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                     KARNATAKA, BANGALORE

                                    ANNEXURE – II


1.    Name of the candidate and address   RAMITHA P. V.
      (in block letters)
                                          K. PANDYARAJAH BALLAL NURSING
                                          INSTITUTE COLLEGE OF NURSING
                                          SOMESHWAR ROAD, ULLAL
                                          MANGALORE – 575 020.

2.    Name of the Institution             K. PANDYARAJAH BALLAL NURSING
                                          INSTITUTE COLLEGE OF NURSING

3.    Course of Study and Subject         M. Sc. NURSING
                                          MEDICAL SURGICAL NURSING

4.    Date of Admission to the Course     12.12.2008

5.    Title of the study




6.   Brief resume of the intended work

            Needle stick injuries are a frequent occurrence among healthcare Nurses. 1 Needle

     stick injury is a result of an accident with a needle. Needle stick injury means a physical

     wound caused by needles, scalpel, scissors, when skin is accidentally punctured. These

     injuries can occur at any time, when people use, disassemble or dispose off needles. 2 The

     risk of accidental needle stick injuries is great during invasive procedures such as collection

     of blood and giving injections.3

     6.1    The need for the study

            According to WHO Bulletin 2003, 30% to 50% of all needle injuries occur during

     clinical procedures.4 The Centers for Disease Control (CDC), 2007 estimates that about

     6,00,000 to 10,00,000 needle stick injuries occur each year. Unfortunately, about half of

     these needle stick injuries go unreported.5 The American Nurses Association (ANA), 2007

     estimates that of the numerous needle stick injuries only about 1,000 healthcare workers

     actually contract an infection. Besides exposure to blood borne pathogens, the nurse is also

     at risk for about 20 other infections apart from blood borne pathogens, which can be

     transmitted through a needle stick, including tuberculosis, syphilis and malaria. When a

     nurse is exposed to a needle stick, the risk of transmitting various types of blood borne

     pathogens (HIV, Hepatitis B or Hepatitis C) from an infected patient to a health care worker

     is greatly increased.1 The Indian Journal of Medical ethics reported that the total number of

     needle stick injuries that an average nurse in India experiences is likely to be higher on

     account of absence of training and protective devices, thus increasing the total exposure to

     possibly infected blood or body fluids.2

       The researcher identified that there were many needle stick injuries among student

nurses, in which some were not reported. This is because of inadequate knowledge on

practice regarding handling and disposal of needles. Despite the growing body of

knowledge concerning needle stick injury, there has been little research focusing on needle

stick injury in the student population. So the researcher felt the need of conducting research

on knowledge regarding needle stick injuries among student nurses with a view to develop a

protocol on the prevention of needle stick injuries.

6.2    Review of literature

       A study was conducted in 2002 in Taiwan to describe the prevalence and

characteristics of needle stick injuries (NSI) in student nurses.        A self-administered

questionnaire was completed by 931 student nurses from 16 hospitals randomly selected

from the 132 accredited hospitals. The questionnaire was completed by 708 of 931 students

who were contacted for participation in this study. NSI during internship was reported by

61.9% (438/708) of students, of whom 14.2% (62/438) made a formal report. The majority

(70.1%) of NSI occurred in the patient’s room. Hollow-bored needles contributed to half

(219/438) of the NSIs of which 86.8% were syringe needles. Just over half (53.2%) of those

items involved in NSIs had been used on patients. Of the hollow-bored needles involved in

NSIs, 21.5% had been used on a patient with an infectious disease. Vaccination against

hepatitis B virus (HBV) was lacking in 47.6% of students.6

       A descriptive study was conducted in 2008 at Greenwood to determine the incidence

of needle stick injuries (NSI) among nursing students at a small liberal arts university, and

evaluates the circumstance around this situation. The study was conducted by 12 junior and

senior nursing students and their instructor. After giving informed consent, 99 of the 102

(97%) nursing students completed an online survey regarding NSI they had incurred and the

surrounding conditions. Students from the second semester forward were included in the

study because this is when exposure to the clinical hazards of NSI starts in this programme.

