The findings of this study indicate that the rate of EIs per the number of hospitalized patients and hospital activities among healthcare and non-healthcare workers had significantly increased during the COVID-19 pandemic.
EIs most frequently occurred during the first shift (from 6 AM to 2 PM), when most medical diagnostic procedures and examinations are performed in hospital practice, most commonly during blood draws, injection administration, and surgical procedures. During the pandemic COVID − 19, there was a higher prevalence of EIs during the winter months. The possible cause was pronounced epidemic waves in the winter months and, consequently more hospitalizations. On the contrary, in the pre-pandemic period, EIs occurred more frequently in the summer months, where the possible cause could be a lower number of workers due to vacations traditionally taken during the summer.
The average age of workers with EI was 29 years during the COVID-19 pandemic and 32 years before the pandemic. Healthcare workers with EIs had an average of 6 years of service during the pandemic and 5 years before the pandemic. These results could be explained by the fact that procedures that expose healthcare workers to a potential exposure event are likely to be performed to a greater extent by younger workers with less experience.
Among the staff that reported EIs, the most represented were those with a secondary vocational education, and among the health workers – nurses. A similar study, conducted in Turkey, was published in 2021 by Diktas et al. A significant increase in exposure rates among nurses was noted between the pre-pandemic and pandemic periods, from 0.8 to 6.89%. The results described by Diktas et al. are consistent with the findings of this study, as they also showed that the highest number of EIs both before and during the COVID-19 pandemic occurred in nurses [15].
European Biosafety Network reported on itswebsite that COVID-19 led to an increase of 276,000 (23%) in the number of sharps injuries to healthcare workers in Europe during the year 2020. The study was conducted in March/April 2021 and surveyed 80 of the largest national hospitals in France, Germany, Italy, Spain and Poland, covering more than 300,000 healthcare workers [16].
The results of our study show that the frequency of EIs increased during the period of the COVID-19 pandemic, relative to the number of admitted patients and hospital activities. Although the total number of EIs reported in the two years before the pandemic was 128 EIs, compared to 113 EIs during the pandemic, these numbers need to be put into context. This result must be viewed differently due to a series of changes that occurred at DUH during the pandemic, including changes in the number of patients and performed hospital procedures in the analyzed two years before the pandemic and two years during the pandemic. Therefore, data were collected on the number of active hospital activities, which are indicators of the burden on the health system in the period before and during the COVID-19 pandemic. Our results showed that the number of active hospital activities was lower compared to the period before the COVID-19 pandemic. The number of inpatients in the analyzed period before the pandemic decreased by 44% in the period during the pandemic. The number of surgical procedures decreased by 60%. The number of outpatient activities decreased by 61%. The number of examinations at the ED decreased by 59%. The total number of active hospital activities decreased during the pandemic by 59% compared to the period before the pandemic. All these changes resulted from the repurposing of the institution, which was not open anymore to all patients during the COVID-19 pandemic.
In the period of the mixed mode of operation when there were COVID-19 and non-COVID-19 wards in the hospital, more EIs were recorded. This could be explained by a greater workload in terms of the two modes of operation where care had to be taken to adequately apply PPE, which were carried out at the same time and consequently, the fatigue of health workers. Stress, anxiety, and possibly other problems with wearing PPE should be considered, as they could affect concentration and fatigue. This is supported by the results of the study carried out in Italy on a sample of 150 nurses in 117 public hospitals, which indicated that the possible causes of sharp object injuries during the COVID-19 pandemic were lack of staff, physical fatigue, work in extraordinary conditions, stress and difficulty handling sharp objects when wearing complete PPE [17]. Furthermore, our study showed an increase in EIs among healthcare workers, which was also confirmed in a similar study conducted at DUH, where one of the conclusions was that the possible cause was the complexity of using PPE [8].
In the period of PPE de-escalation that followed the recommendations of the WHO from December 2020, more EIs were reported, which could be a consequence of the heavy burden and stress of the health system because the waves of the pandemic followed one another, especially after the second wave that started at the end of October 2020. This is supported by the study conducted in 80 European hospitals in Spain, France, Germany, Poland, and Italy, which included 300,000 healthcare workers. An increase in EIs in 2020 was observed due to stress and pressure due to COVID-19, lack of PPE and lack of safety devices [17].
Almost all workers who reported EI in this study were vaccinated against HBV, which speaks in favour of mandatory vaccination against HBV. The only difference was in the level of the anti-HBs titer; the rest of the serology for HBV, HCV, and HIV was negative. A high percentage of HBV vaccination was also recorded in other European countries [17].
Given the state of the COVID-19 pandemic in 2021, it was difficult to attend educational courses [17] and other forms of educational interventions related to the prevention of EI, which likely had an impact on EI frequency. It is important to implement safe practices for daily work in health institutions to prevent EIs, which include, for example, safe disposal and handling of sharp objects [18], not putting the cap back on the needle, proper use of PPE, and the use of needle-free sutures [19].
An important problem that should be highlighted in this context is the non-reporting of EIs. Our study was based on the data about reported EIs. However, there is a possibility that some workers did not report their EIs, and thus we could not include them in this analysis. Earlier research showed that non-reporting of EIs is common. In 2022, Vieira et al. published an article analyzing the underreporting of occupational incidents associated with blood-borne risk factors among hospital employees. Their results showed that the underreporting of such incidents related to biological risk factors was high, especially regarding mucocutaneous injuries (81%). Physicians were the professional category that least reported this type of incident at work (OR = 4.64; 95% CI2.20-9.78). The problem of non-reporting was particularly pronounced among male health workers in surgery. The most common reasons for non-reporting described by respondents in the study by Vieira et al. were the administrative procedure, underestimation of exposure risk, and lack of knowledge about the need to report EI [20]. Therefore, it is necessary to carry out education about vaccination, the ways of transmission of infectious diseases, and the risk of infection by needle sticks, sharp objects and other forms of EIs [21].
In this study, the most numerous group of workers that reported EIs were nurses, who have specific responsibilities and therefore, could be more exposed to the risks of EI and stress during the COVID-19 pandemic. A study conducted in Taiwan showed that nurses had the highest stress level compared to other health workers. The five biggest stressors were “rough and chapped hands due to frequent use of hand washing and disinfecting agents”, “inconvenience when using the toilet at work”, “restriction on eating and drinking at work”, “fear of transmitting the disease to relatives and friends” and “fear of infection with COVID-19”. Discomfort caused by PPE was the main stressor for participants, followed by the burden of patient care [22].
A limitation of this study is its design, which relied on the existing hospital data and did not allow a more substantive exploration of causes that led to EI, i.e. whether it was due to fatigue, stress, some urgent and unpredictable situation, lack of staff, overtime or some other reason. Data collected in only one institution were analyzed. Furthermore, the study lacked confounder control. It would be useful to compare these results with the data of other institutions that had similar organizational conditions during the COVID-19 pandemic. For a better understanding of the causes that lead to EI, it would be valuable to include more variables in future research, such as the worker’s workload (e.g. number of working hours for the past month, use of annual leave), general state of health (e.g. present stress symptoms), workforce shortage (e.g.vacation periods and staff shortages) and other factors that can lead to EIs.
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