Identifying, preventing and controlling needle-stick injuries in Indonesia

The main objective of this dissertation is to develop recommendations for prevention of needle stick injuries in Indonesia, especially in healthcare settings. In order to address this objective, the following specific aims were proposed: 1) calculate incidence of needle stick injuries (NSIs), and identify individual and institutional risk factors; 2) assess the burden of sharps injuries (SIs) in free standing medical laboratories (FSLs) and describe the responses of FSLs following an SI; 3) conduct a meta-analysis to produce quantitative summary estimates of the effectiveness of NSI- interventions from the published literature; and 4) estimate the number of Indonesian HCWs infected by HBV due to NSIs.;Results of Aim 1. This research determined that the incidence rate of NSIs among HCWs on the principal Indonesian islands of Java and Bali was 0.43 per worker/year. A number of risky behaviors and practices were reported by HCWs and found to increase the risk of NSI. These included leaving used needles scattered inside the workplace and disposing used needles into public trash cans, burning or burying them. The risk of NSI was found to increase with the number of injections given per day, and there was evidence that this trend was not linear but that there was a lower risk for an intermediate workload of two to eight injections per day.;Results of Aim 2. FSLs use a variety of quality assurance procedures to control their work. Of 741 FSLs included in this analysis, 106 (14.3%) reported sharps injuries in the previous year. Of these, only 42.5% said that they "reported" the SI to the appropriate authority within their own healthcare organization. About one third (33.7%) said that they made a formal written record of the SI occurring, and nearly 40% said that they conducted an evaluation of the event to learn how to prevent future occurrences. Two factors that were significantly associated with the evaluation response following an SI were having a standard operating procedure (SOP) following an SI and routinely conducting quality audits with follow up activities.;Results of Aim 3. A systematic review of the peer reviewed medical literature revealed that introduction of safety engineered devices (SEDs) combined with training was associated with greater protection than training interventions alone. The summary random effects of the training intervention was 0.66 (95% CI = 0.50 to 0.89). The summary random effects across the five studies that assessed the efficacy of SEDs was 0.51 (95% CI --- 0.40 to 0.64). There were eight studies evaluating the effectiveness of training plus SEDs, with a summary random effects of 0.38 (95% CI = 0.28 to 0.50).;Results of Aim 4. Using a standard disease simulation model, we estimated that there were 4,899 (95% CI; 2,141-8,282) cases of HBV caused by NSIs among Indonesian HCWs in 2013. These cases were in addition to an expected annual incidence of 2,225 (95% CI; 2,089-2,357) additional cases from all other sources. Two strategies for reducing this burden are discussed: increasing HBV vaccination protection (currently only 37%) to 90% could decrease the number of NSI-acquired HBVs cases from 4,899 to about 1,000, while reducing the rate of NSIs (currently 0.43 per worker/year) through the widespread introduction of SEDs and standard precaution would reduce NSIs by 62%.