Safety Science 44 (2006) 387394

www.elsevier.com/locate/ssci

The epidemiology of needle stick injuries among

health care workers in a newly developed country
Syed F. Shah a, Abdulbari Bener b,*, Saad Al-Kaabi c,
Abdul Latif Al Khal c, Soji Samson b
a

Communicable Disease Control and Prevention, Hamad General Hospital,

Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
b
Department of Medical Statistics and Epidemiology, Hamad General Hospital,
Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
c
Department of Medicine, Hamad General Hospital, Hamad Medical Corporation,
P.O. Box 3050, Doha, Qatar
Received 26 May 2005; received in revised form 17 October 2005; accepted 11 November 2005

Abstract
Objective: The main objective of the study is to characterize the epidemiology of needle-stick injuries (NSI) of health care workers (HCWs) working at Hamad Medical Corporation, Doha.
Design: This is a prospective descriptive study among the health care workers on the details of
needle stick injuries in the year 2001.
Setting: 1357-bed three tertiary hospitals of the Hamad Medical Corporation, Doha, Qatar.
Subjects and methods: During the year 2001, a survey was carried out among health care workers
working in the three tertiary care hospitals. Of the 1274 HCWs who were approached to participate in
this study, 1022 workers responded to the questionnaire on needle stick injury with a response rate of
80.2%. Face to face interviews were conducted on the recruited subjects based on a questionnaire that
included variables on age, socio-demographic status and immunization history of studied subjects.
Results: Of the total studied subjects (1022), 214 studied subjects (20.9%) were victims of the needle
stick injuries. 911 HCWs (89.1%) from the total had been vaccinated against hepatitis B (HBV). Higher
percentage of sharp injuries occurred among 148 female HCWs (69.2%) than males (30.8%). Percentage of incidence of sharp injuries occurred were more among 10 specialists (25%) and 10 residents
(25%) than consultants (12.5%). The highest incidence of episodes of needle stick injuries occurred
in the area of specialty such as 28 workers in medicine (13.1%), 20 in laboratory (9.3%) and 19 in

Corresponding author. Tel.: +974 439 3765/3766; fax: +974 439 3769.
E-mail addresses: abener@hmc.org.qa, abaribener@hotmail.com (A. Bener).

0925-7535/$ - see front matter  2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ssci.2005.11.002

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S.F. Shah et al. / Safety Science 44 (2006) 387394

emergency (8.9%) followed by 17 in pediatric (7.9%). 195 of 214 HCWs (91.1%) who had sharp injuries
had taken HBV vaccination. But, the rest of the 19 HCWs (8.9%) had neglected HBV vaccination.
Conclusion: The present study revealed that sharp injuries constitute a considerable proportion of
NSI incidents (21%) and could pose the greatest risk of blood borne virus transmission. It could be
the reason that the HCWs fully knew of the risk but impediments to prevention of NSIs exist. This
could be a topic for further research in the future.
 2005 Elsevier Ltd. All rights reserved.
Keywords: Needle stick injury; Prevalence; Health care workers; Prevention; Qatar

1. Introduction
Health care workers (HCWs) who have occupational exposure to blood are at increased
risk for acquiring blood-borne infections. The level of risk depends on the number of patients
with that infection in the health care facility and the precautions the health care workers
observe while dealing with these patients. There are more than 20 blood-borne diseases,
but those of primary signicance to health care workers are hepatitis due to either the hepatitis
B virus (HBV) or hepatitis C virus (HCV) and AIDS. Results of a study on the epidemiology
of needle stick injuries (NSI) among HCW in two German hospitals indicate that 500,000 NSI
occur annually in Germany (Hofmann et al., 2002). The gures mentioned in many studies
suggest that a sizable number of individuals are at potential risk for transmission of bloodborne diseases to doctors, nurses, laboratory technicians and other health care workers.
The HCWs who are exposed to needles in their clinical activities are at increased risk of
acquiring needle stick injury which may lead to serious or fatal infections with blood-borne
pathogen infections. The potential risk and transmission of blood borne viruses to health
care workers (HCW) through needle stick injury (NSI) led to a universal attention on
the prevention of such incidents, reported by several authors (Whitby and McLaws,
2002; Mallon et al., 1992; Bowden et al., 1993; Jagger et al., 1995). The frequency and nature of injury with dirty hollow-bore needles experienced by HCW in Australian hospital
practice were last published almost a decade ago (Mallon et al., 1992; Bowden et al.,
1993). However, more recently, needle concern has turned to the dangers of injuries to
members of the public due to discard needles (Whitby and McLaws, 2002). Furthermore,
there is intense lay and political concern over the needle stick injuries. In fact, these injuries
are uncommon and regarded as lower risk than those sustained by HCW (Philipp, 1993;
Gerrand, 2000; Whitby et al., 1991; Gershon et al., 1999; Mast et al., 1993).
The aim of the study was to determine the incidence of needle stick injury cases among
HCWs working in hospitals in the state of Qatar. This study was also done to nd out the
factors that might be associated with the occurrence of this problem. The factors were
socio-demographic, duration of exposure, history of HBV immunization and the past
medical history of the respondents.
2. Subjects and methods
A prospective study was conducted in the year 2001 among HCWs working in the three
hospitals of the Hamad Medical Corporation. The study was based on the 1357 bedded
three tertiary care hospitals. These three hospitals provide comprehensive medical services

