A Comparative Study of Ampoule Breaking and Resultant Injury among Registered Nurses
Keywords:
Ampoule, Injury, Incidence, Nursing, Occupational injuries, Risk factors, Sharps injuryAbstract
Breaking ampoules can cause serious injuries and a lack of self-confidence among nurses. These injuries can cause nurses to lose working hours and risk their exposure to blood-borne disease. To prevent injury, ampoule openers are recommended. However, such openers may not be available, so the most standard procedure is to open ampoules manually, requiring skill to do so safely. This comparative study evaluated manual methods for breaking ampoules and resultant injury, length of sharp edge, and identified risk factors for ampoule injury among 56 registered nurses. The participants broke ampoules using six methods with two ampoule sizes (2 ml and 10 ml). Each method used material such as a gauze pad, cotton ball or syringe bag and one hand breaking direction (breaking the ampoule tip in an outward or inward direction). The incidence of injuries, length of the sharp edge of the ampoule, and factors predicting injuries were measured.
In total, 73 of 672 gloves worn by participants showed damage (glove tears). Breaking an ampoule using a syringe bag and an outward direction showed the lowest incidence of injuries and the shortest length of the sharp edge. Significant predictors of ampoule injury were the breaking method, area of nursing specialty, ampoule size, breaking direction, and length of the sharp edges. These findings suggest that breaking an ampoule in an outward direction and using material wrapping entire the ampoule neck can protect against injury.
References
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27. Haldar R, Bajwa SJS, Kaur J. Opening snap off ampoules a safer and uncomplicated method. Rev Bras Anestesiol. 2014; 64:448-449.
28. Zhu SY. Clinical research on nurses breaking off ampoule method. Clinical Journal of Chinese Medicine. 2015;7(1):138-139.
29. Ersin F, Koruk ST, Yilmaz L. Effect of the training provided for nurses on sharp - needlestick injuries and reporting process. International Journal of Caring Sciences. 2016;9(2):561-568.
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4841.20143705.
32. Motaarefi H, Mahmoudi H, Mohammadi E, HasanpourDehkordi A. Factors associated with needlestick injuries in health care occupations: a systematic review. Journal of clinical and diagnostic research: JCDR. 2016;10(8): IE01-IE04. https://doi.org/10.7860/JCDR/2016/17973.8221.
33. Zhang Z. Model building strategy for logistic regression:purposeful selection. Ann Transl Med. 2016;4(6):111. Doi:10.21037/atm.2016.02.15.
34. Sperandei S. Understanding logistic regression analysis. Biochemia medica. 2014;24(1):12-18. https://doi.org/10.11613/BM.2014.003.
35. Kasatpibal N, Whitney JD, Katechanok S, et al. Prevalence and risk factors of needlestick injuries, sharps injuries, and blood and body fluid exposures among operating room nurses in Thailand. Am J Infect Control. 2016;44(1):85-90. https://doi.org/10.1016/j.ajic.2015.07.028.
36. Moayed MS, Mahmoudi H, Ebadi A, Sharif Nia H. Stress and fear of exposure to sharps in nurses. Iran J Psychiatry Behav Sci. 2016;10(3):e3813. https://doi.org/10.17795/ijpbs-3813.
37. Palmer J, Ball D. Opening propofol ampoules. Anaesthesia. 1998;53(4):416-417.
38. Carraretto AR, Curi EF, de Almeida CED, Abatti REM. Glass ampoules: risks and benefits. Braz J Anesthesiol. 2011;61(4):513-521. https://doi.org/10.1016/S0034-7094(11)70059-9.
39. Çalıkoğlu EO, Bedir B, Akçay HB, Gümüş A. Needlestick and sharps injuries among nurses at Atatürk university research hospital and their practices after injury. Eur Res J. 2019;5(1):128-133. https://doi.org/10.18621/eurj.404827.
40. Elmi S, Babaie J, Malek M, Motazedi Z, Shahsavari-Nia K. Occupational exposures to needle stick injuries among health care staff; a review study. J Anal Res Clin Med. 2018;6(1):1-6. http://doi.org/10.15171/jarcm.2018.001.
2. Foda NMT, Elshaer NSM, Sultan YHM. Safe injection procedures, injection practices, and needlestick injuries among health care workers in operating rooms. Alexandria Journal of Medicine. 2018;54(1):85-92. https://doi.org/10.1016/j.ajme.2016.11.002.
3. Garus-Pakowska A, Gorajski M, Szatko F. Did legal regulations change the reporting frequency of sharp injuries of medical personnel? Study from 36 hospitals in Lodz Province, Poland. Int J Occup Med. Environ. Health. 2018;31(1):37-46. https://doi.org/10.13075/ijomeh.1896.01045.
