ISSN: 2320-5407 Int. J. Adv. Res.

12(08), 569-581

Journal Homepage: - www.journalijar.com

Article DOI: 10.21474/IJAR01/19287

DOI URL: http://dx.doi.org/10.21474/IJAR01/19287

RESEARCH ARTICLE
FACTORS ASSOCIATED WITH NEEDLE STICK INJURY AMONG HEALTHCARE WORKERS IN AL-
AHSA, SAUDI ARABIA

Dr. Ahmed Alessa1, Dr. Essa Alsaleh2, Dr. Mohammed Alramadhan3 and Dr. Abdulrazag Al-Salameen3
1. Saudi Board of Preventive Medicine, Al-Ahsa Health Cluster, Al-Ahsa, Saudi Arabia.
2. Infection Control Department, Al-Ahsa Health Directorate, Al-Ahsa, Saudi Arabia.
3. Community Wellness Department, Al-Ahsa Health Cluster, Al-Ahsa, Saudi Arabia.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Background: Needle stick injuries (NSIs) pose a significant
Received: 12 June 2024 occupational hazard for healthcare workers (HCWs), risking
Final Accepted: 14 July 2024 transmission of bloodborne pathogens. This study aimed to identify
Published: August 2024 factors associated with NSIs among HCWs in Al-Ahsa, Saudi Arabia.
Methods: A case-control study was conducted among 380 HCWs (190
Key words:-
Needle Stick Injuries, Healthcare cases, 190 controls) in governmental health facilities. Data were
Workers, Occupational Hazards, collected through a questionnaire addressing participant characteristics,
Infection Control, Safety-Engineered occupational information, and NSI risk factors. Logistic regression
Devices
analysis was used to identify factors associated with NSIs.
Results: Younger age and less work experience were associated with
increased NSI risk. Completion of training programs, including Basic
Infection Control Skills License (OR: 0.56, 95% CI: 0.36-0.91),
orientation programs (OR: 0.43, 95% CI: 0.29-0.71), and workplace
safety training (OR: 0.41, 95% CI: 0.29-0.63), significantly reduced
NSI risk. Disposal containers filled above two-thirds capacity increased
NSI risk (OR: 1.9, 95% CI: 1.0-3.6). Use of certain devices, such as
spinal/epidural needles and arterial catheter introducer needles, was
associated with lower NSI risk.
Conclusion: Comprehensive training programs, proper sharps disposal
practices, and use of certain safety-engineered devices may reduce NSI
risk among HCWs. Targeted interventions for younger, less
experienced HCWs are warranted. These findings can inform the
development of effective NSI prevention strategies in healthcare
settings.

Copyright, IJAR, 2024,. All rights reserved.

……………………………………………………………………………………………………...
Introduction:-
Needle Stick Injuries (NSIs) are one of the most common occupational hazards that could affect the healthcare
workers (HCWs) worldwide, and they are sources of lots of infections(Bouya et al., 2020). Some of these infections
that could transmitted by NSIs as a result of contamination of a sharp object from the blood of affected patients are
hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV)(Sharew et al., 2017).
Studies show that the likelihood of infections through NSIs is between 0.2% and 0.5% for HIV, between 3.0% and
10% for HCV, and 40% for HBV(Cheng et al., 2012). Furthermore, dangerous health conditions ranging from mild

Corresponding Author:- Dr. Ahmed Alessa

Address:- Saudi Board of Preventive Medicine, Al-Ahsa Health Cluster, Al-Ahsa, Saudi 569
Arabia.
ISSN: 2320-5407 Int. J. Adv. Res. 12(08), 569-581

to severe anxiety can be caused by infectious complications attributed to occupational exposure to NSIs(Yasin et al.,
2019).

HCWs that at risk of NSIs are physicians, nurses, laboratory technicians, and those who work in medical waste
management(Berhan et al., 2021). The type of needle and other sharp objects used, as well as their safety protocols,
can influence the risk of injury to healthcare workers(Kwanzaa et al., 2020). Factors associated with NSIs can be
related to practitioner's characteristics, work nature and place, and practice(Mengistu & Tolera, 2020).

Factors related to practitioners are gender, age, type of professional, work experience, marital status, injection safety
training, infection prevention training, and attendance to educational class about NSIs. Regarding to work nature and
place factors which are work load, working in private hospitals, availability of adequate number of needles, syringes
and sharps equipment, availability of safety box, working department/unit, and absence of hospital
policies(Matsubara et al., 2017). Then factors that relate to practice which are disassembling of syringe and needle,
needle recapping, over use of injection, universal precaution, and personal protective equipment(Mengistu & Tolera,
2020).

