Implementation of needle stick injury prevention guidelines in tertiary healthcare settings of Karachi, Pakistan

Needle stick injuries (NSIs) are the most frequent form of occupational injury in hospitals worldwide and are largely responsible for the horizontal transmission of blood borne infections, such as Hepatitis B, C, and HIV. Pakistan government has a law called Hospital Waste Management Rules 2005 which has sections on the handling and disposal of sharps wastes in hospitals, but the law is rarely implemented. In the absence of a comprehensive government policy in Pakistan, hospitals are left to deal with NSI prevention on their own. There is a gap in the literature about why NSI prevention guidelines fail to be implemented in hospitals of Pakistan, as well as what factors facilitate their implementation. Objective: To explore the factors which influence the implementation of NSI prevention guidelines in hospitals of Karachi, Pakistan. Method: This was a qualitative exploratory study conducted in July-September 2015. The study settings were a public and a private sector hospital in Karachi. A total of 60 participants from both the staff (doctors, nurses and housekeeping) as well as administration of the hospitals were enrolled in 7 FGDs and 8 semi-structured interviews. The study participants came from a variety of departments in\u27the two hospitals, including emergency rooms, pathology labs, infection control, operation theatres and intensive care units. All interviews and FGDs were tape recorded and transcribed. Thematic data analysis was done using NVIVO 10 software. Results: Existence of an infection Control (IC) department, awareness and sensitization of staff towards dangers of NSI, enforcement of safety guidelines by the management, availability of safety equipment, use of safety-engineered sharps devices, interdepartmental cooperation with IC department, availability of data regarding NSIs, and reporting of NSIs were cited as facilitatory factors in the implementation of safety guidelines. Careless and irresponsible attitudes of staff, workload, shortage of human resource in IC, anomalies in hospital operations, inexperienced supervision of staff, and political backings of individuals were cited as barriers to implementation of safety guidelines in hospitals.Conclusion: There is a need to have a government policy for NSI prevention in hospitals. Although there are many factors which inhibit the effective implementation of NSI prevention guidelines in hospitals, these can be mitigated and implementation can be enhanced by utilizing more of the faciiitatory factors. Recommendations: Sensitization of both the management and staff of hospitals towards the hazards of NSTs is currently required in hospitals. Use of safety-engineered sharps devices should be encouraged in hospitals, and staff should be taken on board when making NSI prevention guidelines. Scattered roles pertaining to infection control should be integrated in the private sector hospital and a separate infection control department should be established in the public sector hospital. Key words: Needle Stick Injury, Occupational Injury Prevention, Blood-borne infection Transmissio