4. Kahriman I, Polat S, Ede G, Kaptan D. Injury experiences and precautions taken by nurses working in pediatric wards towards penetrative/incisive tools. International Journal of Caring Sciences 2016;9(2):569-578.
5. Özlü ZK, Yayla AÇ, Gümüş K, et al. The safe use of sharps and needlestick among nurses working in surgical clinics, Turkey. Eurasian J Emerg Med. 2016;15:187-192. https://doi.org/10.5152/eajem.2016.85856.
6. Hosseinabadi MB, Khanjani N, Etemadinezhad S, et al. The associations of workload, individual and organizational factors on nurses’ occupational injuries. J Clin Nurs. 2019;28(5-6):902-911. https://doi.org/10.1111/jocn.14699.
7. Cui Z, Zhu J, Zhang X, Wang B, Li X. Sharp injuries: a cross-sectional study among health care workers in a provincial teaching hospital in China. Environ Health Prev Med. 2018;23(1):2-2. https://doi.org/10.1186/s12199-017-0691-y.
8. Çiçek-Şentürk G, Tekin A, Gürbüz Y, et al. Retrospective investigation of 9 years of data on needlestick and sharps injuries: effect of a hospital infection control committee. Am J Infect Control. 2019;47(2):186-190. https://doi.org/10.1016/j.ajic.2018.07.015.
9. Akyol AD, Kargın C. Needle stick and sharp injuries among nurses. Global Journal of Nursing & Forensic Studies. 2016;1(4):1-5. Doi: 10.4172/2572-0899.1000109.
10. de Castro AB, Cabrera SL, Gee GC, Fujishiro K, Tagalog EA. Occupational health and safety issues among nurses in the Philippines. AAOHN J. 2009;57(4):149-157.
11. Matsubara C, Sakisaka K, Sychareun V, Phensavanh A, Ali M. Prevalence and risk factors of needle stick and sharp injury among tertiary hospital workers, Vientiane, Lao PDR. J Occup Health. 2017;59(6):581-585. http://doi.org/10.1539/joh.17-0084-FS.
12. Jahangiri M, Rostamabadi A, Hoboubi N, Tadayon N, Soleimani A. Needle stick injuries and their related safety measures among nurses in a university hospital, Shiraz, Iran. Saf Health Work. 2016;7(1):72-77. https://doi.org/10.1016/j.shaw.2015.07.006.
13. Poorchangizi B, Farokhzadian J, Abbaszadeh A, Mirzaee M, Borhani F. The importance of professional values from clinical nurses’ perspective in hospitals of a medical university in Iran. BMC Med Ethics. 2017;18(1):20-20. 10.1186/s12910-017-0178-9.
14. Arli SK, Bakan AB. Investigation of the attitudes towards needlestick and sharps injury among nursing students. International Journal of Caring Sciences 2018;11(1):178-184.
15. Thomas Scientific. Ampule Snapper 2018 [updated March 12, 2018; cited 2018 April 4]. Available from: https://www.thomassci.com/Laboratory-Supplies/Ampules/_/AMPULE-SNAPPER?q=Ampoule%20Opener.
16. Qlicksmart. A simply safer way to open glass ampoules 2007 [updated June 27, 2019; cited 2017 November 7]. Available from: http://www.boscomed.com.au/assets/Brochures/Qlicksmart/SnapITCombo-BrochureA4. compressed.pdf.
17. Haldar R, Singh Bajwa SJ, Kaur J. Opening snap off ampoules – a safer and uncomplicated method. Braz J Anesthesiol (English Edition). 2014;64(6):448-449. https://doi.org/10.1016/j.bjane.2014.02.006.
18. Stoker R. Preventing injuries from glass ampoule shards. Managing infection control [Internet]. 2009 November 07, 2017:[45-47 pp.]. Available from: https://sofia. medicalistes.fr/spip/IMG/pdf/Preventing_injuries_from_glass_ampoule_shards.pdf.
19. Gyawali S, Rathore DS, Shankar PR, et al. Knowledge and practice on injection safety among primary health care workers in Kaski District, Western Nepal. Malays J Med. Sci. 2016;23(1):44-55.
20. Ho AH. Reducing finger cuts when opening glass ampoules. Anaesth Intensive Care. 2016;44(1):127.
21. Lynn P. Taylor’s clinical nursing skills. 4th ed. China: Wolters Kluwer; 2015.
22. Zabir AF, Choy CY, Rushdan R. Glass particle contamination of parenteral preparations of intravenous drugs in anaesthetic practice. Southern African Journal of Anaesthesia and Analgesia. 2008;14(3):17-19. https://doi.org/10.1080/22201173.2008.10872550.