S.F. Shah et al. / Safety Science 44 (2006) 387394

389

to the whole population of the State of Qatar. The survey was conducted among health
care workers. Of the total 1022 HCWs, 163 physicians, 686 nurses 155 lab technicians
and 18 other HCWs from dierent departments of the hospitals were surveyed. These
HCWs are normally directly exposed to blood products and needle stick injuries while
dealing with patients.
Data about needle stick injuries reported from the hospitals were collected through specially designed questionnaires. The questionnaire and criteria for needle stick injuries were
dened and developed by the primary investigator. The survey was based on standardized
interviews performed by trained social workers and nurses. HCWs have been grouped into
two classes clinical (medical and nursing) and laboratory sta.
The participants were interviewed by social workers and nurses and collected the information based on the questionnaire. The rst part of the questionnaire contained information on socio-demographic data, job category and duration of exposure and the second
part contained the history of HBV-immunization.
Data are expressed in frequencies, mean and standard deviation (SD). In 2 2 tables,
the Fisher exact test (two tailed) was used instead of v-square when the sample size was
small. The level p < 0.05 was considered as the cut-o value for signicance.
3. Results
Table 1 shows some socio-demographic characteristics of the studied HCWs by gender.
Of the 1022 HCWs, 270 (26.4%) were males and 752 females (73.6%) in the age group 25
65 years and their mean age was 39.1 8.2 years old. The majority of the HCWs who participated in this study were Asians (50%), and then Arabs (32%) followed by Qataris
(14%). Most of the participants were nurses (67.1%), followed by physicians including dentists (15.9%) and lab technicians (15.2%).
Table 2 shows the distribution of socio-demographic characteristics of subjects by who
had sharp injuries and not. 214 subjects (20.9%) had a history of needle stick injury and of
those 65.4% were nurses, 23.4% physicians including dentists and 10.7% lab technicians.
Percentage of incidence of sharp injuries occurred were more among specialists (25%)
and residents (25%) than consultants (12.5%). The highest incidence of episodes of needle
stick injuries occurred in the area of specialty such as in medicine (13.1%), laboratory
(9.3%) and emergency (8.9%) followed by pediatric (7.9%).
The study showed there were no signicant dierences between the workers who had
injuries and not in socio-demographic factors of the studied subjects. The only factor that
was identied as an associated factor in the occurrence of needle stick injury was their profession in which there was a signicant dierence found among the profession of the subjects who had sharp injuries and who had not (p < 0.01).
Table 3 shows the history of HBV immunization in subjects. 911 subjects (89.1%) had
been vaccinated against HBV. 91.1% of the HCWs who had sharp injuries had taken HBV
vaccination. But, 8.9% of the HCWs neglected HBV vaccination. This could be due to the
lack of knowledge on hazards of needle stick injuries.
4. Discussion
The study showed that all the HCWs involved in this study were exposed to the risk of
exposure to blood-borne diseases such as HIV and AIDS, hepatitis B and hepatitis C

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Table 1
Distribution of socio-demographic data of subjects by gender
Description

Male
N = 270,
n(%)

Female
N = 752,
n(%)

Total
N = 1022,
n(%)

Age

41.9 8.8

38.1 7.8

39.1 8.2

Age group
<25
2534
3544
4554
>54

2(0.7)
57(21.1)
105(38.9)
80(29.6)
26(9.6)

15(2.0)
250(33.2)
319(42.4)
153(20.3)
15(2.0)

17(1.7)
307(30.0)
424(41.5)
233(22.8)
41(4.0)

Nationality
Qatari
Non-Qatari

25(9.3)
245(90.7)

116(15.4)
636(84.6)

141(13.8)
881(86.2)

Marital status
Currently single
Currently married

29(10.7)
241(89.3)

150(19.9)
602(80.1)

157(17.5)
843(82.5)

