nowadays , with technological advances in medicine , the use of invasive procedures and injections in patients has expanded . as a result
, health care staffs are exposed to a high risk of blood - borne pathogens ( 1 ) .
needle stick injury ( nsi ) is one of the most dangerous occupational situations ( 2 ) . among 20 types of blood - borne pathogens , which are transferred through nsi to health care workers , viral infections such as hepatitis b , c and human immunodeficiency virus ( hiv )
studies have shown that being exposed to infectious diseases and nsi can cause stress in nurses ( 6 ) .
this particular type of stress has a negative impact on the individuals and influences their families and colleagues ( 7 ) .
stress represents a major occupational hazard in modern age and has been incriminated for productivity reduction , absence from job , displacement of personnel , work conflicts and higher health care costs for employees ( 8) . in a study on the psychological consequences of nsi , greene and griffiths found that the severity of the illness caused by needle stick is as significant as other psychological traumas .
moreover , the depression resulting from this situation is similar to other psychological traumas , and the duration of the condition is associated with the duration of obtaining the result of the second test .
this has a far - reaching impact on family relationships , sexual health and presence at the workplace ( 9 ) . between 1992 and 2003 ,
leigh et al . stated that injury stress led to the absence of 903 nurses , physicians and workers .
moreover , 7% of the injuries resulted in loss of more than 31 working days ( 10 ) .
performed a study , which measured the incidence of post - traumatic stress disorder ( ptsd ) after injury , on doctors .
results showed that 12% were suffering from ptsd reactions , therefore suggesting an emphasis on addressing psychological reactions to nsi ( 11 ) . despite numerous studies performed on the prevalence and incidence of injuries from sharp objects in iran , no research with specific tools
therefore , the aim of this study was to assess the degree of stress in nurses , who have been exposed to sharp objects .
the study subjects were nursing staff of several cities that were selected by cluster sampling in three stages . at first
, four provinces were randomly chosen from different geographic areas of iran . in the second stage ,
11 hospitals of these cities were selected by the same form of simple randomization and finally , the nurses were enrolled through census sampling from every shift .
hospitals were located in tehran ( four hospitals ) , isfahan ( three hospitals ) , kerman ( two hospitals ) and hamedan ( two hospitals .
data collection was a two - part questionnaire including demographic characteristics and stress of exposure to sharps injury .
the questionnaire section related to the stress of exposure to sharp injury contained 20 closed questions and the likert response was classified to five scoring levels : very low ( score of 1 ) , low ( score of 2 ) , average ( score of 3 ) , high ( score of 4 ) , and very high ( score of 5 ) .
the minimum total score that could be obtained was 20 and the maximum score was 100 .
the stress questionnaire had four dimensions , including safety policy ( five questions ) , occupational safety ( five questions ) , contact nursing ( four questions ) and mental - environmental conditions ( six questions ) .
the cronbach s alpha coefficient of internal consistency of this instrument was 0.92 and interclass correlation coefficient was 0.94 ( 12 , 13 ) .
the questionnaire assessed stress levels caused by exposure to sharp objects in different situations or circumstances , as well as the amount of stress for nursing staff . in this study ,
based on the formula n = and p = 0.3 , d = 0.04 , the sample size was calculated as 502 , and considering the 10% loss , 550 questionnaires were distributed and 527 questionnaires were returned , thus a total of 527 fully completed questionnaires were included in the study .
the research objectives and the study methods were approved by the ethical committee of baqiyatallah university of medical sciences , teheran , iran , and the study subjects gave their written consent .
the analyses were performed using spss 16.0 ( released 2007 ; spss for windows , spss inc . ,
basic descriptive statistics for quantitative variables was presented using mean ( sd ) and n ( % ) for qualitative variables .
adjusted linear regression model with 95% confidence interval ( ci ) was used to predict the degree of stress in nurses , who were exposed to sharp objects .
after review of the collected 527 questionnaires , the mean age of the study subjects was reported at 35.7 ( sd = 8.7 ) years , and of these , 41.2% were male and 58.8% were female .
the average work experience was 12 ( sd = 8.3 ) years , with a minimum of one year and maximum of 40 years .
of the subjects , 83.1% had bachelor s degree and 58.3% reported a history of injury with a sharp object .
stress from risk of injury by exposure to sharp objects in nurses was reported to be 58.37% .
the average stress score in nursing staff was 58.37 ( sd = 15.08 , 95% ci : 57.08 to 59.66 ) .
table 1 confirms that changes in independent variables were significantly able to predict variance in stress scores .
the adjusted linear regression model explained 36% of the overall variance in stress score ( r2 = 0.60 ) , which was found to significantly predict outcome , f ( 4 , 521 ) = 8.26 , p < 0.001 . according to table 1 ,
the adjusted linear regression model showed risk predictors for stress score in nurses , who were exposed to sharp objects according to ward satisfaction , having master of science , age , and number of contacts .