A cross-sectional study done included all governmental hospital plus one private hospital in Al-Ahsa region in Saudi
Arabia. Data collected over three years from 2016 to 2018 included all reported cases of NSI using EPINet program.
Nurses were the most workers that exposed to NSI by 48%, where the most workplace that injuries occurred were
patient room by 30%. The most purposes that sharp item was used were injection, to draw venous blood sample, and
suturing by 22%, 15%, and 13% respectively(Al Shaikh et al., 2019).

Another cross-sectional study that consists of was conducted in Abha city, Aseer region, Saudi Arabia in 2020.
Inserting intravenous canula was the most purpose that NSIs had occurred by 33%, and in patient room by 42.9%.
Most of the injuries had occurred during handling/passing devices during or after use (25.3%), disposal (24.2%), and
recapping (14.3%)(Alsabaani et al., 2022).

There was no study done about the factors that associated with needle stick injury in Al-Ahsa region. Also, NSIs are
common and have serious complications, we would like to identify the risk factors to prevent them in the future.
This study was aimed to study factors that associated with needle stick injuries among healthcare workers in Al-
Ahsa region of Saudi Arabia.

Methods:-
Study design, Study Setting, and Population:
This is a case-control study conducted in HCWs working in governmental health facilities in Al-Ahsa region of
eastern province in Saudi Arabia. Al-Ahsa consists of public sector hospitals and more than 60 Primary Healthcare
Centers (PHCs) divided in to four sectors; north, eastern, middle, and southern. Up to 10 thousand HCWs working
in the governmental sectors from doctors, nurses, and technicians including laboratory, radiology, operations, dental
assistant, and patient care.

Inclusion and Exclusion Criteria:

All HCWs working in governmental healthcare facilities in Al-Ahsa were included in the study, excluding
unreported NSIs and reported case in interns or health colleges students. Cases were selected from those who
reported to the occupational health department at health cluster in Al-Ahsa to have needle stick injury in 2022 and
2023. Controls selected from who were not reported to had needle stick during the study period were randomly
selected and individually matched to the cases according to the gender, job, health institute, and department.

Data Collection:
Data were collected through a questionnaire designed according to occupational health department in Al-Ahsa
health cluster's forms which are occupational injury reporting and needle stick incident. The questionnaire consists
of general participant's characteristics, occupation information, and the risk factors of NSI. the questionnaire was
filled by the participants self-administered and by interview in which they were contacted and consent obtained.

Data Analysis:
The data were collected, reviewed, and then fed to Statistical Package for Social Sciences version 26 (Released
2019. Armonk, NY: IBM Corp). All statistical methods used were two-tailed with an alpha level of 0.05 considering

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significance if P value less than or equal to 0.05. Descriptive analysis for categorical data was done comparing
General characteristics of study health care workers among groups (cases vs. controls) using Pearson Chi-Square
test and exact probability test (for small frequency distributions). To assess significant factors associated with NSIs
among HCWs, simple logistic regression analysis was used for unadjusted (crude) relation while multiple logistic
regression analysis was applied to assess the most significant adjusted risk factors based on adjusted odds ratio and
its 95% confidence interval. Model fitting was assessed using ROC curve for model discrimination and model's
predictive accuracy for model calibration.

Results:-
A total of 380 HCWs (190 cases and 190 controls) were included in the study (figure 1). The mean age of cases
(HCWs exposed to NSI) versuscontrols was 32.1vs. 34.4 years old with a statistically significant difference
(P=.003). Most cases and controls were females (79.5% for each). Also, 95.3% of cases and control work at
hospital. Likewise, cases and controls have the same job category distribution mainly nurses (62.1%). As for work
years, it was less than 3 years among 61.1% of cases versus 22.6% of controls (P=.001). Also, 41.6% of controls
work for more than 8 hours compared to 27.4% of cases (P=.004). Also, 88.4% of cases had break time versus
77.4% of controls (P=.004). Exact of 74.2% of cases had a bachelor's degree compared to 65.8% of controls
(P=.071). A total of 7.4% of cases were smokers compared to 5.8% of controls (P=.535). A total of 97.9% of cases
completed HBV vaccine in comparison to 95.8% of controls (P=.258) (Table 1).

Table 2. Factors associate with needle stick injury among study health care workers. Considering training factors, all
except for having a postgraduate academic training showed a significant protective effect on NSI with the most
protective factor was Training in workplace safety and health (AOR=0.41). As for general factors, having have pre-
employment training showed a significant risky relation with NSI (AOR=2.7) and also suffering from previous
accidents other than NSI showed 3 times more risk for having NSI (AOR=3.5).

