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\title{Assessment on Magnitude of Needle Stick and Sharp Injuries and Associated Factors among Health Care Workers in East Gojjam Zone Health Institutions, Amahara Regional State, Ethiopia}
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             \author[1]{Zewdie  Aderaw}

             \author[2]{Zewdie  Aderaw}

             \affil[1]{  Debre Markos University}

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\date{\small \em Received: 8 February 2013 Accepted: 3 March 2013 Published: 15 March 2013}

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\begin{abstract}
        


Introduction: Needle sticks and sharp injuries (NSSIs) have been recognized as one of the occupational hazards among health care workers. Occupational exposures to percutaneous injuries are substantial source of infections with blood borne pathogens among health care workers.Objective: The main objective of this study is to determine the prevalence and factors associated with needle stick and sharps injuries among health care workers.Methods: An institutional based cross sectional study design was conducted among health care workers who are working at least one year in east gojjam zone health institutions. A total of 449 study subjects were selected using simple random sampling technique through lottery method and included in the study. Data was collected using pretested Amharic version questionnaire through self administered interview of study subjects. To maintain the quality of data, pretesting, use of local language and supervision of data collection process was done. The collected data was cleaned, entered and analyzed using SPSS version 17 statistical software.

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\keywords{needle stick/sharp injuries, factors associated, health care workers.}

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\section[{Introduction}]{Introduction}\par
eedle sticks and sharp injuries (NSSIs) have been recognized as one of the occupational hazards among health care workers \hyperref[b0]{[1]}. Occupational exposures to percutaneous injuries are substantial source of infections with blood borne pathogens among health care workers and can cause substantial health consequences and psychological stress for Health Care Workers and their loved ones \hyperref[b1]{[2]}. Needle sticks and sharp injuries increase risk of spread of diseases like HIV, Hepatitis B and Hepatitis C \hyperref[b2]{[3,}\hyperref[b3]{4]}.\par
Strategies are available to prevent infections due to sharps injuries including education of Health Care Workers on the risks and precautions, reduction of invasive procedures, use of safer devices and procedures and management of exposures. In the industrialized world, occupational surveillance assess and monitor the health hazards related to blood borne pathogens and prevention measures reduce the risk of transmission. In contrast, in developing countries, exposure and health impacts are rarely monitored and much remains to be done to protect Health Care Workers from such risks that cause infections, illness, disability and deaths that may in turn impact on the quality of health care \hyperref[b4]{[5]}.\par
Studies have shown that reductions of 83\% and 89\% in the number of needle sticks after the introduction of safety engineered intravenous catheters \hyperref[b6]{[6,}\hyperref[b8]{7]} and 74\% reduction in the number of injuries from needles for drawing blood after the introduction of safety engineered alternatives \hyperref[b9]{[8]}. A study done among Health Care Workers in Malaysian Hospital reported that, 66.1\% had the misconception that needles should be recapped after use and 52.5\%know about needleless safety devices \hyperref[b10]{[9]}.\par
Studies done in different countries indicated that the magnitude of needle stick or sharps injuries among HCWs was very high \hyperref[b10]{[9,}\hyperref[b11]{10,}\hyperref[b12]{11,}\hyperref[b13]{12,}\hyperref[b14]{13]}. A study done among Health Care Workers\textbackslash s in Malaysia in 2008 indicated that the prevalence of needle stick or sharps injury was 23.5\% \hyperref[b10]{[9]}. Also studies done among HealthCare Workers in a general hospital in Malaysia in 2005, Saudi Arabia in 2002, Nepal in 2003 and Iran in 2009 showed aprevalence rate of 24.9\%, 74\%, 74\% and 39.4\% respectively \hyperref[b11]{[10,}\hyperref[b12]{11,}\hyperref[b13]{12,}\hyperref[b14]{13]}.\par
Needle stick injury exposure in African countriesis higher than elsewhere and a significantpublic health issue due to the fear of occupational infections faced by ill paid, ill protected and overworked health-care workers. Similar studies in Ethiopia show that 32\% of the needle stick injuries were reported in the Sidama zone, 31\% in north western Ethiopia and 66\% in 52of the health facilities.  {\ref [22]} Certain groups of individuals are at greater risk than others because of the nature of their work. \hyperref[b18]{[16]}. Medical, dental, nursing and midwifery workers are at higher risk for occupational exposure to blood borne pathogens via sharp injuries \hyperref[b14]{[13]}. A study conducted among Malaysia hospital workers reported that medical assistants appeared to face the highest risk of needle stick injury followed by nurses, doctors and health attendants \hyperref[b20]{[18]}. On the other side, numerous studies have found nurses to be the commonest group of Health Care Workers experiencing needle stick injuries \hyperref[b18]{[16]}.\par