Profession
Doctor
Dentist
Nurse
Lab technician
Others

84(31.1)
14(5.2)
109(40.4)
59(21.9)
4(1.5)

44(5.9)
21(2.8)
577(76.7)
96(12.8)
14(1.9)

128(12.5)
35(3.4)
686(67.1)
155(15.2)
18(1.8)

Profession rank (physicians only)

Consultant
Specialist
Resident

11(13.1)
15(17.9)
58(69.0)

1(2.3)
10(22.7)
33(75.0)

12(9.4)
25(19.5)
91(71.1)

Area of speciality
Surgery
Medicine
Maternity
Paediatric
Laboratory
Emergency room
Operating room
ICU/CCU
OPD
Others

17(6.3)
42(15.6)
6(2.2)
19(7.0)
31(11.5)
23(8.5)
12(4.4)
9(3.3)
14(5.2)
97(35.9)

57(7.6)
90(12.0)
33(4.4)
120(16.0)
70(9.3)
39(5.2)
28(3.7)
20(2.7)
51(6.8)
244(32.4)

74(7.2)
132(12.9)
39(3.8)
139(13.6)
101(9.9)
62(6.1)
40(3.9)
29(2.8)
65(6.4)
341(33.4)

through needle stick injury since all of them perform procedures involving needles on
patients in their routine clinical activities. The data showed the incidence of needle stick
injury among the HCWs who were available to participate at the time of this study was
31/100 doctors, 29/100 dentists, 20/100 nurses and 15/100 lab technicians. Moreover,
some of them have not yet received hepatitis B immunization and for those who had
incomplete doses of the vaccine were not fully protected from infection by this virus.
89% of the subjects had received vaccination against HBV. It shows a hospital-wide hepatitis immunization program is available to encourage the HCWs.
Additionally, health education through media, audio-visual and educational posters
that may increase awareness of HCW. Orientation training and reinforcement education

S.F. Shah et al. / Safety Science 44 (2006) 387394

391

Table 2
Distribution of socio-demographic characteristics of subjects by Needle-stick injury
Description

Needle stick injury

Total
N = 1022,
n(%)

Yes
N = 214,
n(%)

No
N = 808,
n(%)

40.0 7.8

38.9 8.3

39.1 8.2

2(0.9)
53(24.8)
93(43.5)
60(28.0)
6(2.8)

15(1.9)
254(31.4)
331(41.0)
173(21.4)
35(4.3)

17(1.7)
307(30.0)
424(41.5)
233(22.8)
41(4.0)

Nationality
Qatari
Non-Qatari

34(15.9)
180(84.1)

107(13.2)
701(86.8)

141(13.8)
881(86.2)

Gender
Male
Female

66(30.8)
148(69.2)

204(25.2)
604(74.8)

270(26.4)
752(73.6)

Marital status
Currently single
Currently married

43(20.1)
171(79.9)

136(16.8)
672(83.2)

179(17.5)
843(82.5)

Professiona
Doctor
Dentist
Nurse
Lab technician
Others

40(18.7)
10(4.7)
140(65.4)
23(10.7)
1(0.5)

88(10.9)
25(3.1)
546(67.6)
132(16.3)
17(2.1)

128(12.5)
35(3.4)
686(67.1)
155(15.2)
18(1.8)

Profession rank
Consultant
Specialist
Resident
Health professional

5(12.5)
10(25.0)
10(25.0)
15(37.5)

7(8.0)
15(17.0)
41(46.6)
25(28.4)

12(9.4)
25(19.5)
51(39.8)
40(31.3)

Area of speciality
Surgery
Medicine
Maternity
Paediatric
Laboratory
Emergency room
Operating room
ICU/CCU
OPD
Others

14(6.5)
28(13.1)
7(3.3)
17(7.9)
20(9.3)
19(8.9)
12(5.6)
8(3.7)
12(5.6)
77(36.0)

60(7.4)
104(12.9)
32(4.0)
122(15.1)
81(10.0)
43(5.3)
28(3.5)
21(2.6)
53(6.6)
264(32.7)

74(7.2)
132(12.9)
39(3.8)
139(13.6)
101(9.9)
62(6.1)
40(3.9)
29(2.8)
65(6.4)
341(33.4)

Age
Age group
<25
2534
3544
4554
>54

p < 0.01.

were conducted in some countries to reduce the risk and hazard needle stick and sharp
injury (Mast et al., 1993; Gerberding, 1994; Cooley and Gabriel, 2004; Naing et al.,
1999; Kotwal et al., 2004; Edmond et al., 1988; Makofksy and Cone, 1993; Corbett,
2004; Reason, 2000; Jagger et al., 1990). One possibility of reducing risk might be physical

