Nursing Project Topics

Improving the Knowledge of Injection Safety Among Student Nurses of the School of Nursing Calabar

Improving the Knowledge of Injection Safety Among Student Nurses of the School of Nursing Calabar

Improving the Knowledge of Injection Safety Among Student Nurses of the School of Nursing Calabar

Chapter One

Objective of the Study

The general objective of the study was to determine level of knowledge, attitude, and practice of nurses on injection safety at Cross River state Hospital.

Specific objective

The specific objectives were:

  1. To determine the level knowledge among nurses on injection safety at the hospital;
  2. To identify the nature of injection practices among nurses at the hospital;
  3. To explore nurses attitudes towards injection safety practices at the hospital




This chapter covers the literature review of the study under the following subtopics; definition of safe and unsafe injection, training on injection safety, nurse’s level of knowledge regarding injection safety, their attitude and nature of practice regarding injection. It will also cover the epidemiological review of unsafe injection in developed countries, developing countries and in Nigeria.

Safe and unsafe injection


Injection is aseptic procedure that involves piercing the skin to deliver medication of for vaccination purposes. This may be through intramuscular, intravenous, intradermal or subcutaneous route. Injection can either be used for therapeutic or vaccination role (MOH, 2007) as 5% of injection are used for vaccination and 95% used for therapeutic purposes (P Sharma et al.,2013).In practice, most of the injection given are for additional revenue earn as they are misused and overprescribe in the healthcare facilities.

Safe injection

Safe injection also called aseptic injection practice is a medical procedure that neither causes harm to the patient nor exposed the nurses to any avoidable risk and also not results in waste that is hazardous to the community (WHO, 2010).

It involve administration of rational injection by a qualified and well-trained person using sterile devices (syringes, needle), adopting sterile technique, and discarding the used devices in a punctured proof specially designed container for appropriate disposal(WHO,2010). Also, it is one of the elements of infection prevention standards recommended by WHO/CDC as guidelines for reducing the risks of transmission or acquiring of blood-borne infections and other pathogens in the hospitals (Gertrude Moyo, 2013).For high quality healthcare services to be achieved, healthcare provider must strictly adhere to simple and cost effective infection prevention practices such injection safety practices (National infection prevention and control for healthcare services in Nigeria,2010).

Unsafe injection

In contrast to injection safety, unsafe injection include number of harmful practices considered harmful to either patients, healthcare providers or the community around such as multiple use of single-use needles and syringes, recapping of needles and improper disposal of sharps(SK Sarin,2013).

Causes and prevalence of unsafe injection varies from country to country worldwide. Several factors such as awareness, level of knowledge, socio-demographic and economic factors (Drucker, 2001). These triggers of unsafe injections practices results into complications, severe and chronic infection and also harms (need-stick injuries) to the nurses and patients causing a financial burden to individuals or to the whole nation.

Infection that results are termed as hospital acquired infections or the blood borne pathogens namely hepatitis B, hepatitis C and HIV/AIDS (CDC, 2015) and are significantly increases the cost of healthcare services through extended stay in the hospitals, increased disability and also prolonged the recovery time of the affected individual(s).Needle –sticks injuries are the major harms resulting from this plague.

Magnitudes and burdens of unsafe injection practice

Unsafe injection contributes to harms and associated risks (infections) that are major setback to healthcare facilities. Almost 10% of the hospitalized patients are at risk of getting the so called hospital acquired infection that is mostly associated with unsafe practices.

Despite the fact that no adequate data on the level of unsafe injection practice in Nigeria, data from Nigeria AIDS Indicators Survey (NAIS, 2007) clearly shows that an estimate of 6.6 million(33.1%) people receive at least one injection, a predisposing factor for the spread of infections.

Worldwide, unsafe injection practices are responsible for approximately 5% of HIV infections, 30% of hepatitis B infections and 40% hepatitis C of infections, whereby about 16-20 billion injection are given annually (O.A. Bolarinwa, 2011; WHO, 2005).