Out of the total of 94 documented and 170 possible cases of occupational HIV infection had been identified worldwide up to 1997, nearly two thirds of cases were reported from the United States \hyperref[b22]{[20]}. This could be due to the fact that most countries, especially those with a high population prevalence of HIV infection, have never instituted surveillance systems that would capture data on such case \hyperref[b23]{[21]}. Needle stick and sharp injuries need to be reported to the relevant authorities so as to facilitate and ensure appropriate counselling; prophylaxis orearly treatment .But most health care workers expose themselves with unnecessary risk of not reporting thus depriving themselves of the benefit of intervention \hyperref[b10]{[9]}.\par
Ethiopian government is currently expanding health institutions in all parts of the country and a number of health professionals are employed in these institutions to provide health car services. Their working environment must be safe and free from occupational hazardse specially from Needle stick and sharp injuries. But asfar my knowledge is concerned there is no scientific study which indicates the magnitude of the problem and its determinant factors in Amahara regional state. As a result this study is designed to investigate  
\section[{e) Sample size determination}]{e) Sample size determination}\par
Sample size was determined using the following single population proportion formula with an assumption of significance level 95\%, degree of error 5\% and proportion of Needle Stick and Sharps Injuries among health care workers was 23\% \hyperref[b10]{[9]}.n = (1.96)2 (0.23) (0.77) = 272(0.05)2 Since we have used multiple stages to get the study subjects, the sample size must be multiplied by a design effect of 1.5 and with 10\% contingency for non-response rate, a total of 449 study subjects were included in the study. First, health care facilities were divided into two i.e health centres and hospitals..Proportional allocation was done for hospital and n= (Z \textunderscore /2) 2 *P (1-P)d2 health centre workers and using random sampling technique 8 health centres from the total 32 health centres and one hospital from the total two hospitals were selected. Finally, proportional allocation was done for each professional category and study subjects from each health institution was selected randomly. 
\section[{f) Data Collection}]{f) Data Collection}\par
A pretested and structured Amharic version questionnaire was used to conduct self administered interview among the selected Health Care Workers. Data was collected through self administered questionnaire. Data collection process was supervised by one supervisor from each health institution. Data was collected on sociol demographic characteristics of respondents, work environment determinant factors and behavioral determinant factors. Job stress and job satisfaction of respondents was assessed using standardized workers response questionnaire scales. 
\section[{g) Study Variables}]{g) Study Variables}\par
The outcome variable of this study is needle stick and sharp injury status and the explanatory variables are  ? Work Place Supervision: workers perceived regular supervisions done by health and safety responsible bodies in the department and working rooms. ? Sleeping problem: The presence of sleeping problems when the worker is at work in the health care unit. 
\section[{i) Data management and quality control}]{i) Data management and quality control}\par
The question naire was administered through Amharic version questionnaire. Sort of orientation was given on he aim of the study and procedures how to fill the questionnaire. Pre testing was doneon 10\% of the sample size who are working in health institutions not included in the study and modifications of the questionnaire were under taken. The collected data was checked for completeness every day by the supervisors and principal investigator. j) Data processing and analysis Data was entered and analyzed using SPSS version 16 windows and descriptive statistics, binary logistic regression and multiple logistic regressions was computed at 95\% CI to identify predictors of needle stick and sharps injury status with p value less than 0.05 as a significant level. Crude and adjusted odds ratios with confidence interval were calculated to see the presence of the association with the outcome variable and to observe the interaction effects of confounding variables, respectively. k) Ethical Clearance Ethical clearance was obtained from the institutional review board of Debre Markos University. Permission to conduct the research was also obtained from, east gojjam health desk and from respective districts and health institution. Verbal consent was obtained from each study participants. Participation were informed through SSS the questionnaire about the interview based on willingness, the right to withdraw at any time and confidentiality was ensured using code numbers, not using identifiers and keeping questionnaires locked. 