Table 3. Factors associate with needle stick injury among study health care workers. About environmental factors,
none of the factors showed a significant association with having NSI with all were risky except for poor ventilation
(AOR=0.91). The same was for workplace factors where all showed insignificant association with having NSI with
all showed risky relation other than "Item left on or near disposal container" (AOR=0.88), and " Item protruding
from opening of disposal container (AOR=0.88)". Considering purpose of sharp item use, to place an
Arterial/Central line decreased the risk of NSI by about 39% (AOR=0.61), for suturing decreased the risk of NSI by
about 50% (AOR=0.5), and for cutting decreased the risk by about 59% (AOR=0.41) with all showed a significant
protective effect (P<0.05 for all). Considering circumstances during use of sharp items, disassembling Device or
Equipment decreased the risk of NSI by about 49% (AOR=0.51); P=0.008.

Table 4. Factors associate with needle stick injury among study health care workers. Considering type of device,
those who used needle had doubles risk for NSI (AOR=2.1). As for type of needle, blood gas syringe use associated
with decreased risk for NSI by 48% (AOR=0.52), use of spinal or Epidural needle associated with decreased risk for
NSI by 78% (AOR =0.22), Unattached hypodermic needle decreased the risk by 50% (AOR=0.5), Arterial catheter
introducer needle associated with decreased risk for NSI by 59% (AOR=0.41), and Central line catheter needle was
associated with decreased risk of NSI by 49% (AOR=0.51). With regard to surgical instrument, the most reported
instruments with decreased risk for NSI were Trocar (71% less risk for NSI), lance (67% less risk for NSI), Vacuum
tube (67% less risk), and Scalpel, disposable (62% less risk). The least protective instruments were Drill bit/bur
(18% less risk), and Retractors, skin/bone hooks (24% less risk for NSI). As for Glass item, Glass slide was
associated by 78% less risk for NSI, Specimen/test tube was associated with 65% less risk for NSI, Medication/IV
bottle associated with 54% less risk, Medication ampule associated with 50% less risk, and Medication vial
associated with 48% less risk for NSI.

Discussion:-
Needle stick injuries (NSIs) remain a significant occupational hazard for healthcare workers (HCWs) worldwide,
posing serious risks of bloodborne pathogen transmission. This study aimed to assess factors associated with NSIs
among HCWs in Al-Ahsa, Saudi Arabia. Our findings highlight several key areas for potential intervention and
prevention strategies.

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The prevalence of NSIs varies widely across different healthcare settings globally. A 2021 survey of 52 Ministry of
Health facilities in Saudi Arabia found 3.2 sharp injuries per 100 occupied beds annually(Abalkhail et al., 2022).
This is considerably lower than rates reported in US hospitals, where the Centers for Disease Control and Prevention
estimate 385,000 sharp-object injuries occur among hospital workers each year(Alfulayw et al., 2021).

The discrepancy may be partly due to underreporting, which remains a significant challenge in accurately assessing
NSI prevalence. Studies have shown that up to 70% of NSIs may go unreported, often due to time constraints,
perception of low infection risk, or fear of repercussions (Pervaiz et al., 2018). A study by Abozead et al., (2015).
found that 80% of junior doctors failed to report NSIs, with the most common reasons being the perceived low risk
of infection and lack of time. This highlights the need for improved reporting systems and education about the
importance of reporting all NSIs, regardless of perceived risk.

Our study found that younger HCWs with less work experience were more likely to experience NSIs, consistent
with findings from other studies(Keicher et al., 2024). This may be attributed to less familiarity with procedures,
higher stress levels, or inadequate training among newer staff. A study by Smith et al., (2006) in Japan found that
nurses with less than 4 years of clinical experience were 2.2 times more likely to experience NSIs compared to their
more experienced colleagues.

Interestingly, our study did not find significant associations between NSI risk and factors such as gender or job
category, which have been reported in some other studies. For instance, Alsadaan et al., ‎(‎2021)found that nurses
were at higher risk of NSIs compared to other HCWs in Saudi Arabia. The lack of such associations in our study
may be due to specific workplace practices or training programs in our study setting that mitigate these risks.

One of the most significant findings of our study was the protective effect of various training programs against
NSIs. HCWs who had completed Basic Infection Control Skills License (BICSL), orientation programs, and
workplace safety training were significantly less likely to experience NSIs. This aligns with numerous studies
highlighting the importance of education in NSI prevention.

