nursing personnel

How to cite this article:
Ganesh SA, Raghunath N, Balaji SK. Assessment of safe injection practices and disposal methods among nursing personnel at health care centres of Hoskote - Rural Bengaluru, India. J Indian Assoc Public Health Dent 2015;13:475-8

How to cite this URL:
Ganesh SA, Raghunath N, Balaji SK. Assessment of safe injection practices and disposal methods among nursing personnel at health care centres of Hoskote - Rural Bengaluru, India. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2022 Aug 18];13:475-8. Available from: https://www.jiaphd.org/text.asp?2015/13/4/475/171191

  Introduction Top

Rural India accounts for 68% of India's total population and half of all residents in rural areas live below the poverty line, struggling for better, and easy access to the health care services.[1] Nurses play a crucial role in rural areas as they are on the frontline of care in such areas. They form the pillars of the health care system and their empowerment and expertise are critical to improving the quality of health care. Hence, they have a significant role in monitoring the health of people in a community.

An injection is a skin piercing event performed to introduce a substance into the body for prophylactic, curative, or recreational purposes. The World Health Organization (WHO) estimates that 12 billion injections are given annually, 5% of which are administered for immunization and 95% for curative purposes.[2] Since the invention of syringe in 1848, a new channel for pathogens to pass from one person to another was opened. Unsafe injection practices facilitate such transmission of blood borne pathogens such as hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV).[3],[4] Estimates suggest that at least 50% of the world's injections administered each year are unsafe, particularly in developing countries.[5] To reduce hazardous effects of unsafe injection practices on the populace, the WHO introduced the concept of injection safety which is defined as are that "does not harm the recipient, does not expose the provider to any avoidable risk and does not result in any waste that is dangerous to other people." Injection safety practice includes hand hygiene; use of gloves where appropriate; skin preparation and disinfection and proper waste management.[6]

The most affected category of health care providers follow unsafe practices are the nursing personnel, injection recipients, and health care workers (HCW's). In recognition of this problem, in 1999 the WHO convened the Safe Injection Global Network, which aims to promote the safe and appropriate use of injections worldwide.[2]

A good injection practice along with proper disposal in health facilities is a reflection of adequate resource allocation, adequate supportive supervision, and good technical support.[7] This study aimed to assess the level of knowledge, practice of injection safety, and its disposal among nursing personnel at health care centres of Hoskote (Rural Bengaluru, Karnataka).

  Materials and Methods Top

A hospital-based study was conducted to assess the knowledge, safe injection practices, and waste disposal methods among the nurses. It was conducted during September 2014 in all the Hospitals/Clinics in Hoskote, Rural Bengaluru-Karnataka. The study protocol was reviewed and approved by Institutional Ethical Review Board. Formal approval letter was obtained from the Head of the Hospitals/Clinics of Hoskote. List of Hospitals/Clinics were obtained from the Indian Medical Association of Hoskote. Voluntary informed written consent was obtained from all participants in the study. Consented Hospitals/Clinicswere included in the study.

A questionnaire of 20 items was prepared, for assessing the knowledge, safe injection practices, and disposal methods among nursing personnel. The demographics details such as age, gender, educational status, and years of experience were also noted. The questions regarding the safe injection practices were compiled from the existing literature (WHO Tool C).[6],[8],[9],[10] The collected questions were subjected to content validation by a panel of 10 dental experts. Face validation was assessed by subjecting the proforma to a pilot study which was carried out on 10% of the desired population in order to check the feasibility and relevance of the prepared format. This population was not included in the main study. The purpose was to identifying the items with a high degree of agreement among experts. Aiken's V was used to quantify the concordance between experts for each item. Aiken's V was calculated using the formula:

Aiken's V = S/[n × (c − 1)]

S = Sum of the rating by an expert minus the lowest possible validity rating by all the experts
n = Number of experts
c = Total number of responses on the Likert scale.[11]

Questions that had an Aiken's V >0.7 were selected for the study. The correlations between the items ranged from 0.77 to 0.83. The questionnaire reliability was tested by test-retest method with an interval of 7 days. Reliability of questionnaire values was 0.78.[11]

During the study period, the investigator visited different rural Clinics/Hospitals of Hoskote Taluk. Assessment of injection practice and disposal of injection wastes was carried out through direct observation. Knowledge regarding injection safety practices was assessed by a self-administered questionnaire. The questionnaire required 5–10 min to complete. The completed questionnaires were then collected and checked for the completeness. In order to avoid interpersonal exchange, the questionnaire was distributed and collected back by the investigator during the same visit.

