Nursing technicians ’ knowledge accident with needle sharp material

RESUMO Objetivo: analisar o conhecimento de técnicos em enfermagem acerca do acidente com material perfurocortante. Método: estudo descritivo, de abordagem qualitativa, realizado em um hospital de grande porte no estado do Piauí, com 12 técnicos em enfermagem. Os dados foram obtidos com roteiro de entrevista semiestruturado e analisados mediante técnica de análise de conteúdo. Resultados: a maioria apresentou conhecimento satisfatório acerca do acidente com material perfurocortante. O descarte inadequado de agulhas e lâminas foi apontado como o principal causador desse acidente. Houve divergência em relação à contaminação ou não do material para ser considerado acidente perfurocortante. Grande parte relatou que esse tipo de acidente é bastante angustiante, perturbador e traumatizante e que tinha dúvidas sobre a notificação e o tratamento desse acidente. Conclusão: embora a maioria apresentasse conhecimento satisfatório sobre acidente com perfurocortante, é necessária maior preocupação com a Biossegurança, a educação continuada e a prevenção de acidentes ao trabalhador. Descritores: Contenção de riscos biológicos; Riscos ocupacionais; Exposição ocupacional; Saúde do trabalhador; Enfermagem do trabalho. ABSTRACT Objective: to analyze nursing technicians’ knowledge about accident with needle sharp material. Method: descriptive study of qualitative approach, performed at a large-sized hospital in the state of Piauí, with 12 nursing technicians. Data were obtained through semi-structured interviews and analyzed through content analysis technique. Results: the majority showed satisfactory knowledge about accident with needle sharp material. Improper disposal of needles and blades was pointed out as the main cause of this accident. There was divergence in relation to contamination or not of the material to be considered needle sharp accident. A large part reported that this type of accident is quite distressing, disturbing and traumatic, in addition to having doubts about the notification and treatment of this accident. Conclusion: although the majority presented satisfactory knowledge about accidents with needle sharp material, there is a need for greater concern with Biosafety, continuing education and prevention of accidents to workers. Descriptors: Containment of biohazards; Occupational risks; Occupational exposure; Occupational health; Occupational health nursing.


INTRODUCTION
Accident with needle sharp material is one of the main occupational risks inherent to health care, and nursing professionals are the most affected due to direct contact with patients, high number of invasive procedures and constant handling of sharp objects and biological materials [1][2][3][4] .In this perspective, the concern with Biosafety, use of Personal Protection Equipment (PPE) and respect to standard precautions are essential to prevent this type of occupational accident 5 .
Needle sharp materials are instruments that cause injuries during handling, once they perforate and cut at the same time, and percutaneous exposure is the most frequent in accidents involving biological material [6][7][8][9] .In this way, to guarantee workers' safety in health services and to prevent accidents with needle sharp materials, the Regulatory Norm 32 was established, through the elaboration of several guidelines for handling and proper disposal of these materials 10 .
In Brazil, occupational accidents with exposure to biological material are of compulsory notification.However, many professionals do not notify these types of accidents, usually because they consider communicating this accident unnecessary, disregard the risks to which they are submitted or fear repression.Therefore, notification and adoption of post-exposure prophylactic measures are crucial for preventing the acquisition of infections transmissible by blood contact 11 .
The main causes of accidents with needle sharp materials are inadequate execution of the technique during the procedure, non-use of personal protective equipment and inappropriate disposal of needle sharp materials [12][13][14] .
Furthermore, a study carried out in São Paulo revealed that professionals aged 30 through 39 years and with less than five years of professional activity had a higher incidence of occupational accidents involving exposure to biological material 14 .
A instruments, such as needles, scalpels and glassware 18 .In addition, the ANVISA highlights that accident with needle sharp material is caused by instruments that perforate and cut, regardless of being contaminated with organic matter or not 19 .
In line with the findings of this study, researches showed that needles, scalpel blades and lancets are the most common instruments that cause accidents with needle sharp materials 20 .Moreover, the fact that nursing Thus, during procedures with needle sharp material, some recommendations are essential for preventing accidents, such as utmost attention, not using the fingers as bulkhead, not recovering, bending, breaking or withdrawing the needle of the syringe, not using needles to fix roles, discarding all needle sharp material, even if sterile, in containers resistant to perforation and with lid.In addition, these manifolds for disposal must be completed only up to 2/3 of its total capacity 18 .
Biosafety, despite being little cited by participants, is fundamental in health services for the safe handling and reduction of needle sharp accidents.In this context, educational institutions should raise awareness among students regarding safe practices, because, in the spaces of teaching-learning process, with the culture toward prevention, professional habits emerge 24 .
In the exercise of labor activities, one effective way to minimize risks to which health workers are exposed consists in correctly using PPE.However, a research shows that nursing professionals do not use correctly all these personal protective equipment recommended by the Brazilian legislation during procedures, which highlights the importance of strengthening the culture of safety at work of health organizations 5 .
Therefore, a study carried out at a highcomplexity hospital of the state of São Paulo showed that 25% of professionals who suffered accidents did not use gloves while executing the procedure 14 .In addition, another research showed that only 16.6% of the injured used PPE, even recognizing that such equipment is  18,26 .
Thus, the victim of such accident with biological material must report the incident immediately to the headship for completion of the first care with the exposed area, then start the flowchart for this type of accident.
Therefore, the health care network must provide professionals who are able to receive and guide victims of such accidents, in order to ensure the effectiveness in care and avoiding losing these professionals 27 .
Regarding how to proceed and who to seek after the accident with biological material, the first care consists of washing the exposed site with soap and water.Subsequently, there should be the assessment of the type of material involved and, if possible, the identification of the patient-source..From this perspective, the organization of healthcare should provide subsidies for promotion of Biosafety, but the employee also needs to be aware, to have attitude, respect and zeal to incorporate, in nursing care, safe practices 20 .
We emphasize that our text has limitations in the generalization of the results, since this is a qualitative study, which reduces the extension of the findings to the universe of participants.The option for a cross-sectional study also hampers observing changes in knowledge along a historical cohort study 28 .