Wang et al., ‎(‎2003)found that nursing students who received specific training on bloodborne pathogen prevention
had a 71% lower risk of NSIs. Similarly, (Amini et al., 2015)reported significantly lower NSI rates among HCWs
who had received infection control training. A systematic review by Tarigan et al., (2015)concluded that educational
interventions can significantly reduce NSI incidence, with some studies reporting reductions of up to 60%.

The protective effect of training likely stems from improved knowledge of proper handling techniques, increased
awareness of risks, and better adherence to safety protocols. However, the quality and frequency of training
programs can vary widely between healthcare institutions. Regular refresher courses and hands-on practical training
sessions may be more effective than one-time orientations.

A study by Afridi et al., (2013)in Pakistan found that regular refresher trainings were associated with a 50%
reduction in NSI risk. Additionally, incorporating simulation-based training has shown promise in improving skills
and reducing NSI risk. (Keicher et al., 2024)reported that simulation-based training resulted in a 34% reduction in
NSI incidence among medical students compared to traditional training methods.

Our study identified several workplace factors associated with NSI risk. Notably, disposal containers filled above
two-thirds capacity were significantly associated with increased NSI risk. This highlights the importance of proper
waste management and regular emptying of sharps containers. Similar findings have been reported in other studies,
emphasizing the need for adequate resources and clear protocols for sharps disposal(Hussain et al., 2020).

A study by Chen et al., (2020)found that overfilled sharps containers were associated with a 3.6-fold increased risk
of NSIs. The authors suggested that implementing a policy of replacing containers when they are two-thirds full
could significantly reduce this risk.

Other workplace factors, such as high patient load, staff shortages, and multiple invasive procedures, have been
associated with increased NSI risk in previous studies(Hoboubi et al., 2019; Rai et al., 2021; Razek et al., 2018).
While our study did not find statistically significant associations for these factors, they remain important
considerations for comprehensive NSI prevention strategies.

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Sepandi et al., (2023)found that organizational factors, including workload, staffing levels, and safety climate, were
significantly associated with NSI risk. The authors emphasized the need for a systems approach to NSI prevention
that addresses these broader workplace factors in addition to individual-level interventions.

The type of device used was significantly associated with NSI risk in our study. Notably, the use of needles was
associated with a doubled risk of NSIs compared to other devices. This is consistent with global trends; a recent
systematic review and meta-analysis by Bouya et al., (2020) found that hypodermic needles were the most common
source of NSIs among HCWs worldwide, followed by IV cannulations and surgical needles.

Interestingly, our study found that certain types of needles and devices were associated with lower NSI risk,
including spinal/epidural needles, arterial catheter introducer needles, and unattached hypodermic needles. This may
be due to specific safety features of these devices or differences in usage patterns and procedures.

The implementation of safety-engineered devices (SEDs) has shown promise in reducing NSI risk. A Cochrane
review by Reddy et al., (2017) found moderate-quality evidence that SEDs can reduce NSIs compared to
conventional devices. For example, a study by Tosini et al., (2010) in France reported a 74% reduction in NSIs
following the introduction of safety-engineered syringes.

However, it's important to note that the effectiveness of SEDs can vary depending on the specific device and context
of use. A study by Guzmán et al., (2019) found that while some SEDs significantly reduced NSI risk, others had
little impact or even increased risk due to unfamiliarity or improper use. This highlights the importance of proper
training and evaluation when introducing new safety devices.

Regular, high-quality training on infection control, proper device handling, and NSI prevention should be mandatory
for all healthcare workers (HCWs). This should include hands-on practice and simulation-based learning. A study
by (Hambridge, 2011) found that a comprehensive training program reduced NSI incidence by 32% over a one-year
period. The effectiveness of training can be further enhanced by incorporating adult learning principles and
interactive techniques. For instance, Wu et al., (2020) reported that simulation-based training resulted in a 34%
reduction in NSI incidence among medical students compared to traditional training methods. Regular refresher
courses are also crucial, as knowledge and skills can decay over time. Wu et al., (2020) found that regular refresher
trainings were associated with a 50% reduction in NSI risk.

Ensuring adequate availability of sharps containers, regular emptying, and clear protocols for disposal can
significantly reduce NSI risk. Our study found that disposal containers filled above two-thirds capacity were
significantly associated with increased NSI risk, a finding echoed in another research.Szczypta et al., (2024) found
that overfilled sharps containers were associated with a 3.6-fold increased risk of NSIs. Implementing a policy of
replacing containers when they are two-thirds full could significantly reduce this risk. Grimmond et al., (2010)found
that implementing a comprehensive sharps safety program, including improved disposal systems, resulted in a 57%
reduction in NSIs over a 5-year period. This program included strategically placing sharps containers at point-of-use
locations, using containers with improved design features, and establishing clear protocols for container replacement
and disposal.