Descriptive statistics were derived to summarize the continuous variables. Results on categorical measurements are presented in number (%). The data, so obtained from the study sample was compiled, systematized, tabulated, and graphed using Microsoft Word and Excel 2007.

  Results Top

A total of 86 nursing personnel who were involved in direct patient care were included in this study. The distribution of participants by age, gender, educational status, and years of experience is shown in [Table 1]. The percentage of participants who had received training on injection safety was 51.2%; 46.5% had received hepatitis B vaccination. In the last 12 months 25.6% were exposed to a needlestick injury (NSI) [Table 2].
Table 1: Demographic characteristics of the subjects

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Table 2: Basic information given by the subjects

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After a NSI around 51.2% of the participants washed their hands after squeezing out blood from the puncture site. Number of subjects who washed their hands with soap and water were 12.8%, while 36% used antiseptic solution in case of accidental NSI. None of the study subjects were acquainted with postexposure prophylaxis. Regarding knowledge on diseases transmitted through unsafe injection, 82.6% were of the opinion that only HIV/AIDS was transmitted, whereas 15.1% were of the opinion that both HIV/AIDS and hepatitis B could be transmitted, and 2.3% of the nurses had no knowledge of transmissible infection [Table 3]. Around 96.5% of the participants did not wear gloves during their injections. While for disposing the used needles and syringes 89.5% of the participants used a safety box [Table 4]. The used needles were disposed into the general waste by 98.8% of the participants and 89.5 of them were not aware of a specific type of disposal of waste in their hospital [Table 5].
Table 3: Response of subjects based on their knowledge

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Table 4: Response of subjects based on their practice

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Table 5: Response of method of disposal in the hospitals

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  Discussion Top

In the present study, around 51.2% of the study population received training on injection safety during their service which was in contrast to the studies conducted by Onyemocho et al. and Popesu et al. who had reported 14.5% and 91%, respectively.[6],[12] Around 46.5% of the nurses had received hepatitis B vaccination in this study. NSI are one of the biological hazards associated with injection use. In this study, 25.6% of the subjects experienced NSI. In studies conducted by Chowdhury et al. and Logez et al., the prevalence rates were higher at 67.5% and 67.8% subsequently.[8],[9]

In this study conducted by Alkandari et al. in 2013, only 93% of the respondents washed their hands before administering injection.[13] In contrast, the study conducted in Bangladesh (Dhaka division) by Chowdhury et al. 33.5% providers washed their hands properly with antiseptic soap or used alcohol-based rub before administering injection.[9] In the current study, all the participants washed their hands and cleaned or wiped the injection site with rectified spirit before administering injection.

It was observed that in the study conducted by Mitra et al. that 57.9% of the nursing students were aware about postexposure prophylaxis similar to the study by Avachat et al.[14],[15] While in the current study observations were noticed as none of the participants exhibited knowledge on postexposure prophylaxis. In this study 82.6% were of the opinion that only HIV/AIDS was transmitted by NSI, 15.1% were of the opinion that both HIV/AIDS and hepatitis B are transmitted. Study done in Ilorin, Nigeria revealed that only 58.3% had knowledge of diseases transmissible through NSI. Similar results were observed in studies conducted in Cambodia and China. The knowledge about diseases transmitted by the NSI was poor in the current study. They may be attributed to the lack of awareness and ignorance as a result of discrepancy between the number of nursing staff delivering care and the patients seeking the health care services in the rural setup. It could also be due to less number of training sessions on injection safety.

A total of 89.5% of the subjects collected the used needles and syringes in the safety box and 10.5% of them dispensed it with general waste. Chowdhury et al. and Timilshina et al. reported that only 16.5% and 55% of them disposed the used syringes and needles in a puncture proof container. In this study, 7% of the subjects incinerated needles and syringes in their hospital, 3.5% of them dumped in a secure pit while 89.5% of them did not know the type of disposal of used needles and syringes in their hospital. According to Gyawali et al. in 2013, 80% of the subjects used incineration as the main waste disposal technique for disposing the injection wastes.[9],[10],[16]

As the nurses are primarily involved in patient care the knowledge about the hazards they are exposed to during their practice is important. They also should be aware of their predisposition to blood borne diseases. The incidence of NSI can be reduced through proper training and motivation of the HCW's. Since this is an observational study there is a tendency that the response to the questions by the subjects may be in a socially acceptable direction which is seen commonly while conducting research with self-reporting. Therefore one of the limitations could be social desirability bias and this may further interfere with the interpretation as well as behavioral differences.

