CHAPTER 2

REVIEW OF LITERATURE
Good research does not exist in vaccum. Research findings should be an extension of previous
knowledge and theory as well as guide for future research activity. In order to build an existing work, it is
essential to understand what is already known about a topic. A thorough review of literature provides a
foundation upon which to raise new knowledge.( Polit and Hungler, 1995)

This chapter deals with review of literature which helps to gain an insight into various aspects of the
program under the study such as designs, methods, tools of measure and techniques for data collection.
The review of literature provides a basis for future investigations, justifies the need for replication,
throws light on the feasibility of the study, indicates constraints of data collection and helps to relate
findings of one study to another. It also helps to establish a comprehensive study of scientific knowledge
in a professional discipline from which valid and pertinent theories may be developed.

The review of literature for the present study has been done from published articles, reports, textbooks,
news letters, and internet searches. It is presented under the following headings:

 Literature related to knowledge of nursing students regarding needle stick injury.

 Literature related to practices of nursing students regarding needle stick injury.
 Literature related to prevention and management of needle stick injury.

LITERATURE RELATED TO KNOWLEDGE OF NURSING STUDENTS REGARDING

NEEDLE STICK INJURY
1.Sudha. B & Dr. Selvanayaki. V (2019) A descriptive study was carried out to assess the knowledge of
first year nursing students on needle stick injuries. The samples were selected by convenient sampling
technique. The sample size was 107 and the study was conducted in selected colleges of Puducherry.
Data on needle stick injuries was collected by using structured knowledge questionnaires. The collected
data were analyzed by using descriptive statistics & inferential statistics. The findings of this study
showed that 88(82.2%) of the student had poor knowledge and 18(16.82%) student had average level of
knowledge and 1(0.3%) student had good knowledge on needle stick injuries. There was a significant
association found between level of knowledge with income of father at P<0.05 level. The study
concludes that it is the need of the hour to educate the nursing students on the prevention and the
consequences of needle stick injuries.

2. Rahul Shil & Shivaleela P Upashe (2020) Conducted a quantitative study using Quasy experimental,
one group pre-test and post-test design were used. A total 30 student nurses were recruited randomly.
Knowledge questionnaire which was developed by investigator used to collect data. The study findings
showed that 6 student (20%) had inadequate knowledge towards needle stick injury, 24 student (80%)
had moderate knowledge and none of them were having adequate knowledge level regarding needle
stick injury.

3. Mohammad Suliman et al. (2018) A cross sectional study was conducted to  measure student nurses'
level of knowledge about needle stick injury and to examine its prevalence and post-exposure measures
in Jordan. Sample consisted of 279 student nurses studying at one private and four government
universities distributed throughout Jordan. The study used an online survey composed of 22 questions
developed from needle stick injury literature. The questionnaire was divided into three parts:
background, to measure students' demographics; knowledge, to measure nurses' understanding of
needle stick injury; and prevalence, to measure exposure to needle stick injury and the follow-up
measures. Student nurses were recruited through Face book. The survey was available online for one
full semester in 2016/2017.  The total number of completed surveys was 279. Most of the students
were female. Their mean age was 21years . The mean score for the knowledge part was 7 out of 10.
Almost one- third of the students had at least one incident of exposure to needle stick injury (26.2%).
Most of the students who had suffered needle stick injury did not inform their clinical instructors
(67.1%) or write an incident report (86.3%). The results showed that there was no significant difference
in the knowledge of total scores between males and females or between students across different
universities. However, a significant difference was found between students in different years of study.
From this study a conclusion is drawn that student nurses in Jordan have a moderate understanding of
issues regarding needle stick injury. This knowledge improved with seniority. However, exposure to
needle stick injury and its under-reporting is a prevalent problem. This study recommends focusing on
needle stick injury in the nursing curriculum, and providing more protection and post-exposure
intervention for students during their clinical practice.

4. Prasuna J, Rakesh Sharma, Anita Bhatt, Arzoo, Disha Painuly, Himani Butola, Anju Yadav
(2013) A cross-sectional study was conducted in North-East India in 2013. The study participants
comprised of 83 nursing students studying in 4th year B.Sc. (N) and 3rd year General Nursing and
Midwifery (GNM). Students were questioned regarding their occurrence to Needle Stick Injury
throughout their clinical training and measures taken following the exposure. They were also asked to
complete the Knowledge questionnaire on needle stick injury. The study among 83 nursing students
included 43 (51.81%) GNM 3rd year and 40 (48.19%) B.Sc. Nursing Students. Out of a total 83 students,
75 (90.36%) were females. The occurrence of needle stick injury during their course was reported by 33
(39.76%) participants. The maximum needle stick injury occurred during first year of course (57.57%). It
was found that 18 (54.54%) of needle stick injuries were not reported. Among those exposed, only 5
(15.15%) students had undergone blood investigation and very few students took post exposure
measures. It was found that, only 23 (69.69%) students were immunized against Hepatitis B before
needle stick injury. The present study indicated a high incidence of needle stick injuries among nursing
students with more under-reported cases and subjects were not aware of post exposure measures. It is
essential to deal with above problems by regular training on real-life procedure at the entry level and
reporting system should be more user-friendly platform .
LITERATURE RELATED TO PRACTICES OF NURSING STUDENTS REGARDING
NEEDLE STICK INJURY
1.Mary Zia , Muhammad Afzal , Hajra Sarwar , Ali waqas , Dr. Syed Amir Gilani (2017) This study is
conducted to assess knowledge and practice of needle stick injury among nurses. The significance of the
study is that this study is beneficial for all nurses, undergraduate students and other health organization.
In conclusion, the awareness of the nurses regarding needle stick injury and its preventive measure on
their practical training was poor. A survey was finished by 253 nurses. In this review, needle stick harm
was characterized by percutaneous harm brought about by empty borne needles, suturing needles,
surgical tool and blades. In this review 77.1% nurses have great learning 20.2% have poor information
and 2.8% have no information about empty borne needles and the fundamental driver of percutaneous
wounds with empty bore needles were recapping) . All in all, the familiarity with the nurses to needle
stick harm and preventive measure and application on their functional preparing was poor. It would be
suggested that the wellbeing training program for needle stick damage and preventive measure should
be introduced to all the nurses and encourage them to apply during their daily practice.

