Volume 3,� Number 5,� March 2022 e-ISSN: 2797-6068 and p-ISSN: 2777-0915
THE RELATIONSHIP
OF NURSE'S COMPLIANCE TO INJECTION SOP AND THE NEEDLESTICK ACCIDENT IN
IRNA 2 SURGERY
|
KEYWORDS Compliance,
Injection Procedure, Needlestick Injury ARTICLE
INFO Accepted: March, 10th 2022 Revised: March, 13th 2022 Approved: : March, 14th
2022 |
ABSTRACT Needle stick injury is important problems in
occupational safety in global health environment. In fact there are still
occurrences of needle sticks that may be related to compliance. This study at
to determine relationship between nurse adherence on injection procedure with
needle sticks injury at IRNA 2 Bedah RSUD dr. Saiful Anwar Malang.
Descriptive analytic cross sectional involving 39 respondents selected by
purposive sampling technique. Data were collected with injection procedure
observation sheet and needle injury observation sheet. Data analysis used
correlation test with = 0.05. A total of 39 respondents, almost all of them
35 respondents or 89.7% had complied with Injection procedure and there was
still one incident of needle stick injury in respondent. Statistical test
results p value = 0.002 or p <0.05, there was a significant relationship
between injection procedure and needle sticks injury at IRNA 2 Surgery RSUD
Dr Saiful Anwar Malang. |
INTRODUCTION
Infectious diseases in hospitals are
considered a serious problem because they threaten occupational health and
safety health workers. In addition, the incidence of
infection also has an impact on the quality of health services and increased
financing for health services (Jannah, 2020). Health workers are at risk of being exposed to transmission
of infectious diseases (blood borne) such as HIV, Hepatitis B, and Hepatitis C,
originating from known or unknown sources of infection such as contaminated
objects, used syringes and other sharp objects (Siregar, 2020) .
The
incidence of needle sticks is one of the important problems in occupational
safety in the global health environment. Based on data from the World Health
Organization (WHO), more than 2 million health workers experience needle stick
accidents among 35 million health workers on duty every year, WHO statistical
data also reports that needle sticks are the cause of 16,000, 66,000, and 1000
cases of HCV, HBV, and HIV each year in health workers (Bouya et al., 2020) . Based on
data from the Centers for Disease Control and
Prevention (CDC) and the
European Agency for Safety and Health at Work (EU-OSHA) reported
more than 385,000 and 1,000,000 needle sticks every year in hospitals in the
United States and Europe. The
number of work accident cases is 24,910 cases with the number of occupational
diseases as many as 40,694 cases (Ministry of Health RI,
2018) . The incidence of needle sticks in Indonesia is
still relatively high, research results show 38-73% of health workers experience needle sticks (Kusnan, 2019) . The
incidence of needle sticks in East Java has not been found complete data, but
several large hospitals in East Java under the auspices of the East Java
Provincial Government such as the Haji Surabaya Hospital reported that for the
2010-2019 period, 22 cases of needle sticks were recorded for 10 periods (Kahayanti, 2020) . Based on
secondary data sources from the Infection Control Prevention Committee (PPI) of
needle stick cases at RSUD Dr. Saiful Anwar Malang in
2019 there was one nurse and one student who experienced needle sticks, and in
2020 there were no reports of needle stick exposure.
The most common accidents that occur
in health services are needle sticks, which are needles used by patients to
pierce the skin of a health care worker. (Mapanawang, Pandelaki
& Panelewen, 2018). Research shows that the average risk of
blood-borne virus transmission in needle stick accidents is 30% for the
Hepatitis B virus, 3% for the hepatitis C virus, and approximately 0.3% for the
HIV virus (Lubis, 2018) .
The causes of needle stick injuries
are injection, closing the syringe, taking blood or when removing the needle.
Most of these injuries occur in the ward or operating room area. The majority
(66.1%) of health workers recapped needles after use and the majority (98.3%)
stated that they used gloves for taking blood, after taking needles from
patients (97.4), and wearing gloves when manipulating sharp objects (95.4). %).
The factors behind the occurrence of needle stick injuries vary in each
workplace. Predisposing
factors, reinforcing factors,
enabling factors that influence a person's behavior in the Green model of
healthy behavior and lifestyle, such as compliance and injection safety, can be used as a basis for explaining the incidence of
needle stick injuries. (Kahayanti, 2020) . Paramedics on duty in hospitals are exposed
to the risk of needle stick injuries with the impact of infection, which
becomes an obstacle to work safety and health for them as well as the
responsibility of the hospital to ensure the safety and health of medical
workers.
