ࡱ> [ bjbj 4ΐΐ^ >M$qqqqLLL]=_=_=_=_=_=_=$AC:=Q)LL))=qq=///)vqq]=/)]=//;h<qh", w);I==0> <|Ci,C <C<L2~!H/#%gLLL==.LLL>))))CLLLLLLLLL : RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION MR. BASIL K BABU I YEAR M. Sc NURSING MEDICAL SURGICAL NURSING, (2010 12 BATCH) SRI SHANTHINI COLLEGE OF NURSING #188/B, PARVATHI NAGAR, OPP: SUB REGISTRAR OFFICE, LAGGERE MAIN ROAD, LAGGERE, BANGALORE -560058 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION. 01  NAME OF THE CANDIDATE AND ADDRESSMR.BASIL K BABU 1st YEAR M.SC NURSING, SRI SHANTHINI COLLEGE OF NURSING #188/B,PARVATHI NAGAR, OPP:SUB REGISTRAR OFFICE, LAGGERE MAIN ROAD, LAGGERE,BANGALORE -560058. 02 NAME OF THE INSTITUTIONSRI SHANTHINI COLLEGE OF NURSING , #188/B,PARVATHI NAGAR, OPP:SUB REGISTRAR OFFICE,LAGGERE MAIN ROAD, LAGGERE, BANGALORE -560058. 03 COURSE OF THE STUDY AND SUBJECT MASTER DEGREE IN NURSING MEDICAL SURGICAL NURSING 04 DATE OF ADMISSION TO COURSE 30/06/2010 05 TITLE OF THE TOPICTHE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON PREVENTION OF NEEDLE STICK INJURIES AMONG GNM STUDENTS. 6. BREIF RESUME OF THE INTENDED WORK INTRODUCTION Reject your sense of injury and the injury itself disappears -Marcus Aurelious A needle stick injury is a  HYPERLINK "http://en.wikipedia.org/wiki/Percutaneous" \o "Percutaneous" percutaneous piercing wound typically set by a needle point, but possibly also by other sharp instruments or objects. Commonly encountered by people handling needles in the medical setting, such injuries are an  HYPERLINK "http://en.wikipedia.org/wiki/Occupational_hazard" \o "Occupational hazard" occupational hazard in the medical community. These events are of concern because of the risk to transmit  HYPERLINK "http://en.wikipedia.org/wiki/Blood-borne_disease" \o "Blood-borne disease" blood-borne diseases through the passage of the  HYPERLINK "http://en.wikipedia.org/wiki/Hepatitis_B" \o "Hepatitis B" hepatitis B virus (HBV), the  HYPERLINK "http://en.wikipedia.org/wiki/Hepatitis_C" \o "Hepatitis C" hepatitis C virus (HCV), and the  HYPERLINK "http://en.wikipedia.org/wiki/Human_Immunodeficiency_Virus" \o "Human Immunodeficiency Virus" Human Immunodeficiency Virus (HIV), the virus which causes AIDS. Despite their seriousness as a medical event, needle stick injuries have been neglected: most go unreported needle sticks have been recognized as occupational hazards.1 Needle stick injuries are a common event in the healthcare environment. When drawing blood, administering an intramuscular or intravenous drug, or performing other procedures involving sharps, the  HYPERLINK "http://en.wikipedia.org/wiki/Hypodermic_needle" \o "Hypodermic needle" needle can slip and injure the healthcare worker. This sets the stage to transmit viruses from the source person to the recipient. These injuries also commonly occur during needle recapping and as a result of failure to place used needles in approved  HYPERLINK "http://en.wikipedia.org/wiki/Sharps_container" \o "Sharps container" sharps containers. During surgery, a surgical needle may inadvertently penetrate the glove and skin of the surgeon or assistant. Penetrating accidents of the surgeon or assistant with the  HYPERLINK "http://en.wikipedia.org/wiki/Scalpel" \o "Scalpel" scalpel or other sharp instruments are also handled as a needle stick injury. Generally needle stick injuries cause only minor bleeding or visible trauma, however, even in the absence of bleeding the risk of viral infection remains. Scalpel injuries tend to be larger than a needle stick. In turn, a needle stick injury may also pose a risk for a patient if the injured health professional carries HBV, HCV or HIV. Needle stick injuries are not limited to the medical community. Any environment where sharps are encountered poses a risk. Needle stick injuries may occur not only with freshly contaminated sharps, but also, after some time, with needles that carry dry blood. While the infectiousness of HIV and HCV decrease within a couple of hours, HBV remains stable during desiccation and infectious for more than a week.1 While needle stick injuries have the potential of transferring bacteria, protozoa, viruses and prions, from a practical point the transmission of the  HYPERLINK "http://en.wikipedia.org/wiki/Hepatitis_B" \o "Hepatitis B" hepatitis B and  HYPERLINK "http://en.wikipedia.org/wiki/Hepatitis_C" \o "Hepatitis C" hepatitis C viruses and the  HYPERLINK "http://en.wikipedia.org/wiki/Human_Immunodeficiency_Virus" \o "Human Immunodeficiency Virus" Human Immunodeficiency Virus (HIV) is important The specific risk of a single injury depends on a number of factors when the patients harbor the virus of concern. Injuries with a hollow-bore needle, deep penetration, visible blood on the needle, a needle that was located in a deep artery or vein, or with blood from terminally ill patients are known to increase the risk for HIV infection.1 While the vast majority of needle stick injuries occur when the source-person does not carry the HBV, HCV, and HIV and thus do not carry a risk of infection, these events nevertheless cause stress and anxiety and signal a breakdown in protocol and prevention. Preventive steps can be taken at several levels and include reduction or elimination of use of sharps as much as possible, engineering controls (i.e. needles with safety devices), administrative controls including training and provision of adequate resources, and work practice controls; the latter may include using instruments (not fingers) to grasp needles, load scalpels, and avoiding hand-to-hand passing of sharp instruments. Engineering advances include the development of safety needles and  HYPERLINK "http://en.wikipedia.org/wiki/Needle_remover" \o "Needle remover" needle removers. The adherence to "no-touch" protocols that eliminate direct contact with needles in their use and disposal greatly reduce the risk of injury. In the surgical setting blunt-tip suture needles are able to reduce needle stick injuries. After a needle stick injury, certain procedures must be followed to minimize the risk of infection for the recipient. The affected area should be rinsed and washed thoroughly with soap. 2 6.1 NEED FOR STUDY Statistics from the US provide some insight into these occupational risks. Every year, healthcare workers experience between 6,00,000 and 8,00,000 exposures to blood-borne pathogens. The most serious and commonly transmitted pathogens are Hepatitis B and C virus (HBV, HCV) and the human immunodeficiency virus (HIV), the virus that causes AIDS. Each of these viruses poses a different risk if a healthcare worker is exposed. More than 20 other infections can be transmitted through needle sticks, including syphilis, malaria, and herpes. At least 1,000 healthcare workers are estimated to contract serious infections annually from needle stick and sharp injuries.4 As of June 2001, there were at least 57 CDC documented cases of healthcare workers with occupationally acquired HIV and at least 137 cases of possible transmissions. According to world health report 2002 published by WHO, needle stick injury is accountable for 40 per cent of Hepatitis B, 40 per cent of Hepatitis C, and 2 per cent of HIV infections. The Centers for Disease Control and Prevention (CDC) estimates that each year 3,85,000 needle sticks and other sharps related injuries are sustained by hospital based healthcare personnel.3 Based on various studies, researchers have documented that needle stick injuries are under reported by health care workers and the number of exposures could potentially be much higher (Hamory, 1983). Chiarello (1992) cites several studies that found rates of under-reporting between 40.4% and 53% for nurses and 92% for laboratory personnel. Physicians under reported needle stick injuries by 70% to 95%. All the above studies shows that needle stick injury is common. so there is need to teach the students regarding prevention of needle stick injury and its management.4 6.2 REVIEW OF LITERATURE Husoyam conducted a study on needle stick injury and reporting routines in Norwegian shows that health care workers transmission of blood-borne agents through percutaneous exposure. Reporting of sharps injuries is essential for instigation of adequate post-exposure prophylaxis and follow-up. We aimed at providing an account of number of sharps injuries reported by type of health care worker and the reporting systems used for injuries that have an inherent risk of transmitting blood-borne agents. On average, 210 sharps injuries are reported annually at Hauk eland University Hospital. In addition analyses of hepatitis and HIV linked to 159 sharps injuries that had not been reported otherwise, were requested annually. 