Of the students surveyed, nine reported having experienced a NSI. None of the NSIs were

reported to agency personnel. Findings suggest that annual education about the incidence,

risks and policies regarding NSI should be provided to both clinical instructors and nursing


       A cross sectional study was conducted in 1998-1999 in Pune to assess the

knowledge and awareness regarding risk of HIV transmission through accidental needle

stick injury (NSI) amongst the nursing students. The study was done amongst the first,

second and third year nursing students of the nursing school at Sassoon General Hospitals,

Pune. A majority of the 290 nursing students had attended HIV positive patients in the past.

Many of them had misconceptions regarding the risk of HIV infection through accidental

NSI (86%). A significant proportion of the first year students, i.e., 95 (89.6%) were not

aware of the correct method of disposal of disposable needles and syringes as against 18

(8.9%) of the third year students. Of the third year students, 74 (82.2%) said they would

encourage bleeding while 103 (97%) of the first year students said they would apply

pressure or bandage after an NSI. Two hundred and seventy-three (94.2%) of the students

said they would use soap, water and disinfectants to clean the injured area.3

       A cross-sectional study was conducted in 2004 at university teaching hospitals of

Shiraz, Iran; among medical, dental, nursing and midwifery students to determine the

frequency of needle stick injuries (NSIs) and the knowledge, attitude and practices of these

students regarding their prevention. The self administered questionnaire was completed by

688 (53%) students. 71.1% (489/688) of the students had NSIs that most commonly (43.6%)

occurred in patient rooms. 82% (401/489) of NSIs were not reported; 87.8% (604/688) of

the students received information about Standard Isolation Precautions and 86.2% Of them

had been vaccinated against Hepatitis B.7

       A non experimental descriptive study was conducted in 2008 at Gujarat “to develop

and validate a protocol related to needle stick injury (NSI) for staff nurses working in

selected hospitals”. Self reporting structured questionnaire consisting of 12 criteria

questions was used for knowledge assessment. Major findings of the study showed that NSI

was 83.05% whereas only 22.03% had been reported among which 11.86% had taken post

exposure prophylaxis. Incidence was cent percent in the casualty and 92.3% in the ICU.

This implied that maximum NSIs were in the areas where emergency treatment and

procedures are instituted. A factor contributing to negligence of NSI was lack of reporting


6.3    Statement of the problem

       “A study to assess the knowledge regarding needle stick injuries among student

nurses in selected nursing institutions of Mangalore with a view to develop a protocol on

prevention of needle stick injuries.”

6.4    Objectives of the study
1.     To assess the knowledge among student nurses on needle stick injury.

2.     To assess the prevalence of reported and unreported needle stick injuries.

3.     To compare level of the knowledge among different grades of nursing students.

4.     To prepare and validate a protocol related to needle stick injury.

6.5     Operational definitions

1.      Needle stick injury: In this study needle stick injury refers to a piercing wound

        from a needle or other sharp object like scalpel or scissors that may result in

        exposure to blood or other body fluids.

2.      Knowledge: In this study knowledge refers to the student’s correct responses

        regarding needle stick injuries.

3.      Student nurses: In this study student nurses refers to students those who are

        undergoing second and third year Diploma Nursing and second, third and fourth year

        B Sc Nursing in selected institutions of Mangalore.

4.      Protocol: In this study protocol refers to a written plan specifying the procedures to

        be followed in handling and disposal of needles and other sharp instruments in

        clinical settings.

6.6     Assumptions

        The present study assumes that student nurses will have minimal knowledge on

needle stick injuries.

6.7     Delimitations

        Present study will be delimited to student nurses in selected nursing institutions of


     6.8   Hypotheses

     H1:   There will be a significant difference in the level of knowledge on needle stick

           injuries among different grades of nursing students.