\section[{III.}]{III.} 
\section[{Result a) Socio demographic characteristics}]{Result a) Socio demographic characteristics}\par
From the total 449 study subjects, 432 (96.2\%) of them were included in the study. Among these 295 (68.3\%) were from health centres and 137 (31.7\%) were from hospital. The mean and median age of the workers is 33.32 and 26 + 1.3 years, respectively. From the total 8respondents 247 (57.17\%) were male health care workers and 402 (93\%) were Orthodox Christians by religion. One hundred ninety four (45\%) were married and the mean monthly salary of workers is 1528 Ethiopian Birr. Workers have a mean work experience of 6.2 years in health institutions. From the total health care workers included in the study 212  {\ref (} From the total health care workers, 295 (68.3\%) were working in health centres and 328(75.9\%) worked in the night shift the previous years. From the total respondents, 231 (53.47\%) had got information about infection prevention and 357 (82.64\%) knew that there is a safety rules and regulations in their institution. One hundred forty three (33.1\%) had got training on infection prevention and 184 (42.6\%) had been supervised by the concerned bodyon the application of infection prevention principles and rules. Among the total respondents, 360 (83.3\%) have safety box in their working rooms to dispose infectious wastes including needle stick and sharp materials and 87 (20.1\%) of the respondents had reported that there are contaminated needle stick and sharp materials around their working area. From the total respondents, 304 (70\%.4) had reported the safety box had torn out.  In the last one year, a total of 96 (22.2\%) health care workers had experienced at least one sharp and needle stick injury and from these 38.2 injuries were not reported totally to the concerned body. 
\section[{i. Socio demographic factors}]{i. Socio demographic factors}\par
In the bivariate analysis, workers age, religion, educational status, marital status and work experience did not show any kind of association with the occurrence of needle stick and sharp injury among health care workers in health institutions. However, sex of the worker (COR2.13, 95\% CI: 1.31, 3.14) and monthly salary of worker (COR 1.91, 95\% CI: 1.19, 3.07) had showed a significant association with sharp and needle stick injury.\par
In multivariate analysis, the result revealed that males have a probability of more than two times in experiencing needle stick and sharp injury compared with females (AOR 2.46, 95\% CI: 1.37, 4.42) . Also workers who can earn monthly salary of below 1528 ETB have a probability of about three times more likely to be injured due to sharp and needle sticks (AOR 2.96, 95\% CI:1.57,5.24). 
\section[{ii. Work environment factors}]{ii. Work environment factors}\par
In the bivariate analysis of work environmental factors, health care workers who are working at hospitals are 1.86 times probability of affected by needle stick and sharp injuries (COR1.86, 95\% CI: 1.17,2.98). Also infection prevention and safety information access (COR2.11, 95\% CI: 1.33, 3.35) and getting training on infection prevention and safety (COR 2.19, 95\% CI: 1.28, 3.77) had significant association with the occurrence of sharp and needle stick injury in health care workers. Health care workers who had got information on infection prevention and safety had a probability of more than 2 times in experiencing injury compared with their counterparts. Similarly health care workers who had no trainings on infection prevention and safety are more than two times probability of having needle stick and sharp injuries. Regular supervision of health care workers working site reduces the occurrence of sharp and needle stick injury among health care workers by 1.75 times (COR 1.75, 95\% CI:1.09,2.93).\par
In the logistic multivariate analysis of cofounder variables which are significant in the bivariate analysis, only provision of information on infection prevention and safety remains statistically significant. Workers who had got information on infection prevention are more than two times probability of reducing sharp and needle stick injury (AOR 2.31, 95\% CI:1.37, 3.95).\par