51 % of sharps injuries were reported by nurses, 10 % by laboratory workers, 6 % by doctors and 33 % by others.5 Rajis conducted a study on on Guideline 'Needle stick injuries' risk assessment and post-exposure management in practice in Bithoven . The objective of the national guideline 'Needle stick injuries' is to make the assessment of needle stick injuries more structured and uniform. The injury is classified as high risk or low risk according to the volume of blood transmitted. For high-risk injuries measures to prevent hepatitis B, hepatitis C and HIV infection have to be considered, whereas for low-risk injuries only measures to prevent hepatitis B. The need for post-exposure prophylaxis is determined by the victim's immunity to hepatitis B and the presence of hepatitis B virus, hepatitis C virus or HIV in the source person. Post-exposure prophylaxis against hepatitis B consists primarily of hepatitis B vaccination; hepatitis B immunoglobulin is added in the case of a high-risk injury with a hepatitis B positive source or a source belonging to a risk group for hepatitis B. In high-risk injuries the victim is tested for hepatitis C and HIV transmission (except in case of a seronegative source). Antiretroviral post exposure prophylaxis is advised for high-risk injuries with a HIV seropositive source or a source belonging .6 Von Over Beck J Wess conducted a study on Needle stick accidents procedures following potentially infectious exposure in medical personnel in Bern (Germany)shows that exposure of blood carries with a definite risk for the health care worker of infection by various blood borne pathogens, especially the hepatitis B, hepatitis C, and human immunodeficiency virus. The risk of transmission from exposure to HIV is lower than that associated with exposure to HBV and HCV. Should HIV infection occur, however, the outcome is likely to be fatal. Although general infection control precautions, safer use of needles, gloves, and other procedures may substantially reduce the incidence of occupational exposures, they cannot eliminate the risk completely. The post-exposure management is discussed. Neither the efficacy nor the safety of AZT (zidovudine) for use as a chemo prophylactic agent following occupational exposures to HIV has been established. Nevertheless in selected cases it can be proposed to health care workers.7 Panuzio A conducted a study on biological fluid related accident amongst professionals working in calclinical laboratories in Maracaibo, Venezuelans. The occupational exposure biological medical technicians working in public clinical laboratories caused by accidental percutaneous contact, associated factors and compliance with post-exposure blood. This was a descriptive cross-sectional study. The sample consisted of 156 medical technicians assigned to clinical laboratories in the metropolitan area of Zulia state in Venezuela. Data was collected by applying an instrument for exploring exposure and related factors, as well as compliance with established post-biological exposure measures. There was evidence of exposure caused by percutaneous accidents, mainly represented by a moderate level of needle-pricks and cuts (2-3.99 mean). There was a moderate level of factors regarding percutaneous injury in the hands and fingers associated with hollow needles, blood and blood products and superficial severity in sample taking and processing areas when recapping needles or handling sharp or cutting objects. A medium level (2-3.99 mean) of compliance was obtained for post-exposure handling. A significant correlation was found (p<001) between percutaneous exposure and level of compliance with post-exposure. The study concluded that magnitude and characteristics of exposure to biological fluids detected in this work represents a problematic situation which can affect staff health and must be approached by institutions to ensure effective prevention management .8 Rev Salad conducted a study in 25 health care facilities in Gharbiya governorate to assess safe injection practices among health care workers (HCWs). Two questionnaires, one to collect information about administrative issues related to safe injection and the other to collect data about giving injections, exposure to needle stick injuries, hepatitis B vaccination status and safe injection training. Practices of injections were observed using a standardized checklist. The study revealed that there was lack of both national and local infection control policies and lack of most of the supplies needed for safe injection practices. Many safe