Implications of the Study:

This study provides valuable insights into the factors associated with needle stick injuries (NSIs) among healthcare
workers in Al-Ahsa, Saudi Arabia. The findings highlight the importance of comprehensive training programs,
proper sharps disposal practices, and the potential benefits of safety-engineered devices. Healthcare institutions can
use these results to guide the development and implementation of targeted NSI prevention strategies. The study also
emphasizes the need for continuous education and training, particularly for younger and less experienced healthcare
workers who may be at higher risk for NSIs.

Limitations of the Study:

1. The reliance on self-reported data may introduce recall bias, potentially affecting the accuracy of reported NSIs
and associated factors.
2. The study was conducted in a single region of Saudi Arabia, which may limit the generalizability of findings to
other healthcare settings or geographical areas.

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3. Underreporting of NSIs, especially among certain groups of healthcare workers, may have influenced the
results.
4. The study did not investigate some potential confounding factors, such as workload intensity or specific
workplace policies, which could impact NSI risk.

Although all these limitations, the results of the study are very important and need to be taken into consideration in
practice.

Conclusion of the Study:-

This study identifies several key factors associated with needle stick injuries among healthcare workers in Al-Ahsa,
Saudi Arabia. The findings underscore the protective effect of comprehensive training programs, including Basic
Infection Control Skills License, orientation programs, and workplace safety training. The study also highlights the
importance of proper sharps disposal practices and the potential benefits of certain safety-engineered devices.
Younger healthcare workers with less experience were found to be at higher risk for NSIs, suggesting a need for
targeted interventions for this group. These results provide a foundation for developing and implementing more
effective NSI prevention strategies in healthcare settings. Future research should focus on longitudinal studies to
establish causal relationships and evaluate the long-term impact of preventive measures.

Acknowledgments:-
We would like to thank all persons provide the data for us and everyone participated in the data collection.

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28. Smith, D. R., Mihashi, M., Adachi, Y., Nakashima, Y., & Ishitake, T. (2006). Epidemiology of needlestick and
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Appendix:
Figure 1:- Flowchart of participants recruitment in the study

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Table 1:- General characteristics of study health care workers groups, Al-Ahsa, Saudi Arabia.
Characteristics Group p-value
Control Case
No % No %
Age in years < 30 60 31.6% 92 48.4% .003*
30-39 98 51.6% 77 40.5%
40+ 32 16.8% 21 11.1%
Gender Male 39 20.5% 39 20.5% 1.00
Female 151 79.5% 151 79.5%
Nationality Saudi 126 66.3% 151 79.5% .004*
Non-Saudi 64 33.7% 39 20.5%
Work facility Hospital 181 95.3% 181 95.3% 1.00
PHCC 9 4.7% 9 4.7%
Department Surgery 34 17.9% 36 18.9% .995
Critical care / ER 70 36.8% 67 35.3%
Dental 13 6.8% 13 6.8%
Laboratory 10 5.3% 9 4.7%
Others 63 33.2% 65 34.2%
Job category Nurse 118 62.1% 118 62.1% 1.00
Technician 26 13.7% 26 13.7%
Doctor 46 24.2% 46 24.2%
Work years <3 43 22.6% 116 61.1% .001*
3-5 54 28.4% 31 16.3%
6-10 43 22.6% 26 13.7%
> 10 50 26.3% 17 8.9%
Working hours < 8 hours 111 58.4% 138 72.6% .004*
> 8 hours 79 41.6% 52 27.4%
Break time No 43 22.6% 22 11.6% .004*
Yes 147 77.4% 168 88.4%
Qualification Bachelor's degree 125 65.8% 141 74.2% .071
Diploma 42 22.1% 25 13.2%
Post-graduate 23 12.1% 24 12.6%
Marital status Single 61 32.1% 73 38.4% .431^
Married 124 65.3% 112 58.9%
Divorced 5 2.6% 5 2.6%
Smoking Smoker 11 5.8% 14 7.4% .535
Non-Smoker 179 94.2% 176 92.6%
Hepatitis B vaccination Completed vaccination 182 95.8% 186 97.9% .258^
Incomplete vaccination 3 1.6% 3 1.6%
Not vaccinated 5 2.6% 1 .5%
P: Pearson X2 test ^: Exact probability test
* P < 0.05 (significant)