It is recommended that the implementation of the proper infection control practices be done by specific training courses, strict regulations, supervision, and even application of specific reward and punishment schemes. Also, there is an urgent need for widespread promotion of injection safety messages among consumers and providers of health services. The education about safe injection practices must be appreciated in a multifaceted manner and should be operated at a number of levels (organizational, individual, and community). In addition, by introducing the system of reporting the authorities, immediately after an accidental NSI. We can promote safety and plan infection prevention initiatives.

  Conclusion Top

This present study elucidates a range of unsafe injection practices, knowledge, and disposal methods. Overall results states that practices about injection safety was good, but the knowledge and disposal methods among nursing personnel were not up to the standard recommended practices. Such differences should be reduced by comprehensive programs on occupational hazards at the individual and hospital level.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Chandramouli C. Census of India 2011 – Rural Urban Distribution of Population (Provisional Population Totals). Available from: http://www.censusindia.gov.in/2011-provresults/paper2/data_files/india/Rural_Urban_2011.pdf. [Last cited on 2014 Aug 02].  Back to cited text no. 1
Kermode M. Unsafe injections in low-income country health settings: Need for injection safety promotion to prevent the spread of blood-borne viruses. Health Promot Int 2004;19:95-103.  Back to cited text no. 2
Bolarinwa OA, Salaudeen AG, Aderibigbe SA, Musa OI, Akande TM. Injection safety practices among primary health care workers in Ilorin, Kwara State of Nigeria. Health Sci J 2012;3:496-508.  Back to cited text no. 3
Vong S, Perz JF, Sok S, Som S, Goldstein S, Hutin Y, et al. Rapid assessment of injection practices in Cambodia, 2002. BMC Public Health 2005;5:56.  Back to cited text no. 4
IPEN Study Group. Injection practices in India. WHO South East Asia J Public Health 2012;1:189-200.  Back to cited text no. 5
Onyemocho A, Anekoson JI, Pius EO. Knowledge and practice of injection safety among workers of Nigerian prison service health facilities in Kaduna state. Am J Public Health Res 2013;1:171-6.  Back to cited text no. 6
Aziz A, Esena RK, Gborgbortsi WD. Assessment of injection safety practices in health facilities in Bongo and Talensi Districts in the upper east region of Ghana: Part 1-injection safety practices. Int J Sci Technol Res 2013;11:347-58.  Back to cited text no. 7
Logez S, Soyolgerel G, Fields R, Luby S, Hutin Y. Rapid assessment of injection practices in Mongolia. Am J Infect Control 2004;32:31.  Back to cited text no. 8
Chowdhury AK, Roy T, Faroque AB, Bachar SC, Asaduzzaman M, Nasrin N, et al. A comprehensive situation assessment of injection practices in primary health care hospitals in Bangladesh. BMC Public Health 2011;11:779.  Back to cited text no. 9
Gyawali S, Rathore DS, Kc B, Shankar PR. Study of status of safe injection practice and knowledge regarding injection safety among primary health care workers in Baglung district, western Nepal. BMC Int Health Hum Rights 2013;13:3.  Back to cited text no. 10
Aiken V. Content validity and reliability of single item or questionnaire. Educ Psychol Meas 1980;40:955-99.  Back to cited text no. 11
Popesu CD, Mihailescu GP, Pasat L. Injection practices among nurses, Valcea, Romania, 1998. Morb Mortal Wkly Rep 2001;50:59-61.  Back to cited text no. 12
Alkandari A, Aljodar S, Albahhouh HA, Makboul G, El-Shazly M. Knowledge, attitude and self-reported behaviour of primary health care workers for hepatitis B and C virus and health care associated infection. Greener J Med Sci 2013;3:018-31.  Back to cited text no. 13
Mitra SP, Mallik S, Das M, Roy AM. Injection safety: Perception and practice of nursing students in tertiary setting. Indian J Prev Soc Med 2010;41:185-7.  Back to cited text no. 14
Avachat S, Phalke DB, Dhumale GB. Awareness regarding pre- and postexposure prophylaxis for human immunodeficiency virus/acquired immunodeficiency syndrome among nursing students [letter]. Indian J Community Med 2007;32:159.  Back to cited text no. 15
  Medknow Journal  
Timilshina N, Ansari MA, Dayal V. Risk of infection among primary health workers in the Western Development Region, Nepal: Knowledge and compliance. J Infect Dev Ctries 2011;5:18-22.  Back to cited text no. 16


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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