practices were infrequent as proper needle manipulation before disposal (41%), safe needle disposal (47.5%), reuse of used syringe & needle (13.2%) and safe syringe disposal (0%). The study concluded that exposure to needle stick injuries were common among the interviewed HCWs (66.2%) and hand washing was the common post exposure prophylaxis measure (63.4%). Only 11.3% of HCWs had full course hepatitis B vaccination.9 Vazk conducted a study on prevalence of injuries and reporting of accidents among health workers at the University Hospital of the West Indies . This study investigated the knowledge, awareness and practices of health care workers towards universal precautions at the University Hospital of the West Indies. The aim of study prevalence of injuries experienced by health care workers, as well as incidence of accidents and compliance with post-exposure prophylaxis. A cross sectional survey was conducted in September and October 2007 Almost two-thirds (62.3%) of the respondents were aware of policies and procedures for reporting accidents while one-third (33.2%) were unsure. All nurses were aware of policies and procedures for reporting accidents, followed by medical doctors (88%) and medical technologists (61.2%). The majority (81.5%) of the respondents experienced splashes from bodily fluid. Over three-quarters of medical doctors (78%) and two-thirds of nurses (64%) reported having experienced needle stick injuries, while the incidence among medical technologists was remarkably lower (26%). The majority of the respondents (59%) experienced low accident incidence while just over one-tenth (14%) reported high incidence. Eighty four respondents reported needle stick injuries; just under two-third. The study concluded that majority of health care workers were aware of policies and procedures for reporting accidents. Splashes from body fluids, needle stick injuries and cuts from other objects were quite prevalent among health care workers. There is a need for monitoring systems which would provide accurate information on the magnitude of needle stick injuries and trends over time, potential risk factors, emerging new problems, and the effectiveness of interventions at The University Hospital of the West Indies and other hospitals in Jamaica.10 STATEMENT OF THE PROBLEM A Study To Assess The Effectiveness Of Structured Teaching Programme on Prevention Of Needle Stick Injuries Among GNM Students In selected Nursing Schools at Bangalore. 6.3 OBJECTIVES: To assess the knowledge regarding prevention of needle stick injuries in term of pre test score. To assess the knowledge regarding prevention of needle stick injury in term of post test score. To assess the effectiveness of structured teaching programme by comparing pre test and post test level of knowledge score. To determine the association between post test knowledge score and socio demographic variables such as age, sex, placement, .religion, type of family. 6.4 HYPOTHESIS: H1 The mean post test knowledge score of prevention of needle stick injuries is significantly higher than the mean pre test knowledge score by paired t test at 0.01 level. H2. There is significant association between the knowledge with selected demographic variables such as age, sex placement, religion, type of family by Chi square(2)test at 0.05 level. 6.5. VARIABLES: INDEPENDENT VARIABLES: Level of knowledge about the structured teaching programme regarding prevention of needle stick injuries. DEPENDENT VARIABLES: Structured teaching programme on prevention of needle stick injuries. 6.6. OPERATIONAL DEFINITIONS: EFFECTIVENESS: It refers to significant increase in the knowledge as determined by significant difference in pre test and post test knowledge score. STRUCTURED TEACHING PROGRAMME: It is a teaching programme or material preparing in English regarding prevention of needle stick injuries among the GNM students. PREVENTION: It is reserved for those interventions that occur before the initial onset of disorder. It is an act of hindering NEEDLE STICK INJURIES: It is a percutaneous piercing wound typically set by needle point but possibly also by other sharp instruments or objects. GNM : While completing courses through the school of nursing as graduate non matriculated students. STUDENTS: A learner who is enrolled in an educational institution. SCHOOL: Its an institution for learning for  HYPERLINK "http://www.definitions.net/definition/acquiring" acquiring  HYPERLINK "http://www.definitions.net/definition/knowledge" knowledge and mental training. 