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Indian Journal of Community Medicine

Knowledge and Awareness amongst the Nursing Students Regarding Risk of HIV Infection Through Accidental Needlestick Injury

Author(s): Geeta Bhat, Bandana Patnaik, Asha Pratinidhi, Anagha Gupte, Anuja Desai

Vol. 29, No. 3 (2004-07 - 2004-09)


Objectives: To assess the knowledge and awareness regarding risk of HIV transmission through accidental needlestick injury amongst the nursing students.

Study design: Cross-sectional.

Setting: College of nursing attached to a tertiary care hospital.

Participants: First, Second and Third year nursing students.

Study variables: Knowledge, Awareness.

Statistical Analysis: Chi-square test.

Results: A majority of the 290 nursing students had attended HIV positive patients in the past. Many of them have misconceptions regarding the risk of HIV infection through accidental needlestick injury (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 a needlestick injury. 273 (94.2%) of the students said they would use soap, water and disinfectants to clean the injured area.

Conclusions: There is an urgent need of correcting the existing misconceptions through educational programmes early in the course and providing supportive institutional policies.

Key words: HIV transmission, needlestick injury


AIDS is making new demands on the health services and the competence of health workers. The nursing staff plays a major role in looking after the diagnostic needs, therapeutic help and psychological support of the patients1. The nursing students share this responsibility especially in the overcrowded Government hospitals. They are mainly responsible for collection of blood, administration of oral and injectable drugs, preparing bed, sending laundry, collection and sending laboratory specimens etc.

The risk of accidental needlestick injuries is great during invasive procedures such as collection of blood and giving injections.

There is confusion regarding correct responses to such accidents both at the administrative levels where policy decisions for institutions are to be made as well as amongst the nursing staff and students themselves who are not aware about the preventive aspects and of the immediate propylactic steps to be taken in case of such accidents.

There is an urgent need to develop a coordinated approach for the provision of information, support and referral for health care workers who sustain occupationally related needlestick injuries. Assessment of exposures and initial management of occupational exposures varies between institutions and often reflects the level of staff education and previous experience in areas of infection control and transmission of blood borne diseases2.

Thus the amim of an present study was to assess the knowledge and awareness amongst the nursing students regarding the risk of HIV infection after an accidental needlestick injury and to make relevant suggestions.

Material and methods:

A cross-sectional study was done amongst the first, second and third year nursing students of the nursing school at Sassoon General Hospitals, Pune during the academic session of 1998-99. A semiopen self-administered questionnaire with questions pertaining to knowledge and awareness of risk of HIV transmission after needlestick injury was used. Statistical analysis was done using Chi square test.


There were 290 nursing students attending the Nursing Course conducted at the institution. Of these, 106, 94 and 90 students were in the first year, second year and third year respectively. The mean age of the students was 17.94 years. All the students had completed 12th standard.

Of the 290 students, 215 (74.13%) reported having attended at least one patient with HIV positive status in the past. The nurses in the upper grade were more likely to have attended an HIV positive patient. Nearly 29% of the first year students had also attended an HIV positive patient. The nursing students have to attend to a large number of patients (>15 patients) with HIV positive status during their course. When enquired as to what were their feelings while caring for these patients, 183 (85.11%) reported negative feelings of stress, anxiety, fear and hesitation.

Of the 290 students, 38 (13.1%) were not even aware that the virus could be transmitted through infected needles. A majority of them (76.3%) were first year students. In this study, of the 252 students who were aware of the possibility of transmission of HIV through infected needles, only 63 (25%) subjects had the correct information of the 0.3% risk of infection through infected needles. The remaining subjects reported greater degrees of risk. (Table I)

When asked as to how they would dispose off disposable needles and syringes, there was a significant difference in the responses obtained from the students of the three classes (Table II). In all, 11 (3.7%) said they would recap the used needles. When enquired as to what they would do after an accidental needlestick injury, 74 (82.2%) of the third year students said they would encourage bleeding, while 103 (97.1%) of the first year students said they would apply pressure or bandage after such an episode. The junior students were not aware of the correct steps to be taken after a needlestick injury as compared to senior candidates. As the junior students lack the necessary skills and training they may be at more risks of accidental injuries. Hence making them aware of the preventive and protective aspects in this regard is a necessity.