iii. Behavioural Factors Among the worker behaviour related factors in the bivariate analysis, sleeping disturbance problem (COR 0.36, 95\%CI: 0.22, 0.61), job satisfaction (COR Workers in East Gojjam Zone Health Institutions, Amahara Regional State, Ethiopia 0.32, 95\% CI: 0.19, 0.52) and job stress (COR 2.33, 95\%CI: 1.46, 3.70) showed a significant association with the occurrence of needle stick and sharp injuries. Workers who have been stressed due to their work have 2.33 times probability of experiencing sharp and needle stick injury and similarly hose who have not been satisfied by their job have a 68\% probability of experiencing injury. However, khat chewing, and smoking cigarettes have no any statistical significant association with the occurrence of needle stick and sharp injuries. On the other side, khat chewing (COR 1.63, 95\%CI: 0.55, 4.84) and smoking cigarettes (COR0.55, 95\% CI: 0.22, 1.41) have no statistical significant association with the occurrence of needle stick and sharp injury in health care workers.\par
In the logistic multivariate analysis, only job satisfaction (AOR 0.38, 95\%CI: 0.23, 0.65) and Job stress (AOR 2.22, 95\%CI: 1.32, 3.74) are statistically significant with the occurrence of sharp and needle stick injury. Workers who are not satisfied by their job are 62\% more likely to exercise sharp and needle stick injury compared with their counter parts. Also who are who are stressed due to their job are more than two times to experience sharp and needle stick injury compared with workers who do not stressed due to their job.  
\section[{Discussion}]{Discussion}\par
The study revealed that the one year prevalence of needle stick and sharp injury is 22\%. This finding is similar with a study done in Malaysia hospital in 2010 (23.5\%) \hyperref[b10]{[9]} and in 2005(24.9\%) \hyperref[b11]{[10]}. However this result is lower than studies in Saudi Arabiain 2002 (74\%) \hyperref[b12]{[11]}, Nepal in 2003 (74) \hyperref[b13]{[12]} and Iran in 2009 (39.4\%) \hyperref[b14]{[13]}. These differences are due to the fact that there are interventional efforts in infection prevention and safety activities. Workers in East Gojjam Zone Health Institutions, Amahara Regional State, Ethiopia 
\section[{IV.}]{IV.} 
\section[{Volume XIII Issue III Version I}]{Volume XIII Issue III Version I}\par
The statistical analysis in this study indicates that male workers are more victims as compared with female workers. This may be due to the fact that females are better in safety precautions compared to males. But another study in Malaysia indicated that there is a significant association between sex of the worker and the occurrence of sharp and needle stick injury among health care workers. \hyperref[b11]{[10]}.This difference may be disparities in socioeconomic development of workers. In this study age of the worker did not showed a significant association with the prevalence of sharp and needle stick injury. However, a study in Malaysia indicated that there is a statistical difference based on sex of worker \hyperref[b11]{[10]}.\par
This study revealed that three hundred ninety seven of health care workers (91.9\%) believe that needle stick and sharp injury is a preventable public health problem but only 261 (60.4\%)used Personnel Protective Equipment during their work. It also indicated that from the total workers 328 (75.9\%) works in night shifting hours and 90 (20.8\%) have a problem of sleeping disturbance which has a significant role in exposing to sharp and needle stick injuries. The statistical analysis result indicates that working at night shift have no significance association with prevalence of needle stick and sharp injuries. But having sleeping disturbance problem during work have a statistically significant effect on prevalence of sharp and needle stick injury.\par
This study indicated that 231 (53.47\%) had got information on infection prevention from different sources. However, only 143 (33.1\%) had got formal trainings on infection prevention and safety in the last one year. Getting information on health and safety has a statistically significant association with the prevalence of sharp and needle stick injury but getting training on infection prevention and safety has lost its significance in the logistic multivariate analysis. From the total health care workers working sites, only 184 (42.6\%) had been supervised and there is a statistical significance difference on the prevalence of sharp and needle stick injury. In this study divorced health care workers and workers who earn below the mean monthly salary are statistically victims to sharp and needle stick injury. Different studies indicated that job satisfaction and stress had a great role on the prevalence of sharp and needle stick injury. This study revealed that 195(45.14\%) of workers had been satisfied by their job and 241 (55.79\%) had been stressed in relation to their job. Job satisfaction and job stress had showed statistically significant association with the prevalence of sharp and needle stick injury. 