2. Gurpreet Kaur, Rashmi Choudhary, Poonam Sharma (2017)  This study aimed to assess the
knowledge and practices of nursing students regarding handling and disposal of sharp items. A
quantitative approach with descriptive research design was adopted. With use of convenient sampling
technique, 150 nursing students were selected. Structured knowledge questionnaire and checklist were
used to collect data on knowledge and practices respectively of nursing students in the month of March-
April, 2016. Study findings revealed that the majority 70 (46.7%) subjects were having fair knowledge
followed by 67 (44.7%) subjects having good knowledge whereas majority 143 (95.3%) subjects were
having good practices. Results shows that there is moderate positive correlation (r= 0.258) between
knowledge and practices. Significant association of level of knowledge with age, course, and year of
study was found. There was no significant association of level of practices with socio-demographic
variables.

3. Anh Tran Thi Quynh, Katrina Einhellig (2017)  The cross- sectional study was conducted between
2013 and 2014 in nursing students of Tien Giang Medical College who participated in clinical practice.
There were 360 students who participated in the study using simple random sampling. Data were
collected using the practical assessment checklist and demographic characteristics questionnaire. Data
were processed using STATA 12.0, and analyzed using Chi-square and Fisher test. The students who did
general practice correctly accounted for ( 52.50%), and those who did practice incorrectly was (47.5%).
The students who used gauze or wool wrap in inhaler were( 59.7%), wearing gloves in practice (39.2%),
do not disassemble needles from syringes after injection (50%), and removing needles into barrel after
injection (65.6%). There was statistically significant relationship between time of participation in clinical
practice and correct practice with p-value 0.04 (<0.05) The correct practice of nursing students related
to the prevention of needle stick and sharps injuries remains low. There was a significant relationship
between time of participation in clinical practice and correct nursing practice. It is suggested that
students must be taught about the risk of infection at the beginning of clinical practice, and constantly
reminded throughout the learning process, especially for injection safety awareness, knowledge and
techniques about the risk of transmission of HBV, HCV and HIV by sharp objects in the healthcare
facility.
LITERATURE RELATED TO PREVENTION AND MANAGEMENT OF NEEDLE STICK
INJURY
1.Hanny Handiyani, L. Meily kurniawidjaja, Dewi Irawaty and Rita Damyanti (2018) This study aimed to
identify the effective needle stick injury prevention strategies for nursing students in the clinical settings.
This study demonstrated the high rates of needle stick injuries in low and middle (India, 91.85%) and
high income countries (Taiwan, 56.15%). Most injuries especially occurred when students are opening
the ampoules (53.15%) and performing I/V cannulation (44.50%). The review identified four main
strategies to prevent needle stick injuries; education, trainings, safe needle use, and effective
communication. This study suggested the development of education and trainings curriculum and self-
report and culture, the provision of financial, material, and manpower resources to support the
prevention of needle stick injuries.

2. Anshuli Trivedi, Pradeep Kumar Kasar, Rajesh Tiwari, Prashant Verma, Arvind Sharma (2013) A
Quasi experimental study was conducted at Nursing College, NSCB Medical College Jabalpur (M.P.)
among 100 nursing students. A questionnaire was used to assess existing knowledge of prevention and
management of needle stick injury, then students were given series of lectures and interactive sessions
to prevent and manage needle stick injury then same group was subjected to post intervention
assessment. It was observed that 78% respondents suffered needle stick injury was during recapping of
needle. Other than needle, 86% respondents getting struck by stylet of IV catheter, 14% subjects
recalled more than 5 incidences of needle stick injury in past 15 days. In post intervention assessment it
was observed that intervention made a significant impact in knowledge of students for prevention and
management of needle stick injury. The intervention motivated 5 more students for Hep. B
immunization.

3. H.Wang et al (2003) Conducted a study on staff nurses who had completed 3 years of academic work
and 3 months of clinical practice. They were randomized to receive standard education which includes
60 minutes lecture and 20 minutes video with teaching aid and printing material covering a wide range
of issues. It emphasized the prevention of needle stick injury. Adherence to universal precautions was
documented using an observational checklist looking at the hand washing, wearing gloves and handling
needles. Knowledge and behaviour score were quite high at baseline in both groups. At 4 months, the
result was significantly higher in educational group. Direct observations were carried out. There were
significantly fewer needle stick injury among nurses who received educational intervention.

Summary
This chapter deals with the review of literature related to the problem of the present study. The review
was carried out to get familiar with the various aspects of problem under study. The literature surveyed
and has been organized under following headings.

1. Literature related to knowledge of nursing students regarding needle stick injury.

2. Literature related to practices of nursing students regarding needle stick injury.
3. Literature related to prevention and management of needle stick injury.
The review of literature brought to the light that not many studies have been done in India, that
too among nurses on the said problem.

The extensive review of research and non research literature on the problem area has helped
the researcher to integrate the available information for identifying the research methodology,
designing the research tool that is preparing the knowledge questionnaire. It further helped to
plan the data analysis.