6.7. ASSUMPTION: The General Nursing And Midwifery students may not have knowledge regarding the prevention of needle stick injuries. 6.8 DELIMITATION: The study is delimitated to GNM students in selected nursing schools at Bangalore. 7. MATERIALS AND METHODS: 7.1 SOURCE OF DATA: Data will be collected from the GNM students in selected nursing school at Bangalore. 7.2 METHOD OF COLLECTION OF DATA: 7.2.1 RESEARCH DESIGN: Quasi experimental design. 7.2.2 RESEARCH APPROACH: Quantitative approach. 7.2.3 SETTING OF THE STUDY: Selected Nursing Schools at Bangalore. 7.2.4 POPULATION: GNM students. 7.2.5 SAMPLE SIZE: The total sample of the study consist of 75 GNM students. 7.2.6 SAMPLING TECHNIQUE: Simple Random Technique 7.2.7 SAMPLING CRITERIA: INCLUSION CRITERIA: GNM students those 1. Who are Studying in selected nursing schools in Bangalore 2. Who are able to read, write and speak English 3. Who are willing to participate in study EXCLUSION CRITERIA: GNM students those 1. Who are not willing to participate in study 2. who are not available during the period of data collection 7.2.8 DATA COLLECTION TOOL: The researcher develop a structured knowledge questionnaires. It consist of part-1 and part-2. Part-1: Selected demographic variables such as age, sex, placement, religion, type of family. Part-2: Knowledge questionnaires regarding prevention of needle stick injuries among GNM students. 7.2.9. METHOD OF DATA ANALYSIS: The data analysis through descriptive statistics and Inferential statistics. DESCRIPTIVE STATISTICS: Frequency, Mean percentage, standard deviation of demographic variables. INFERENTIAL STATISTICS: % paired  t test to compare the pre and post test knowledge score of 0.01 level. % Chi square (2) test will be used to find the association between the selected demographic variables and knowledge score of students. 7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR ANIMALS? -No- 7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION: Permission will be obtained from : ( The research committee of Sri Shanthini College of Nursing. 8. LIST OF REFERENCE: Mlder K. Dtsch Arztebl.Needle stick injury.2009.@ en.wikipedia.org/wiki/needle stick injury. Prss-stn A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am .J Ind .Med 2005; 48: 48290. @www.google.com Chalupa S, Markkanen PK, Galligan CJ, Quinn M. HYPERLINK "http://findarticles.com/p/articles/mi_qa4022/is_200803/ai_n25419744/pg_2/?tag=content;col1"  Needlestick and Sharps Injury Prevention:Are We Reaching Our Goals?" 2009.@www.google.com Klein SM, Foltin J, Gomella LG . Emergency Medicine on Call. New York2003.www.google.com Husoyam,mindeT,Knuden H,Tidsskr No Laegeforen,.Needle stick injury routines.2010 April:130(7),Nowerign. www .pubmed. gov. in Rujis WH,Timen .A Guidelines of needle stick injuries risk assessment and post exposure management in practices Ned Tijdschr Geneeskd. 2008 Sep 6; 152(36):1967-71. Review. Dutch. PMID: 18807333.www.pubmed.gov Von Overbeck J,Wess D Furrer H Needle stick accident procedure following potentially infectious exposure in medical personel In Geneva.www.pubmed.gov.in Panunzi,Nunez,Banboza M,Molero.Zambrano T, Fuentes B,Para.cepeda.Biological fluid related accidents amongst professional working in clinical laboratories in Maracaibo,Venezulea. www .pubmed.gov.in. Rev Salud Publication(Bogota)..Ismail NA, Ftouch A M,E I Shoubay W H. Safe injection practice among health workers Egypt Public health association 2005,80(5-6):563-83. www.pubmed.gov.in Vaz K,MC Growder D,Crawford T, Alexander.Lindo RL.,Irving R .Prevalence of injuries and reporting of accidents among health care workers at the university hospital in West Indies.2003. Joyce M Black,Jane Hokanson Hawks, Textbook of Medical Surgical Nsg .7th edition,published by J P Brothers.1999. Lippin cott Williams&Wilkins, Medical Surgical nsg 11th edition,published by Wolters Kluwer(India)Pvt Limited, New Delhi.2002. 9. SIGNATURE OF THE STUDENT : 10. REMARKS OF THE GUIDE : The study will help the G.N.M students to improve their knowledge regarding Prevention of needle stick injuries. 11. NAME AND DESIGNATION OF 11.1 GUIDE : Mrs. Nisa Associate Professor, 11.2 SIGNATURE : 11.3 HEAD OF THE DEPARTMENT : Mrs. Nisa Associate Professor, 11.4 SIGNATURE : 12. 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