the stress of nurses was measured based on different domains of the questionnaire after standardization ( figure 1 ) .
this study , using a proprietary questionnaire , was conducted to investigate the stress of dealing with sharp objects by nursing staff .
regarding the occupational safety domain , one study showed a significant relationship between carelessness of nurses and injuries from sharp objects , especially in the setting of insufficient number of nurses ( 1.92 times ) , weariness and excitement ( 2.16 times ) , lack in resources support ( 1.88 times ) and inexperience of nurses ( 1.74 times ) .
considering the actual conditions of a shortage of nurses , there is an increase of the degree and amount of damage secondary to injury ( 14 ) .
the study of torshizi and ahmadi measured the domain of patient care stress in nurses by using two items , exposure to body fluids and risk of infectious diseases transmission , which were insufficient for the evaluation of stress produced by sharp objects ( 15 ) .
the severity and extent of the stress of a contact - care study conducted on two nurses that were injured during care of an hiv patient , in addition to emotional problems during a 22-month follow up , led to depression , anxiety , insomnia and nightmares in the participants , even after receiving negative laboratory results about any possible infection ( 16 ) .
each of the studies focused on only one of the items of the area . in the study of oconnor
, it was demonstrated that injury by sharp objects caused leave or absence and prolonged work interruption due to anxiety or stress disorder , with a rate of one out of 20 individuals , resulting in a reduction of the quality of work ( 17 ) .
the study of seng et al . showed that only 146 cases out of 242 injured health workers reported their injuries to the authorities ( 4 ) .
results of other studies showed that improvement in performance attitudes and increasing awareness and education are essential to control and reduce damage ( 18 ) .
the cause of damage is related to the workplace , including improper conditions for disposal of the needles and sharp instruments , overcrowding , noise , heat , chaos , lack or inadequate protective equipment gloves , goggles and gowns , which account for 27.2% and patient - related factors , such as sudden movements , improper use of equipment designed for patient and disease - related damage by sharp objects , which are responsible for 7.6% of the total causes ( 19 ) . in the area of safety policy ,
serinken et al . showed that personnel - related factors , including failure to use protective equipment , carelessness , lethargy , and lack of proper training , caused 64.9% of incidents ( 19 ) .
it is noteworthy to mention that only 36% of nurses , who were injured with needle stick within the past year , reported this to their supervisor or hospital emergency ward or infection control committee ( 20 ) .
, showed a high level of awareness and knowledge of the universal precautions , however , there s still a gap between science and practice , which leads to the extended rate of damage ( 21 )
. however , other results showed that health workers required more training ( 22 ) . in another study
, 38.3% of the subjects had a history of injury from needles and sharp objects within the last six months ( 23 ) .
we calculated the incidence of injuries with sharp objects at 58.3% , which is different to the study of sharifian et al . because of the three - month period of investigation in their study , compared to our study , which was performed during a longer time period ( 24 )
however , the results of a study in germany showed a reduced incidence of nsi in nurses inclined to use a safety box .
the use of safety equipment reduced the rate of such injuries from 69% to 52% ( 25 ) . in our study , despite the fact that more than 75% of the participants worked more than the required time , there was no significant difference in the amount of stress .
however , a study in baltimore confirmed that working for 13 hours or more during a day marked a significant contribution to the incidence of nsi ( 26 ) .
the results of this study , showed that stress levels in nurses are highly increased by working with sharp objects , an issue , which requires special attention from authorities to implement educational programs and raise the awareness and ability of the staff to prevent injury and to improve the skills of self - control in stressful situations .
mastery over the mind , the environment and the health service is the best course , in addition , to ensure risk - free environments , providing facilities to reduce injuries and making managers understand their duties to follow up and provide medical service and prophylaxis in the event of injury , are necessary .
 backgroundinjuries caused by sharp objects , which involve biological hazards are considered as one of the most important factors that lead to stress among the nursing staff . 
 contact with sharp objects is a major concern among healthcare workers , especially nurses.objectivesthis study was done to determine the amount of stress caused by exposure to sharp medical instruments among nurses.materials and methodsthis was a cross - sectional research on 527 nurses , working at different medical centers across iran , with a cluster - sampling method . 
 the relevant data was collected with a valid and reliable questionnaire . 
 the cronbach s alpha coefficient of internal consistency of this instrument was 0.92 and interclass correlation coefficient was 0.94resultsthe results showed that ward satisfaction , having master of science , age , and number of contacts were significantly able to predict variance in stress scores . 
 the adjusted line regression model explained 36% of the overall variance in stress score ( r2 = 0.60)conclusionsthe results of this study showed that exposure to sharp objects may cause high stress in the nursing staff . 
 considering higher levels of stress in the area of contact care , the provisions on how to deal with patients and safe care can help reduce stress . 
1. Background
2. Objectives
3. Materials and Methods
4. Results
5. Discussion