\section[{Conclusion and Recommendation}]{Conclusion and Recommendation}\par
In this study the prevalence of sharp and needle stick injury is low and had showed a decrease in magnitude from the previous study results. Job stress, job satisfaction, having sleeping disturbance problem, having health safety information access and low monthly salary had showed a significant association with the occurrence of sharp and needle stick injury.\par
Therefore to reduce this problem among health care workers: 1. Regular provision of information by ministry of health, regional health office and different nongovernmental organizations on infection prevention and safety should be strengthened at all levels through different means to health care workers. 2. Ministry of health, Health care institutions management and regional health burea should strengthen mechanisms to improve job satisfaction of workers. 3. Efforts by Ministry of health, Health care institutions management, regional health bureau and the worker him/herself should be strengthened to reduce job stressors among health care workers. 4. For workers who are working in night shifts should get sleep health education. 5. Low rate paid workers are victims of sharp and needle stick injury. Therefore special attention should be given to these workers in the infection prevention activities. 6. The effectiveness of infection prevention training is not as such attractive in reducing injuries. Therefore, the training modality, training type, materials, methods and in general the setup should be assessed totally to make it an effective protective method.\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_0}}\end{figure}
   \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.8402502606882168\textwidth}P{0.009749739311783107\textwidth}}
II.\tabcellsep Methodology\\
a) Study Design\tabcellsep \\
\multicolumn{2}{l}{An institutional based cross sectional study}\\
\multicolumn{2}{l}{design was conducted among health care workers.}\\
\multicolumn{2}{l}{b) Study area and period}\\
\multicolumn{2}{l}{This study was done among Health Care}\\
\multicolumn{2}{l}{Workers in east gojjam zone from September to October}\\
\multicolumn{2}{l}{2012. The capital city of east gojjam zone, Debre}\\
\multicolumn{2}{l}{Markos own is found 292 kilometers away from Addis}\\
\multicolumn{2}{l}{Ababa, capital city of Ethiopia. East gojjam zone is one}\\
\multicolumn{2}{l}{of the 11 zones in the Amahara regional state.}\\
\multicolumn{2}{l}{According to the 2007 census report, it has a total}\\
\multicolumn{2}{l}{population of 2,152,671 of which 1,066,094 are males}\\
\multicolumn{2}{l}{and 1,086,577 were females. According to east gojjam}\\
\multicolumn{2}{l}{zone health bureau report, the zone has two hospitals}\\
\multicolumn{2}{l}{and 32 health centers.}\\
\multicolumn{2}{l}{c) Source Population}\\
\multicolumn{2}{l}{Source population are all clinical health care}\\
\multicolumn{2}{l}{workers who are working in east gojjam zone}\\
\multicolumn{2}{l}{governmental hospitals and health centers.}\\
\multicolumn{2}{l}{d) Study Population}\\
\multicolumn{2}{l}{Study population are the selected Health Care}\\
\multicolumn{2}{l}{providers who are working at least for one year in}\\
\multicolumn{2}{l}{hospitals and health centers.}\end{longtable} \par
 