Currently, the global burden due to previous and present unsafe injection practice scaled up to 0.5 million death, with grater portions of deaths occurring in Asia and Africa among persons aged greater than 15years (O.I. Musa, 2011).

Approximately 8.5% of 35 million healthcare workers including nurses experience needle-sticks yearly. This contributes to 40% of infections due to sharps namely hepatitis B, hepatitis C, and 2- 3% of HIV infections (Yacoub R, et al., 2010). Moreover, 9 out of 10 patients attending healthcare institutions receive an injection, among which 70% of the injections administered are unnecessary and could be given orally (I.A. Joshua,2005).





The chapter specifies the materials and methods used in determining the level of knowledge, attitude practice of nurses of injection safety in Cross River state Hospital.

Research design

This was a descriptive cross-sectional study design. The study design adopted both quantitative design through the use of structured, standardize, self-administered questionnaires and a qualitative design through the use of structure standardize observation checklist.

Study variables

Independent variables were knowledge attitude and practice and the socio-demographics characteristics. The dependent variable was injection safety.

Target population

The target population was the qualified nurses working in Cross River state Hospital, Calabar.

Study population

Nurses in NCRH meeting the inclusion criteria.. Nurses were targeted because of them being the majority of healthcare providers in giving injections after doctors’ prescription render them risk of acquiring infection and harms (Moyo, 2013).




This chapter presents of the study collected from the respondents (nurses).Data analysis and presentations done in pie chart, bar graphs and in tables as illustrated below.



 Discussion of findings


Safe injection practices are medical procedures recommended by WHO/CDC with the intentions of preventing the transmissions of infectious diseases from healthcare providers to patients or vice versa in healthcare institutions. Because it is not always justifiable if an individual has infectious disease or not, basic safety measures should be applied when dealing with any patient every time to ensure transmission of diseases does not occur (Siegel& Rhinehart, 2007).

In this, discussion of the study findings is presented as shown below. Focal points were the respondents’ characteristic, knowledge of respondents regarding injection safety, injection safety practices, and nurses’ attitude towards unsafe injection practices.

Characteristic of the participants

Age and Sex distribution

In this study, findings related to participants’ characteristics revealed that out of 97 nurses who voluntary consented and participated in this study, majority of them (n=89) were female(Figure 1). This is an expected reality as nursing is being perceived by majority as a female dominant profession. A study done by Vincent E Omorogbe et al, (2012), Gertrude Moyo, (2013) and Musa O.I, (2005) on injection safety practice also revealed similar findings. Mean duration of training female nurses is also higher compared to male training in nursing program (Omorogbe et al, 2012).

Average age of all the respondents was 42 with minimum age being 26years and maximum age of 56years.Majority of them (n=71)were within the age group of 30-40 years with less than three quarter being within age group 20-30 years(Figure 2). Those aged above 50years were the least in number. Similar finding was reported in a study done in 3 Moroccan health centers by Djeriri K et al., (2005).

Level of education (Nursing cadre)

Expectedly, Registered nurse/midwifes (Diploma level) participated had the highest proportion compared to other nursing cadres (Figure 3). Very few of the respondents has an undergraduate degree (Bsc.N).This is very important because it is among the nursing cadres required for effective and sustainability of primary healthcare delivery to the community in Nigeria (O.A. Bolarinwa et al., 2011).This validate the actual situation of most public healthcare facilities in Nigeria where majority of nurses are trained at diploma level, Nigeria Health Workforce Information System (KHWIS, 2012).Similar result was also reported in a study done in Nigeria on injection safety by C.N. Obionu (2007).


Nurses in this facility had high rates of unsafe injection practice. Majority of them showed positive attitude towards injection safety and a good level of knowledge about injection safety. Training concentrating on injection safety, guidelines to dispose biomedical waste and monitoring of the activity is needed.


  1. There is need for on job training of nurses through seminars, workshops and conferences to ensure that injections are administered in a safer manner.
  2. Need for Supervision on correct and proper usage of injection
  3. Need for periodic injection safety assessment and auditing in all Calabar healthcare facilities including Cross River state Hospital to promote provision of injection safetys that does not harm.


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