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Table 3
History of HBV immunization and past history of subjects by needle-stick injury
Description

Needle stick injury

Total
N = 1022,
n(%)

Yes
N = 214,
n(%)

No
N = 808,
n(%)

Received vaccination against HBV

195(91.1)

716(88.6)

911(89.1)

Status of HBV vaccination

Completed regular
Completed discontinued doses
Completed only one dose
Completed two doses
Not taken any dose

156(72.9)
10(4.7)
15(7.0)
14(6.5)
19(8.9)

557(68.9)
38(4.7)
41(5.1)
80(9.9)
92(11.4)

713(69.8)
48(4.7)
56(5.5)
94(9.2)
111(10.9)

intervention of a recapping device (Mast et al., 1993; Gerberding, 1994) to allow safe
recapping as an alternative to immediate disposal. Also, there could be approved sharp
bins in areas of clinical activity and on trolleys wheeled to the bedside to facilitate immediate needle disposal (Whitby and McLaws, 2002; Edmond et al., 1988; Corbett, 2004).
Some strategies can be made in a certain areas of improvement concerning reducing risk
and hazardous such as recapping and probably increasing knowledge in nurses of the possible outcome of blood borne virus infection (Whitby and McLaws, 2002; Gerberding,
1994). Overall, multiple safety devices have been developed and variable eects have been
reported very widely (Younger et al., 1992; Yassi et al., 1995; Kaushik, 2004; Orenstein
et al., 1995; Perry et al., 2004; Sinclair et al., 2002).
Finally, introduction of safety devices should not simply be an emotional response to
health care worker concerns, but must be shown to have proven ecacy and must be
accompanied by a cost containment strategy.
Study combined from more than 20 prospective studies worldwide of the health care
workers exposed to HIV infected blood through percutaneous injury revealed an average
transmission rate of 0.3% per injury (Gerberding, 1994) .The incidence of episodes of needle stick injury among the HCWs in Qatar was little bit high (21%). It was not possible to
compare the results on case and incidence with other studies because there was no study
conducted on NSI in the past in the State of Qatar.
Some guidelines which were set out by NIOSH (Jagger et al., 1995) of the USA in order
to reduce the risk of needle stick injury are to eliminate the use of needles if possible, otherwise to implement the use of devices with safety features through engineering control. An
increasing number and variety of needle devices with safety features are now available.
Health care workers can help the employer in the selection and evaluation of such devices.
Also, it is important to nd out whether HCWs knew about new needles safety devices. It
is the responsibility of the employers to provide safe devices and working conditions to
HCWs to protect their own safety and health.
Some possible cost-eective interventions to prevent occupational exposure to blood
borne diseases among HCWs include educational seminars, preparation of patients before
procedures to reduce unexpected patient movement and also formulating an infection control committee (Hofmann et al., 2002; Perry et al., 2004).
This study revealed that HCWs especially nurses in Qatar were at risk of needle stick
injury during their clinical practice which puts them at higher risk of blood borne infection

S.F. Shah et al. / Safety Science 44 (2006) 387394

393

because the incidence of cases and episodes tend to increase. In Qatar, nurses had the highest incidence of NSIs because nurses use needles more in administering drugs than the
other professions. Also, HCWs in the age group (3544) of each profession such as nurses,
dentists, and lab technicians experienced more needle stick injuries than the other age
groups except physicians in the age group (4554). The data provided some important epidemiological aspects of needle stick injuries among HCWs of Hamad Medical Corporation, Qatar. This study is a salient reminder of the importance of the introduction of
safety instruction and prevention program in safe needle handling techniques for HCWs.
There is a plan to conduct a further study to investigate the needle stick injuries by type of
needles, assess the adequate knowledge of new needle devices and safety features, and circumstances associated with NSI.
5. Conclusion
The present study revealed that sharp injuries constitute a considerable proportion of
NSI incidents (21%) and could pose the greatest risk of blood borne virus transmission.
It could be the reason that the HCWs fully knew of the risk but impediments to prevention
of NSIs exist. This could be a topic for further research in the future. It outlines precautions to be taken when dealing with blood and body uids. Educational talks or lectures
should be given to HCWs on hazards and prevention to needle stick injuries as well as
acquiring and installing sharp disposal bins.
Acknowledgements
This work would not have been possible without the cooperation of the study participants and the sta of Preventive Health Care Department and Hamad Medical Corporation. The authors would like to thank Mr. Othman Al-Khidir and Mr. Abdulaziz
Farooq of the Medical Statistics Department for data entry and their help.
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