\caption{\label{tab_0}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{}
\end{longtable} \par
 
\caption{\label{tab_1}?}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.85\textwidth}}
013\\
2\\
Year\\
Volume XIII Issue III Version I\end{longtable} \par
 
\caption{\label{tab_2}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.005219650448748228\textwidth}P{0.6420170051960321\textwidth}P{0.021280113367973547\textwidth}P{0.014052905054322152\textwidth}P{0.0658478979688238\textwidth}P{0.09636277751535191\textwidth}P{0.005219650448748228\textwidth}}
\tabcellsep Variables Variable Working institution\tabcellsep Category\tabcellsep Response Health centre\tabcellsep Number Number 295\tabcellsep Percent Percent 68.3\\
\tabcellsep Sex of worker\tabcellsep Male\tabcellsep Hospital\tabcellsep 247 137\tabcellsep 57.17 31.7\\
\tabcellsep Night shift work\tabcellsep Female\tabcellsep Yes\tabcellsep 185 328\tabcellsep 42.82 75.9\\
\tabcellsep Age of worker\tabcellsep \multicolumn{2}{l}{Above mean (>33.3 years) No}\tabcellsep 374 104\tabcellsep 86.57 24.07\\
\tabcellsep \multicolumn{3}{l}{Below mean (<33.3 years) Health and safety information access Yes}\tabcellsep 58 231\tabcellsep 13.43 53.47\\
\tabcellsep Religion\tabcellsep Orthodox\tabcellsep No\tabcellsep 402 199\tabcellsep 93.06 46.06\\
Year 013 2\tabcellsep \multicolumn{3}{l}{Muslim Protestant Training on infection prevention and Marital status Married control Single Supervision by other bodies Divorced Monthly salary Above the mean (>1528 ETB) Yes No Yes No Knowledge on safety rules and Yes Below the mean (<1528 ETB) regulations No Work experience Above the mean (>6.2 years) Presence of safety box in the room for Yes Below the mean (< 6.2 years) recapped needles No Educational status Less than grade 10 Presence of contaminated needles and Yes Certificate sharp materials in the working area No Diploma Condition of the safety box in the room Overfilled First degree Torn out Medical doctor Empty Health care worker Cleaner Other}\tabcellsep 13 17 143 194 289 216 184 22 248 236 357 196 75 339 360 93 72 6 87 9 345 64 54 15 304 2 55 76 19\tabcellsep 30.09 33.10 3.93 66.89 44.90 42.59 50 57.41 5.1 82.64 54.63 17.36 45.37 83.3 78.47 6.7 21.53 20.1 29 79.9 20 12.5 206 70.4 77 12.7 4 17.6 4.4\\
( )\tabcellsep \multicolumn{3}{l}{Profession c) Workers behaviour characteristics Nurse Health officer Medical doctor From the total respondents, 90 (20.8\%) have a Midwifery problem of sleeping disturbance during worktime and Laboratory 26 (6\%) and 19 (4.4\%) of the respondents chew khat Other* and smoke cigarettes, respectively. One hundred ninety five (45.14\%) of the workers were satisfied by their job}\tabcellsep 212 43 5 18 63 15\tabcellsep 49.0 10.0 1.2 4.2 14.6 3.5\tabcellsep D D D D ) F (\\
\tabcellsep \multicolumn{3}{l}{*it refers to pharmacy, environmental health, optometry and(55.8\%) have job related stresses. From the total}\tabcellsep \\
\tabcellsep \multicolumn{3}{l}{study participants, 397 (91.9\%) believe that needle stick}\tabcellsep \\
\tabcellsep \multicolumn{3}{l}{and sharp injury is a preventable problem and 403}\tabcellsep \\
\tabcellsep \multicolumn{3}{l}{(93.3\%) believes that sharp and needle stick injury have}\tabcellsep \\
\tabcellsep \multicolumn{3}{l}{high risk of infectious diseases. Two hundred sixty one}\tabcellsep \\