The results of interviews with 10
nurses who were met by researchers at IRNA 2 Surgery at random showed that 70%
of nurses said they had never experienced a needle stick incident while in RSUD
Dr. Saiful Anwar Malang. Two nurses said splinters of an ampoule
while trying to break the glass ampoule packaging of the prescribed medication
had punctured them. One nurse had an incident of needle sticks while recaping or recapturing a patient's injection needle. The
results of more in-depth interviews conducted on the three nurses showed that
there was a human error factor when administering the injection. The nurse who was punctured by the ampoule admitted that she did not use
gloves when she tried to break the ampoule, while the nurse who was punctured
by the needle said that she tried to recapture the used needle with the
two-handed technique. All nurses agreed that adherence to the injection SOP was
very important to avoid needle sticks, but the results of observations from
researchers during the preliminary study found that two out of ten nurses still
did not perform the injection procedure according to the established SOP. Have
not applied the five-moment hand washing obediently and are also still doing
recapping on used needles, especially with inappropriate techniques.
The purpose
of this study was to determine the relationship between
nurses' adherence to the injection SOP with the incidence of needle sticks in IRNA 2 Surgery RSUD dr.
Saiful Anwar Malang.
METHOD
RESEARCH�������������������������������
The design used in this study is a cohort
study design, the selection of a cohort study considers the need for an
observational study to study the relationship between adherence and the
incidence of needle sticks by following up for a certain period so that it can be identified and calculated the magnitude of the
incidence of needle sticks.
The populations
in this study were all nurses who served in IRNA 2 Surgery RSUD Dr. Saiful Anwar Malang. in a period
of 2 months, namely in October and September 2021, totaling 39 respondents.
Meanwhile, the number of samples calculated based on the Slovin
formula was obtained as many as 39 patients with inclusion
criteria in this study were: willing to be respondents, nurses who were still
actively serving at IRNA 2 Surgery RSUD Dr. Saiful
Anwar Malang, a nurse who already has clinical authority to administer
injections to patients. The sampling is through purposive sampling method. The
test used is the Pearson correlation test if the data meets the assumption of
normality and the Spearman Rank correlation test if it does not meet the
normality assumption.���������
RESULT AND DISCUSSION
Research result
The
statistical results of respondents based on observations of needle stick events
are shown in the following table:
Table 1 Needlestick Incident
|
Needlestick Incident |
Frequency |
Percentage (%) |
|
Not |
38 |
97.4 |
|
Injected |
1 |
2.6 |
|
Total |
39 |
100 |
Source: Primary Data
(2021)
Based on the table 1 it
is known that from 39 respondents, almost all of them,
namely 38 respondents (97.4 %) did not experience injection. The following table
presents a cross tabulation between
the SOP injection compliance variables and the incidence of needle sticks.
Table 2 Cross Table
of Correlation of Injection
SOP Compliance with Needlestick Incidence.
|
Variable |
Needlestick Incident |
Total |
||
|
Not Punctured |
Needled |
|||
|
Injection SOP Compliance |
Not obey |
3 (7.7 %) |
1 (2.6 %) |
4 (10.3 % ) |
|
Obey |
35 (89.7 % ) |
0 (0%) |
35 (89.7 % ) |
|
|
Total |
38 (97.4 % ) |
1 (2.6 %) |
39 (100%) |
|
Source: Primary Data
(2021)
Based on table 2, it is
known that from 39 respondents, most of them, namely 35 respondents or 89.7%, were obedient in performing injections according to the
SOP and did not experience needle sticks, while 1 respondent (2.6%) experienced
needle sticks and did not comply with the injection SOPs. at IRNA 2 Surgery
RSUD Dr. Saiful Anwar Malang.
a.
Statistical Data Analysis
The
following table presents the results of the lambda
correlation analysis between motivational
variables and the implementation of early mobilization of respondents.
Table 3 Results of
Data Analysis of the Lambda Correlation of
Motivation with the Implementation of Early Mobilization
|
Statistic test |
coefficient (r) |
Significance (p) |
|
Lambda Correlation |
-
0.480 |
0.002 |
Source: Primary Data
(2021)
Based on table 3, it is
known that the lambda statistical
test results obtained a value of p = 0.002 or p < 0.05, which means H1 is accepted, so it can be interpreted that there is a significant relationship
between injection
SOP compliance with the incidence of needle
sticks in IRNA 2 Surgery RSUD Dr. Saiful Anwar Malang.
