Stinging-cutting Accidents and Healthcare Waste Management’s Knowledge Among Healthcare Professionals in Public Hospitals in Catania (South Italy)
Authors: Ferrante Margherita , D’Agati Placido , La Rosa Sebastiano De Maria , Carini Santa A. , Trovato Angela , Fiore Maria 
Published: August 2018

Background:
Stinging-cutting accidents (needle-stick and sharps accidents) continue to pose a considerable environmental and occupational health risk. In Italy and in the world, the number of stinging-cutting is still unknown, primarily due to under-reporting. The inappropriate management of healthcare waste may be the cause of accidents needle-stick and sharps.

Objective:
Our aims were to evaluate the frequency and the modality of stinging-cutting accidents and to assess healthcare waste management’s knowledge among nurse and auxiliary nurse of the departments where the accidents occurred.

Method:
Both a retrospective incidence study and a cross-sectional anonymous survey were conducted, during the 3-year period 2013-2015, in Catania (south Italy) public hospitals. The retrospective incidence study consisted of analysing needle-stick and sharps accidents officially reported in the records of the hospitals. Detailed information on the needle-stick and sharps accidents was analysed too. The survey consisted of assessing the knowledge of nurse and auxiliary nurses about healthcare waste management. The survey was proposed only to hospital staff in the operative units where the injuries occurred. A multiple-choice questionnaire was used for data collection regarding knowledge on healthcare waste management. Data were analysed using chi-square and Kruskal-Wallis tests, the effect size was quantified by Cramer’s V.

Results:
Retrospective incidence study: needles and scalpel-blades accidents occurred in 240 health professionals, during the 3-year period. Results show an injury rate of 1.4 per year (mean value), which decreased from 2013 to 2015 (1.8% vs 1.2% vs 1.1%). The accidents were experienced by health professionals (62.1% female) aged from 20 to 68 years, by nurses more than doctors (65.8% and 18.3%) and on Wednesday (22.9%) followed by Tuesday (17.9%), Thursday (17.1%), Friday (14.6%), Monday (12.5%), Saturday (8.8%) and Sunday (6.3%) (p= 0.000). Needle-stick accidents were more frequent than scalpels-blades accidents (91.2% vs 8.8%, p=0.000). The frequency of needles accidents was higher in nurses than in doctors (95.6% vs. 86.4%) while of scalpel-blades accidents, was higher among doctors compared to nurses (13.6% vs. 4.4%) (p=0.039, Cramer’s V 0.155). The most frequent site of the lesion was the left (15.8%) and right (16.3%) second finger. The most frequent cause of needle-stick accidents was needle puncture during medical procedure (67%) and the most frequent cause of sharps accidents was unattended scalpel-blades (33%). Surprisingly we have observed 4% of needle-stick accidents caused by recapping.

Cross-sectional anonymous survey: 428 healthcare professionals completed the survey. The percentage of the correct answers to the knowledge questions for all the operative units combined (Internal Medicine, Orthopedics, Anesthesia, Surgery and Gynecology) was 70%. The right way to dispose of a diaper not contaminated by blood from a patient who does not have oral-fecal infectious diseases (56% wrong answers), the bag of urine, which does not contain traces of blood and properly emptied (64% wrong answers), sanitary napkins in blood (68% wrong answers), and a IV bottle partially filled with drug (85% wrong answers) were identified as the most important aspects for future interventions.

Conclusion:
The study showed an underestimation of needle-stick and sharps medical accidents and lack of knowledge about healthcare waste management procedures. Future approaches are needed for providing education and training of safe handling and disposal of sharp devices, to create awareness followed by which, legislative actions would be taken.