\tabcellsep \multicolumn{3}{l}{(60.4\%) used Personnel protective equipment and/or}\tabcellsep \\
\tabcellsep gloves when it was necessary.\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_3}F}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.4299418604651163\textwidth}P{0.2532703488372093\textwidth}P{0.0654796511627907\textwidth}P{0.10130813953488373\textwidth}}
\multicolumn{2}{l}{Ethiopia, November 2012}\tabcellsep \tabcellsep \\
Variables\tabcellsep Category\tabcellsep Number\tabcellsep Percent\\
Sleeping disturbance problem\tabcellsep Yes\tabcellsep 90\tabcellsep 20.83\\
\tabcellsep No\tabcellsep 342\tabcellsep 79.17\\
Khat chewing\tabcellsep Yes\tabcellsep 26\tabcellsep 6.02\\
\tabcellsep No\tabcellsep 403\tabcellsep 93.3\\
Smoke cigarettes\tabcellsep Yes\tabcellsep 21\tabcellsep 4.8\\
\tabcellsep No\tabcellsep 411\tabcellsep 95.2\\
Job satisfaction index\tabcellsep Above the mean score\tabcellsep 195\tabcellsep 45.14\\
\tabcellsep Below the mean score\tabcellsep 237\tabcellsep 54.86\\
Job stress index\tabcellsep Above the mean score\tabcellsep 241\tabcellsep 55.79\\
\tabcellsep Below the mean score\tabcellsep 191\tabcellsep 44.21\\
Belief on preventability of needle stick\tabcellsep Preventable\tabcellsep 397\tabcellsep 91.9\\
and sharp injury\tabcellsep Not preventable\tabcellsep 35\tabcellsep 8.1\\
Belief on risky nature of needle stick\tabcellsep High risk\tabcellsep 403\tabcellsep 93.3\\
and sharp injuries\tabcellsep Moderate risk\tabcellsep 25\tabcellsep 5.8\\
\tabcellsep Low risk\tabcellsep 4\tabcellsep 1\\
PPE and glove use practice when\tabcellsep Never\tabcellsep 34\tabcellsep 7.9\\
necessary\tabcellsep Some times\tabcellsep 53\tabcellsep 12.3\\
\tabcellsep Most of the time\tabcellsep 84\tabcellsep 19.4\\
\tabcellsep All of the time\tabcellsep 261\tabcellsep 60.4\\
\multicolumn{2}{l}{d) Prevalence and factors associated with sharp and}\tabcellsep \tabcellsep \\
needle stick injury\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_4}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.18747560182173065\textwidth}P{0.21567989590110606\textwidth}P{0.05364346128822381\textwidth}P{0.19300585556278463\textwidth}P{0.08295380611581002\textwidth}P{0.11724137931034483\textwidth}}
Variables\tabcellsep Category\tabcellsep \multicolumn{3}{l}{Injury status COR (95 \% CI)}\tabcellsep AOR (95 \% CI)\\
\tabcellsep \tabcellsep Yes\tabcellsep No\tabcellsep \\
Sex of worker*\tabcellsep Male\tabcellsep 68\tabcellsep \multicolumn{2}{l}{179 2.13 (1.31,3.14)}\tabcellsep 2.46 (1.37, 4.42)\\
\tabcellsep Female\tabcellsep 28\tabcellsep \multicolumn{2}{l}{157 1}\tabcellsep 1\\
Age of worker\tabcellsep Above mean (>33.3)\tabcellsep 85\tabcellsep \multicolumn{2}{l}{289 1}\\
\tabcellsep Below mean (<33.3)\tabcellsep 11\tabcellsep 47\tabcellsep 1.26 (0.62,2.53)\\
Religion\tabcellsep Orthodox\tabcellsep 88\tabcellsep \multicolumn{2}{l}{314 1}\\
\tabcellsep Muslim\tabcellsep 4\tabcellsep 9\tabcellsep 0.63 (0.19,2.10)\\
\tabcellsep Protestant\tabcellsep 4\tabcellsep 13\tabcellsep 0.29 (0.29,2.86)\\
Educational status\tabcellsep Less than grade 10\tabcellsep 6\tabcellsep 29\tabcellsep 2.42 (0.36,16.34)\\
\tabcellsep Certificate\tabcellsep 9\tabcellsep 20\tabcellsep 1.11 (0.17,7.22)\\
\tabcellsep Diploma\tabcellsep 64\tabcellsep \multicolumn{2}{l}{206 1.61 (0.29,8.99)}\\
\tabcellsep First degree\tabcellsep 15\tabcellsep 77\tabcellsep 2.57 (0.43,15.3)\\