Lambda statistical
test results obtained correlation coefficient value or r = - 0.480. The value of r indicates
the close relationship between injection SOP compliance with the incidence of
needle sticks in the strong category. The correlation coefficient value is
negative, indicating that there is an inverse relationship between SOP compliance and the incidence
of needle sticks. The higher the level of compliance with the injection SOP,
the lower the incidence of needle sticks in IRNA 2 Surgery RSUD Dr Saiful Anwar Malang.
Discussion
��
Based on the
results of the study, it is known that from 39 respondents, almost all of them,
namely 35 respondents or 89.7% have complied with the Injection SOP. However,
there were still a small number of respondents; it is 4
respondents (10.3 %) who did not comply with the injection SOP.
The results of research conducted by Ahsan et.al (2019)
that there is a significant relationship between education level and compliance
in performing SOP Injection. The level of education correlates with the
level of adequate knowledge of the injection SOP. Knowledge possessed by nurses
is generally obtained through education that has been
undertaken. The higher the level of education, the wider the knowledge it has. Notoatmodjo (2019) also revealed that higher education will
make it easier for someone to accept new things and it will be easier for him
to adjust to it. Nurses are required to have comprehensive
knowledge/understanding of knowledge about injection instructions, correct
patient, correct drug, correct dose, correct route, correct time, following
injection guidelines, documentation of injection procedures and correct
documentation.
The researcher believes
that the results of further analysis
based on observations of injection SOP compliance show that the majority of
respondents have complied with all steps of the injection SOP stages. However,
there are still notes at the tool preparation stage. Some respondents did not
complete the availability of countermeasures or pads when taking action. At the
implementation stage, some respondents skipped the stages of attaching the
perlak and pedestal under the limb to be stabbed. In addition, there are some
respondents who also still skip the stage of throwing the syringe into the safety
box without recapping it, meaning that some respondents still do recapping
before the needle is thrown into the safety box.
The researcher believes that the high level of respondents'
compliance in carrying out SOP injections may be related to the factors of the
respondent's level of education and length of service. This is supported by
data on the education level of the majority of respondents from DIII Nursing,
almost half of them have completed their nursing education. Apart from
education level, the majority of respondents have more than three years of
working experience. The respondent's length of service of more than three years
indicates that the respondent's skill level has been adequate in terms of
nursing actions, especially injections.
Identify the incidence of needle sticks in IRNA
2 Surgery RSUD Dr. Saiful Anwar Malang
Based on research results it is known that out of 39 respondents, almost all 38 respondents
(97.4%) did not experience needle sticks. However, there was
still one respondent (2.6 %), who
had a needle stick.
Based on Kurniawati's research (2018), statistical tests obtained an r-value of 0.623,
which means that the younger the respondent is, the more at risk of work
accidents, and a p-value of 0.008 where the p-value is less than 0.05 so that
from these results it can be seen that there are the relationship between age
and the practice of applying SOPs and grades. Karsono (2018), states that young age affects work practices.
The younger age group is slightly less experienced in work than the older age
group. In Lawrence Green's theory, human behavior is
analyzed from the level of health. The health of a person or society is
influenced by two main factors, namely behavioral factors (behavior
causes) and factors outside of behavior (non-behavior causes).
Factors that influence a person's attitudes and practices can be influenced,
including: age, education, knowledge and the surrounding environment (Potter
& Perry, 2019).
The researcher argues
that based on further analysis, respondents who experienced needle stick
incidents were 26 years old. The age of 26 years is included in the category of
early adulthood. The respondent's age tends to be easy
compared to the average respondent. The results showed that the average age of the respondents was 40
years. Researchers
believe that age has an important influence on
the incidence of work accidents. The younger age group has a higher tendency to
experience work accidents than the older age group. This is caused by negligence and carelessness
regarding work accidents. The older a person gets, the more likely they are to
be thorough and experienced at work.