23. Belachew YB, Lema TB, Germossa GN, Adinew YM. Blood/body fluid exposure and needle stick/sharp injury among nurses working in public hospitals; Southwest Ethiopia. Frontiers in Public Health. 2017;5(299). Doi:10.3389/fpubh.2017.00299.
24. Handiyani H, Meily Kurniawidjaja L, Irawaty D, Damayanti R. The effective needle stick injury prevention strategies for nursing students in the clinical settings: a literature review. Enferm Clin. 2018;28:167-171. Doi:10.1016/S1130-8621(18)30060-3.
25. Lien C, Liu P, editors. Ergonomic analysis and survey of sharp injuries on opening the glass ampoule. 2017 4th International Conference on Industrial Engineering and Applications (ICIEA); 2017 21-23 April 2017.
26. Zhang X, Gu Y, Cui M, Stallones L, Xiang H. Needlestick and sharps injuries among nurses at a teaching hospital in China. Workplace Health Saf. 2015;63(5):219-225. https://doi.org/10.1177/2165079915580035.
27. Haldar R, Bajwa SJS, Kaur J. Opening snap off ampoules a safer and uncomplicated method. Rev Bras Anestesiol. 2014; 64:448-449.
28. Zhu SY. Clinical research on nurses breaking off ampoule method. Clinical Journal of Chinese Medicine. 2015;7(1):138-139.
29. Ersin F, Koruk ST, Yilmaz L. Effect of the training provided for nurses on sharp - needlestick injuries and reporting process. International Journal of Caring Sciences. 2016;9(2):561-568.
30. Browner WS, Newman TB, Hulley SB. Estimating sample size and power: applications and examples. In: Hulley SB, Cummings SR, Browner WS, editors. Designing Clinical Research. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2013. p. 55-83.
31. Martínez-Mesa J, González-Chica DA, Bastos JL, Bonamigo RR, Duquia RP. Sample size: how many
participants do I need in my research? An Bras Dermatol. 2014;89(4):609-615. Doi:10.1590/abd1806-
4841.20143705.
32. Motaarefi H, Mahmoudi H, Mohammadi E, HasanpourDehkordi A. Factors associated with needlestick injuries in health care occupations: a systematic review. Journal of clinical and diagnostic research: JCDR. 2016;10(8): IE01-IE04. https://doi.org/10.7860/JCDR/2016/17973.8221.
33. Zhang Z. Model building strategy for logistic regression:purposeful selection. Ann Transl Med. 2016;4(6):111. Doi:10.21037/atm.2016.02.15.
34. Sperandei S. Understanding logistic regression analysis. Biochemia medica. 2014;24(1):12-18. https://doi.org/10.11613/BM.2014.003.
35. Kasatpibal N, Whitney JD, Katechanok S, et al. Prevalence and risk factors of needlestick injuries, sharps injuries, and blood and body fluid exposures among operating room nurses in Thailand. Am J Infect Control. 2016;44(1):85-90. https://doi.org/10.1016/j.ajic.2015.07.028.
36. Moayed MS, Mahmoudi H, Ebadi A, Sharif Nia H. Stress and fear of exposure to sharps in nurses. Iran J Psychiatry Behav Sci. 2016;10(3):e3813. https://doi.org/10.17795/ijpbs-3813.
37. Palmer J, Ball D. Opening propofol ampoules. Anaesthesia. 1998;53(4):416-417.
38. Carraretto AR, Curi EF, de Almeida CED, Abatti REM. Glass ampoules: risks and benefits. Braz J Anesthesiol. 2011;61(4):513-521. https://doi.org/10.1016/S0034-7094(11)70059-9.
39. Çalıkoğlu EO, Bedir B, Akçay HB, Gümüş A. Needlestick and sharps injuries among nurses at Atatürk university research hospital and their practices after injury. Eur Res J. 2019;5(1):128-133. https://doi.org/10.18621/eurj.404827.
40. Elmi S, Babaie J, Malek M, Motazedi Z, Shahsavari-Nia K. Occupational exposures to needle stick injuries among health care staff; a review study. J Anal Res Clin Med. 2018;6(1):1-6. http://doi.org/10.15171/jarcm.2018.001.
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2020-01-02
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Chiannilkulchai N, Kejkornkaew S. A Comparative Study of Ampoule Breaking and Resultant Injury among Registered Nurses. PRIJNR [Internet]. 2020 Jan. 2 [cited 2024 Apr. 20];24(1):89-101. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/181625
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