\tabcellsep Medical doctor\tabcellsep 2\tabcellsep 4\tabcellsep 1\\
Marital status *\tabcellsep Married\tabcellsep 29\tabcellsep \multicolumn{2}{l}{165 0.27 (0.035,2.09)}\tabcellsep 0.11 (0.01,0.99)\\
\tabcellsep Single\tabcellsep 66\tabcellsep \multicolumn{2}{l}{150 0.11 (0.01,0.82)}\tabcellsep 0.5 (0.23,0.54)\\
\tabcellsep Divorced\tabcellsep 1\tabcellsep 21\tabcellsep 1\tabcellsep 1\\
Monthly salary*\tabcellsep \multicolumn{2}{l}{Above the mean (>1528) 64}\tabcellsep \multicolumn{2}{l}{172 1}\tabcellsep 1\\
\tabcellsep \multicolumn{2}{l}{Below the mean (<1528) 32}\tabcellsep \multicolumn{2}{l}{164 1.91 (1.19,3.07)}\tabcellsep 2.96 (1.57,5.24)\\
Work experience*\tabcellsep Above the mean (>6.2)\tabcellsep 80\tabcellsep \multicolumn{2}{l}{259 0.67 (0.37,1.22)}\tabcellsep 0.87 (0.44,1.72)\\
\tabcellsep Below the mean (< 6.2)\tabcellsep 16\tabcellsep 77\tabcellsep 1\\
Institution type *\tabcellsep Health centre\tabcellsep 55\tabcellsep \multicolumn{2}{l}{240 1}\\
\tabcellsep Hospital\tabcellsep 41\tabcellsep 96\tabcellsep 1.86 (1.17,2.98)\tabcellsep 1.58 (0.91,2.77)\\
Night work shift\tabcellsep Yes\tabcellsep 74\tabcellsep \multicolumn{2}{l}{254 0.92 (0.54,1.58)}\\
\tabcellsep No\tabcellsep 22\tabcellsep 82\tabcellsep 1\\
Health and safety\tabcellsep Yes\tabcellsep 38\tabcellsep \multicolumn{2}{l}{193 1}\tabcellsep 1\\
information access*\tabcellsep No\tabcellsep 58\tabcellsep \multicolumn{2}{l}{141 2.11 (1.33,3.35)}\tabcellsep 2.31 (1.37,3.95)\\
Training on infection\tabcellsep Yes\tabcellsep 20\tabcellsep \multicolumn{2}{l}{123 1}\\
prevention*\tabcellsep No\tabcellsep 76\tabcellsep \multicolumn{2}{l}{213 2.19 (1.28,3.77)}\tabcellsep 1.04 (0.57,1.92)\\
Supervision by\tabcellsep Yes\tabcellsep 34\tabcellsep \multicolumn{2}{l}{151 1}\tabcellsep 1\\
concerned bodies *\tabcellsep No\tabcellsep 82\tabcellsep \multicolumn{2}{l}{165 2.20 (1.39,3.46)}\tabcellsep 1.42 (0.76,2.65)\\
Sleeping disturbance\tabcellsep Yes\tabcellsep 34\tabcellsep 56\tabcellsep 1\\
problem*\tabcellsep No\tabcellsep 62\tabcellsep \multicolumn{2}{l}{280 0.36 (0.22,0.61)}\tabcellsep 2.81 (1.57,5.04)\\
Khat chewing\tabcellsep Yes\tabcellsep 4\tabcellsep 22\tabcellsep 1.63 (0.55,4.84)\\
\tabcellsep No\tabcellsep 92\tabcellsep \multicolumn{2}{l}{311 1}\\
Smoke cigarettes\tabcellsep Yes\tabcellsep 7\tabcellsep 14\tabcellsep 0.55 (0.22,1.41)\\
\tabcellsep No\tabcellsep 89\tabcellsep \multicolumn{2}{l}{332 1}\\
Job satisfaction index*\tabcellsep Above the mean score\tabcellsep 64\tabcellsep \multicolumn{2}{l}{131 0.32 (0.19,0.52)}\tabcellsep 0.38 (0.23, 0.65)\\
\tabcellsep Below the mean score\tabcellsep 32\tabcellsep \multicolumn{2}{l}{205 1}\\
Job stress index*\tabcellsep Above the mean score\tabcellsep 38\tabcellsep \multicolumn{2}{l}{203 2.33 (1.46,3.70)}\tabcellsep 2.22 (1.32,3.74)\\
\tabcellsep Below the mean score\tabcellsep 58\tabcellsep \multicolumn{2}{l}{133 1}\end{longtable} \par
 
\caption{\label{tab_5}Table 4 :}\end{figure}
 			\footnote{Assessment on Magnitude of Needle Stick and Sharp Injuries and Associated Factors among Health CareWorkers in East Gojjam Zone Health Institutions, Amahara Regional State, Ethiopia} 			\footnote{© 2013 Global Journals Inc. (US)} 			\footnote{© 2013 Global Journals Inc. (US)} 		 		\backmatter  			  				\begin{bibitemlist}{1}
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