The results of further
analysis of the researchers found that respondents who experienced needle
sticks had a working period of less than three years. The incidence of needle
sticks may be
related to the nurse's tenure. Nurses who are placed in an
inpatient ward who have a working period of less than 5 years and have not
attended training have a higher risk of needle sticks. Researchers
believe that nurses who are at high risk for needle sticks generally have a high patient occupancy capacity, such as in Room 19 IRNA
II RSUD Dr. Saiful Anwar so that the workload of nurses, especially injection
procedures, is high, and most of the nurses who work are still relatively new (junior)
so the potential risk of work accidents with sharp objects is high. This can be
a matter of concern for the manager of nursing staff or HR in designing the
pattern of workforce in the room, there should be a balanced composition
between seniors and juniors as well as the need for ongoing coaching or
training on controlling the risk of work accidents, especially sharp object
injuries that have the potential to transmit several dangerous diseases
including HIV /AIDS.
An analysis of the
relationship of compliance with the incidence of needle sticks in IRNA 2
Surgery RSUD dr. Saiful
Anwar Malang
Based on the results of the study, it was found that out of 39 respondents, most
of them were 35 respondents or 89.7% were obedient in doing injections
according to the SOP and did not experience needle sticks. While 1 respondent
(2.6%) experienced needle sticks and did not comply with the injection SOPs. at
IRNA 2 Surgery RSUD Dr. Saiful Anwar Malang. The results of the lambda
statistical test obtained a p
value = 0.002 or p < 0.05, which means H1 is accepted, so it can be interpreted that there is a significant relationship
between injection
SOP compliance with the incidence of needle
sticks in IRNA 2 Surgery RSUD Dr. Saiful Anwar Malang. Lambda
statistical test results obtained
correlation coefficient value or r =
- 0.480. The value of r indicates the
close relationship between injection SOP compliance with the incidence of
needle sticks in the fairly strong category. The correlation coefficient value
is negative, indicating the close relationship between SOP compliance and the
incidence of needle sticks is inversely proportional. The higher the level of
compliance with the injection SOP, the lower the incidence of needle sticks in IRNA 2
Surgery RSUD Dr Saiful Anwar Malang.
Nugroho�s research (20 1 8) also shows that there is a significant relationship between the
practice of applying SOP injection and the incidence of needle stick
accidents. SOP is a procedure that
must be passed in a certain work process that can be accepted by someone who is
authorized or responsible for maintaining a certain level of appearance so that
activities are completed effectively and efficiently. In general, accidents in
nurses are exposed to needles. Therefore, it is necessary to strive to improve
SOP compliance while working.
Another evidence from research conducted by Pangalila et al (2017)
that needle stick accidents can occur, when a nurse is about to inject a
patient, and suddenly the patient moves spontaneously so that the tip of the
syringe that will be injected into the patient is only punctured by the nurse
herself. Besides that, it's vulnerable is when nurses do recapping (insert used syringes by hand into the
lid before throwing it away) resulting in needlestick injuries to nurses this
incident has happened a lot (Pangalila et al., 2017)
The researcher argues
that based on the data on the incidence
of needle sticks, it is related to child neglect take action to close the syringe (recapping) which
should be based on the latest SOP is not recommended to close (no recapping)
and immediately disposed of in the safety box. The incident caused injury or injury to the respondent. Hands are
often injured or injured because the type of work done by respondents in using
syringes requires a lot of compliance in the application of injection
SOPs. Syringes should be immediately disposed
of in a safety box or recapped using
the one-handed method, in order to avoid accidental needle sticks. The
researcher believes that there is a relationship between the practice of safe
injecting behavior and the incidence of needle stick injuries, meaning that the
less the application of safe injections, the more cases of needle stick
injuries will increase, this indicates a linear relationship between the two
variables. Based on the results of this study, if the officers, especially
nurses, are not careful or work not according to standard operating procedures,
the possibility of having a needle stick injury is also higher. The practice of
safe injecting behavior has an indicator that nurses do clear injections, which
can then provide protection to workers in health services, especially nurses.
CONCLUSION
Based on the results of the study, it can be concluded
as follows, almost all
respondents, namely 35 respondents (89.7 %) obeyed the Injection
SOP. Almost all respondents, namely 38 respondents (97.4%) did not experience
needle sticks. Lambda statistical test results obtained p value =
0.002 or p <0.05, which means that there is a significant relationship
between injection SOP compliance with needle stick events in IRNA 2 Surgery Dr
Saiful Anwar Hospital Malang. The value of the correlation coefficient or r = - 0.480, indicates
the close relationship between SOP injection compliance with the incidence of
needle sticks is inversely proportional in the fairly strong category.
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Copyright holders:
Adi Wiarto, Achmad Dafir Firdaus,
Sismala Harningtyas (2022)
First publication right:
Devotion -
Journal of Community Service
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