Table 2:- Factors associate with needle stick injury among study health care workers, Al-Ahsa, Saudi Arabia.
Factors Group p- OR (95% AOR (95%
Control Case value CI) CI)
N % N %
o o
Training factors
Basic Infection Control Skills License 13 73.2 11 59.5 .005* 0.54 (0.35- 0.56 (0.36-
(BICSL) 9 % 3 % 0.83)* 0.91)*
Infection control course 13 71.1 11 61.1 .040* 0.64 (0.42- 0.66 (0.48-
5 % 6 % 0.98)* 0.99)*
Orientation Program 11 60.5 75 39.5 .001* 0.42 (0.28- 0.43 (0.29-

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5 % % 0.64)* 0.71)*
Training in workplace safety and health 10 54.2 60 31.6 .001* 0.39 (0.25- 0.41 (0.29-
3 % % 0.59)* 0.63)*
Undergraduate academic training 65 34.2 41 21.6 .006* 0.52 (0.33- 0.61 (0.41-
% % 0.84)* 0.96)*
Postgraduate academic training 54 28.4 44 23.2 .241 0.75 (0.48- 0.77 (0.51-
% % 1.20) 1.35)
Self-training 54 28.4 37 19.5 .041* 0.60 (0.37- 0.63 (0.41-
% % ^ 0.98)* 1.04)
General factors
Do you deal with contaminated items? 16 84.7 16 86.3 .662 1.1 (0.6-2.0) 1.4 (0.7-2.2)
1 % 4 %
Are you satisfied with the work? 17 90.5 16 85.8 .153 0.63 (0.33- 0.66 (0.39-
2 % 3 % 1.19) 1.25)
Did you have pre-employment training? 15 82.1 17 92.1 .004* 2.5 (1.3-4.8)* 2.7 (1.6-5.1)*
6 % 5 %
Do you use protective equipment properly? 18 99.5 18 97.9 .177 0.24 (0.03- 0.22 (0.02-
9 % 6 % 2.2) 2.1)
Do you suffer from chronic diseases? 23 12.1 26 13.7 .646^ 1.2 (0.63-2.1) 1.3 (0.66-2.4)
% %
Do you suffer from overwork and lack of 53 27.9 59 31.1 .500 1.2 (0.74-1.8) 1.4 (0.82-2.2)
concentration % %
Do you use any medicines or sedatives? 26 13.7 28 14.7 .769^ 1.1 (0.61-1.9) 1.3 (0.63-2.1)
% %
Have you suffered from previous accidents 24 12.6 59 31.1 .000* 3.1 (1.9-5.3)* 3.5 (2.1-5.8)*
other than NSI? % % ^
Are you aware of infection control policy? 18 96.3 18 96.3 1.000 1.0 (0.34-2.9) 1.0 (0.33-2.8)
3 % 3 %
OR: Crude odds ratio AOR: Adjusted odds ratio CI: Confidence interval
* P < 0.05 (significant)

Table 3:- Factors associate with needle stick injury among study health care workers, Al-Ahsa, Saudi Arabia,
continued).
Factors Group p- OR (95% AOR (95%
Control Case value CI) CI)
N % N %
o o
Environmental factors
Poor lighting 20 10.5 29 15.3 .168 1.5 (0.83- 1.4 (0.80-
% % 2.8) 2.4)
Poor ventilation 24 12.6 22 11.6 .753 0.90 (0.48- 0.91 (0.50-
% % 1.67) 1.71)
Noise 38 20.0 44 23.2 .454 1.2 (0.73- 1.1 (0.68-
% % 1.9) 1.8)
Bad workplace arrangement 39 20.5 44 23.2 .535 1.2 (0.71- 1.1 (0.70-
% % 1.9) 1.7)
Workplace factors
Device left on floor, table, bed or other 35 18.4 48 25.3 .107 1.5 (0.91- 1.4 (0.90-
inappropriate place % % 2.4) 2.2)
Item left on or near disposal container 30 15.8 26 13.7 .563 0.85 (0.47- 0.88 (0.61-
% % 1.5) 1.9)
Item protruding from opening of disposal 22 11.6 19 10.0 .620 0.84 (0.44- 0.88 (0.62-
container % % 1.6) 1.8)
Item pierced side of disposal container 12 6.3 13 6.8 .836^ 1.1 (0.48- 1.1 (0.49-
% % 2.5) 2.4)