A majority of the students i.e. 273 (94.2%) said they would use soap, water and disinfectants to clean the injured area and report the accident to the authorities. The remaining 17 (5.8%) were not aware as to what should be done after an accidental needlestick injury.


AIDS imposes on the nurses lots of stress associated with a sense of professional and personal inadequacy and fear of becoming infected3.

Ippolito G. et al have reported that HIV infection can be acquired through occupational injury during intervention on HIV infected patient. The HIV sequences of the doctor and patient were encoded, analyzed and compared and found to be closely related3. Based on data from over 5,100 exposures from 26 studies worldwide, the Centre for Disease Control and Prevention, estimate that the overall risk of infection from accidental exposure is 0.3% if expsoure is parenteral, 0.1% if via mucous membrane4. In another study amongst health care workers from over 300 health care institutions, the risk of seroconversion following parenteral exposure consistently remained less than 1%5.

There are many misconceptions about the risk of transmission through infected needles that need to be corrected. The risk of HIV transmission through accidental needlestick injury does exist though the risk is low. Universal biosafety precautions if strictly adhered to while working in a health care setting reduces the risk further.

As per WHO recommendations, needles should not be recapped, bent, broken, removed from disposable syringes or otherwise manipulated by hand as these procedures increase the risk of needlestick injuries6. These practices should be stopped by introducing educational programms for enhancing the knowledge and skills of the nursing students early in the course. As the junior students lack the necessary skills and training, they may be at more risks of accidental injuries. Hence making them aware of the protective steps and relevant institutional policies regarding such episodes is a necessity.

While the level of occupational risk is low, the consequences of infection with HIV are dire and should not be underrated7. Infected health care workers have received little support from the profession and the media8. There is no effective vaccine available as yet. Though chemoprophylaxis for health care workers after accidental HIV exposure is now recommended by International AIDS Society4, they are not within the reach of many institutions. Hence there is a need to improve the knowledge of the nursing students regarding the risks, the universal biosafety precautions and appropriate responses to accidental injuries early in their course. Including the relevant information in their curriculum could be an important intervention.

There was substantial improvement in compliance with universal precautions in an emergency department following institution of a policy9. Health care workers who receive injuries need to have confidence that by immediately reporting the injury they will receive appropriate advice and treatment as well as support and encouragement8. Thus it is of utmost importance that each institution should have a clear cut and uniform policy regarding prevention of such accidents and the correct steps to be taken after such an episode in the form of referral services, counseling, chemoprophylactic drugs etc. All health care workers should be made aware of this policy and necessary supportive services provided for its implementation.


  1. AIDS : Prevention and Control. WHO, Geneva, Pergamon Press, Oxford. 1988; 97-111.
  2. Furnel V.L., Gold J., Melling P., Murphy C., Resnik S., Tomkins M., Schroeder K. : The new South Wales 24 hours needlestick injury hotline. International Confernce AIDS. 1996 Jul; 7-12, 11 (1) : 310 (Abstract No. Tu B 22.59).
  3. Scalpel injury and HIV infection in a surgeon. The studio Italiono Rischio Occupazionale da HIV (SIROH) (letter). Ippolito G. et al. Lancet 1996 Apr; 13: 347 (9007); 1042.
  4. New Guidelines set for Occupational HIV Exposure (News). Rowe P.M. Lancet 1996 Jul 6:348 (9019) : 48.
  5. Marcus R. : Health care workers exposed to patients infected with HIV. International Conference AIDS. 1989 Jun 4-9; 5:63. (Abstract No. WAO.1).
  6. WHO AIDS series 3. Guidelines for nursing management of people infected with HIV, WHO, Geneva, 1988.
  7. Deshpande Alaka, Joshi Shashank : HIV infection and biosafety guidelines. J.K. Art Printers Bombay, 1993 : 21.
  8. Erridge P. The rights of HIV infected health care workers B.M.J., 1996 Apr 13; 347 : 1042.
  9. Kelen G.D., Green G.B., Hexter D.A. et al : Substantial improvement in compliance with universal precautions in an emergency department following institution of a policy. Arch Intern Med. 1991 : 151 : 2051-56.

Department of Preventive and Social Medicine,
B.J. Medical College, Pune

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