7.   Material and methods

     7.1   Source of data

           Data will be collected from student nurses in selected nursing institutions of


     7.1.1 Research design

           Descriptive study with non-experimental design will be used.

     7.1.2 Setting

           The study will be conducted in selected nursing institutions of Mangalore.

     7.1.3 Population

           Population selected for the study would comprise of student nurses in the selected

           institutions in Mangalore.

     7.2   Methods of data collection
     7.2.1 Sampling procedure

           Stratified random sampling.

     7.2.2 Sample size

           200 student nurses.

7.2.3 Inclusion criteria for sampling

     Second and third year diploma nursing and second, third and fourth year B. Sc.

      nursing students of selected nursing institutions of Mangalore.

     Students who are willing to participate in the study.

     Students who are present during the time of data collection.

7.2.4 Exclusion criteria for sampling

     First year diploma nursing and first year B. Sc. nursing students.

     Students who are not having clinical exposure.

7.2.5 Instruments intended to be used

1.    Demographic proforma.

2.    Knowledge questionnaire on needle stick injury.

7.2.6 Data collection method

      The researcher will obtain permission from authorities and the consent will be

      obtained from subjects. A self reporting structured questionnaire will be given,

      participants have to complete and hand them back to the researcher on the same day.

7.2.7 Data analysis plan

      Collected data will be analyzed using descriptive and inferential statistics. Mean,

      mean percentage, standard deviation and ANOVA will be used to analyze the

      knowledge scores.

7.3   Does the study require any investigations or interventions to be conducted on
      patients, or other animals? If so please describe briefly.

      No, the study does not require any investigations on patients, or other animals.

7.4   Has ethical clearance been obtained from your institution in case of 7.3?

      The permission to conduct the study is obtained from principal K. Pandyarajah

      Ballal Nursing Institute College of Nursing. The ethical committee consent of

      institution has also been obtained.

8.   References

     1.    Blackwell L, Bolding J, Cheely E, Coyle E, McLester J, McNeely E, et al. Nursing

           students' experiences with needle stick Injuries. Journal of Undergraduate Nursing

           Scholarship 2006;9(1).

     2.    Kataria J. A study to develop and validate a protocol related to needle stick injury

           for health team members (staff nurses) working in selected hospital. Nightingale

           Nursing Times 2008 Nov;4(8):34-44.

     3.    Bhat G, Patnaik B, Gupte A, Desai A. Knowledge and awareness amongst the

           nursing students regarding risk of HIV infection through accidental needle stick

           injury. Indian Journal of Community Medicine 2004;29(3):143-4.

     4.    Hutin Y. Best infection control practices for intradermal, subcutaneous and

           intramuscular needle injections. Bulletin of WHO 2003;81(7).

     5.    Centre   for   disease    control    &   prevention.   [online].    Available    from:


     6.    Shiao JS, McLaws ML, Huang KY, Guo YL. Student nurses in Taiwan at high risk

           for needle stick injuries. Annals of Epidemiology 2002;12(3):197-201.

     7.    Malekmakan L, Askarian M. The Prevalence of needle stick           injuries in medical,

           dental, nursing and midwifery students at the university teaching hospitals of Shiraz,

           Iran. Indian Journal of Medical Sciences 2006;60(6):227-32.

9.    Signature of the candidate

10.   Remarks of the guide

11.   Name and designation of (in block letters)

      11.2 Guide                           MRS. KANUMILLI VISALAKSHI
                                           ASSOCIATE PROFESSOR
                                           K. P. B. N. I., ULLAL,

      11.2 Signature

      11.3 Co-guide (if any)               MISS. KAINI CECILIA
                                           K. P. B. N. I., ULLAL,

      11.4 Signature

12    12.1 Head of the department          MRS. KANUMILLI VISALAKSHI
                                           ASSOCIATE PROFESSOR
                                           MEDICAL SURGICAL NURSING
                                           K. P. B. N. I., ULLAL,

      12.2 Signature

13.   13.1   Remarks of the Chairman and Principal

      13.2   Signature


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