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Item protruded from trash bag or inappropriate 11 5.8 13 6.8 .673^ 1.1 (0.52- 1.2 (0.62-
waste container % % 2.7) 2.6)
Inadequate needles, syringes and sharps 36 18.9 45 23.7 .260 1.3 (0.81- 1.4 (0.83-
equipment % % 2.2) 2.4)
Inadequate disposal containers 24 12.6 32 16.8 .247^ 1.4 (0.79- 1.6 (0.82-
% % 2.5) 2.9)
Disposal container filled above two third 19 10.0 31 16.3 .069^ 1.8 (0.95- 1.9 (1.0-
% % 3.2) 3.6)*
Purpose of Sharp Item use
Injection, intra-muscular/subcutaneous 14 74.7 13 71.1 .419 0.83 (0.52- 0.88 (0.62-
2 % 5 % 1.3) 1.6)
Heparin or saline flush (syringe) 10 54.7 74 38.9 .002* 0.52 (0.35- 0.62 (0.36-
4 % % 0.79) 0.81)
To connect IV line 11 60.5 96 50.5 .050* 0.66 (0.44- 0.69 (0.52-
5 % % 1.0) 1.03)
To Draw Blood Sample 11 57.9 11 58.4 .917 1.0 (0.68- 1.1 (0.71-
0 % 1 % 1.5) 1.9)
To place an Arterial/Central line 72 37.9 53 27.9 .038* 0.63 (0.41- 0.61 (0.39-
% % 0.97)* 0.87)*
Suturing 82 43.2 51 26.8 .001* 0.48 (0.31- 0.50 (0.36-
% % 0.74)* 0.82)*
Cutting 88 46.3 46 24.2 .001* 0.37 (0.23- 0.41 (0.29-
% % 0.57)* 0.69)*
Drilling 34 17.9 22 11.6 .082^ 0.60 (0.33- 0.63 (0.39-
% % 1.01) 1.11)
Electrocautery 23 12.1 13 6.8 .080^ 0.53 (0.26- 0.71 (0.29-
% % 1.1) 1.1)
During use of sharp item
Multi-step Procedure 86 45.3 75 39.5 .253 0.78 (0.52- 0.81 (0.55-
% % 1.2) 1.3)
Disassembling Device or Equipment 45 23.7 25 13.2 .008* 0.48 (0.28- 0.51 (0.31-
% % 0.83) 0.88)
Preparation for reuse of reusable instrument 36 18.9 34 17.9 .791 0.93 (0.55- 0.91 (0.52-
% % 1.6) 1.4)
Recapping used needle 45 23.7 53 27.9 .348 1.3 (0.78- 1.4 (0.79-
% % 1.9) 2.0)
OR: Crude odds ratio AOR: Adjusted odds ratio CI: Confidence interval
* P < 0.05 (significant)

Table 4:- Factors associate with needle stick injury among study health care workers, Al-Ahsa, Saudi Arabia,
continued).
Factors Group p- OR (95% CI) AOR (95%
Control Case value CI)
No % No %
Type of Device
Needle 16 88.4 17 93.7 .072 1.9 (0.9-4.0) 2.1 (1.1-4.3)*
8 % 8 %
Surgical instrument 13 73.2 11 60.0 .007* 0.55 (0.35- 0.61 (0.41-
9 % 4 % 0.84) 0.92)
Glass item 11 62.1 94 49.5 .013* 0.59 (0.39- 0.61 (0.41-
8 % % 0.89) 0.93)
Type of Needle
Disposable syringe 15 80.0 12 67.9 .007* 0.52 (0.33- 0.49 (0.29-
2 % 9 % 0.84) 0.79)
Pre-filled cartridge syringe 83 43.7 68 35.8 .116 0.71 (0.47- 0.73 (0.52-