CONCLUSION
technicians have increased load of activities along with the patient, in addition to manipulating and handling with greater frequency needle sharp materials, making them more susceptible to the occurrence of these types of accidents, highlighting the importance of supervision and continuing education to these professionals 14,21 .Regarding the most recurring causes of needle sharp accidents, the statements of this study corroborate the results of a study that identified carelessness, lack of technical failure and improper disposal of material as the main factors that provide this type of accident.In addition, the occurrence of accidents with needle sharp materials showed association with the overload of work, the patient's conditions and the inadequacy of materials, equipment and infrastructure 20 .Furthermore, lack of knowledge about risks, lack of training and qualification, shortage of materials in quantity and quality, the insufficient number of professionals, physical and mental fatigue and little experience are factors that contribute to increased incidence of accidents with needle sharp instruments 13,22-23 .
victim's consent to perform serological tests, monitoring during six months, chemoprophylaxis, if necessary, checking the vaccination against hepatitis B, in addition to providing emotional support, due to post-accident stress 10 .In this context, the indication or not of post-exposure chemoprophylaxis occurs by assessing the risk of exposure, taking into account the type of biological material, severity and type of exposure, the (non-)identification of the patient-source and the anti-HIV serology.Furthermore, the clinical, immunological and laboratory data of the patient-source identified as infected by the Human Immunodeficiency type of accident, but some reported doubts in relation to the notification and the flowchart of post-exposure care.This highlights the importance of continued education and the strengthening of the worker's health, in order to reduce this type of occupational accident and ensure the effective care to victims of occupational accidents with needle sharp material.Furthermore, the culture of Biosafety needs to be implemented in nursing care, once the study participants little mentioned it, even being the most effective mechanism to prevent this kind of accident.Therefore, we emphasize that strategic planning, ongoing training, guidelines, routine inspections and internal audits are necessary to improve the safety culture at work, ensure these professionals' knowledge about accidents with needle sharp material, post-accident flowchart and Biosafety measures, aiming to contribute to behavioral change in relation to adherence to safe practices and, concomitantly, to reduce this type of accident at work.

Causes and consequences of accidents with needle sharp material in the nursing technician's perspective
of Hospital Infection Control of that hospital, which allowed identifying a considerable number of accidents with needle sharp material involving nursing technicians.In this sense, in order to Cardoso ALC, et al Accident with needle sharp material Rev Pre Infec e Saúde.2018;4:needlesharp material was founded by the manuals of the Ministry of Health (MOH) and the National Sanitary Surveillance Agency (ANVISA -Agência Nacional de Vigilância Sanitária) 18-19 .This study followed the ethical principles of Resolution 466/2012 of the National Health Council, being approved by the Research Ethics Committee of the State University of Piauí, with CAAE 615999316.5.0000.5209and opinion 1.887.249.The service time in the nursing area ranged from 6 months to 37 years.Cardoso ALC, et al Accident with needle sharp material Rev Pre Infec e Saúde.2018;4:7285 4 After analysis, three categories emerged: Category 1 -Nursing technician's knowledge about accidents with needle sharp material; "Materials that can perforate or cut when in contact with the skin, and they can be contaminated or not" (D 5) Category 2 -

Nursing technicians' questions about management in accidents with needle sharp material
Rev Pre Infec e Saúde.2018;4:7285 6