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% % 1.01) 1.09)
Blood gas syringe (ABG) 11 60.0 82 43.2 .001* 0.50 (0.33- 0.52 (0.36-
4 % % 0.76)* 0.82)*
Needle on IV line 11 58.9 95 50.0 .080 0.69 (0.46-1.0) 0.73 (0.53-
2 % % 1.05)
Winged steel needle 44 23.2 38 20.0 .454 0.83 (0.50-1.3) 0.82 (0.49-1.3)
% %
IV catheter stylet 64 33.7 51 26.8 .147 0.72 (0.46-1.1) 0.70 (0.44-
% % 1.09)
Vacuum tube blood collection 42 22.1 31 16.3 .152 0.68 (0.41-1.2) 0.69 (0.42-1.2)
holder/needle % %
Spinal or Epidural needle 22 11.6 5 2.6% .001* 0.21 (0.07- 0.22 (0.1-
% 0.55)* 0.68)*
Unattached hypodermic needle 35 18.4 18 9.5% .012* 0.46 (0.25- 0.50 (0.29-
% 0.85)* 0.93)*
Arterial catheter introducer needle 29 15.3 14 7.4% .015* 0.44 (0.23- 0.41 (0.20-
% 0.86)* 0.81)*
Central line catheter needle 41 21.6 23 12.1 .014* 0.50 (0.28- 0.51 (0.28-
% % 0.87)* 0.89)*
Drum catheter needle 18 9.5% 14 7.4% .460 0.76 (0.36-1.6) 0.73 (0.32-1.4)
Surgical instrument
Lancet 78 41.1 38 20.0 .001* 0.35 (0.22- 0.33 (0.21-
% % 0.56) 0.48)
Suture needle 91 47.9 66 34.7 .009* 0.57 (0.38- 0.55 (0.33-
% % 0.87) 0.76)
Scalpel, reusable 52 27.4 26 13.7 .001* 0.42 (0.25- 0.44 (0.26-
% % 0.70) 0.75)
Razor Pipette (plastic) 14 7.4% 9 4.7% .282 0.62 (0.26-1.5) 0.60 (0.25-1.3)
Scissor 99 52.1 65 34.2 .001* 0.47 (0.32- 0.45 (0.30-
% % 0.72)* 0.69)*
Electro-cautery device 26 13.7 12 6.3% .017* 0.42 (0.20- 0.44 (0.25-
% 0.87)* 0.93)*
Bone cutter 19 10.0 11 5.8% .128 0.55 (0.25-1.2) 0.53 (0.22-1.1)
%
Bone chip 13 6.8% 9 4.7% .380 0.67 (0.28-1.6) 0.70 (0.30-1.8)
Towel clip 28 14.7 15 7.9% .035* 0.49 (0.26- 0.44 (0.21-
% 0.96)* 0.88)*
Microtome blade 16 8.4% 8 4.2% .092 0.47 (0.20-1.1) 0.46 (0.22-1.2)
Trocar 26 13.7 8 4.2% .001* 0.27 (0.12- 0.29 (0.14-
% 0.63)* 0.72)*
Vacuum tube (plastic) 24 12.6 9 4.7% .006* 0.34 (0.15- 0.33 (0.15-
% 0.76)* 0.74)*
Specimen/test tube (plastic) 32 16.8 17 8.9% .022* 0.48 (0.25- 0.51 (0.27-
% 0.91)* 1.02)
Fingernails/teeth 7 3.7% 3 1.6% .200 0.42 (0.10-1.6) 0.40 (0.09-1.4)
Scalpel, disposable 48 25.3 23 12.1 .001* 0.40 (0.23- 0.38 (0.20-
% % 0.70)* 0.67)*
Retractors, skin/bone hooks 19 10.0 15 7.9% .472 0.77 (0.38-1.6) 0.76 (0.38-1.5)
%
Staples/steel sutures 23 12.1 16 8.4% .237 0.66 (0.34-1.3) 0.68 (0.36-1.4)
%
Wire 21 11.1 13 6.8% .150 0.59 (0.28-1.2) 0.61 (0.31-1.3)
%
Pin 17 8.9% 9 4.7% .104 0.51 (0.22-1.2) 0.50 (0.21-1.2)

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Drill bit/bur 12 6.3% 10 5.3% .660 0.82 (0.34-1.9) 0.82 (0.33-1.9)

Pickups/Forceps/Hemostats/Clamps 48 25.3 24 12.6 .002* 0.42 (0.25- 0.44 (0.26-
% % 0.73) 0.81)*
Glass item
Medication ampule 99 52.1 69 36.3 .002* 0.52 (0.34- 0.50 (0.33-
% % 0.79)* 0.75)*
Medication vial 81 42.6 51 26.8 .001* 0.49 (0.32- 0.52 (0.33-
% % 0.76)* 0.79)*
Medication/IV bottle 88 46.3 54 28.4 .000* 0.46 (0.30- 0.46 (0.31-
% % 0.70)* 0.70)*
Pipette (glass) 13 6.8% 8 4.2% .262 0.59 (0.24-1.5) 0.60 (0.25-1.6)
Vacuum tube (glass) 16 8.4% 13 6.8% .562 0.79 (0.37-1.7) 0.82 (0.41-1.9)
Specimen/test tube (glass) 29 15.3 12 6.3% .005* 0.37 (0.18- 0.35 (0.16-
% 0.75)* 0.68)*
Capillary tube 11 5.8% 5 2.6% .125 0.44 (0.14-1.3) 0.47 (0.16-1.6)
Glass slide 18 9.5% 5 2.6% .005* 0.25 (0.09- 0.22 (0.06-
0.71)* 0.63)*
OR: Crude odds ratio AOR: Adjusted odds ratio CI: Confidence interval
* P < 0.05 (significant)

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