Effectiveness of quality improvement on occurrence of needle stick injuries (NSIs) in Harare city, Zimbabwe, 2017: A Quasi-experimental study 

Zvanaka Sithole1, Kudzai Masunda2, Collen Madembo2, Chonzi Prosper2, Stanely Tapesana1, Shecriton Muguza2, Olufemi Ajumobi3, Lilian Bulage4,5, Tsitsi Juru1,&, Notion Tafara Gombe1, Gerald Shambira1, Mufuta Tshimanga1


1Department of Community Medicine, University of Zimbabwe, Harare, Zimbabwe

2Harare City, Zimbabwe

3African Field Epidemiology Network, Nigeria Country Office, Abuja

4African Field Epidemiology Network, Kampala, Uganda

5Uganda Public Health Fellowship Program, Kampala, Uganda

&Corresponding author

Juru Tsitsi, Health Studies Office P.O. Box CY 1122 Causeway Harare, Harare, Zimbabwe


Received: 20/10/18   Accepted: 09/11/18   Published: 13/11/18


CITATION: Zvanaka Sithole, Kudzai Masunda, Collen Madembo, Chonzi Prosper, Stanely Tapesana, Shecriton Muguza, et al. Effectiveness of quality improvement on occurrence of Needle Stick Injuries (NSIs) in Harare City, Zimbabwe, 2017: A Quasi-experimental study. J Interv Epidemiol Public Health. 2018 Nov;1(1). 

© Sithole Zvanaka et al. Journal of Interventional Epidemiology and Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Globally, healthcare workers (HCWs) incur an estimated two million needle stick injuries (NSIs) per year and 90% of these injuries occur in Africa. In Zimbabwe, neither the prevalence nor the factors associated with HCW-acquired NSI are known. Harare city recorded an increase in NSIs among nurses from 1% in 2013 to 7% in 2016, highest being from the Southern District. We designed and evaluated the effectiveness of a quality improvement (QI) approach towards reduction of NSI incidence. Methods: We conducted a quasi-experimental study purposively among 83 nurses in southern District. We designed and implemented an intervention package comprising training, deployment of social behavioral change materials and workflow re-organisation. We measured effectiveness of the intervention using Plan, Do Check Act cycle. Data on intervention effectiveness was collected pre and six months post-implementation, using structured questionnaires. Analysis was presented with frequencies, means, and proportions. Results: Lack of knowledge 99% (82/83), unorganised activities 60% (50/83) and limited space in the treatment rooms 59% (49/83), were the major reasons for NSI before intervention. Pre-intervention, 10% (8/83) of the nurses had good knowledge level while 96% (80/83) had good knowledge level post- intervention. The NSI incidence rates pre-intervention was 0.97 NSI/month and 0.17 NSI/month post-intervention, a decline rate of 82% (p< 0.01). Total cost saved by the intervention was $5 777.00. Conclusions: Lack of knowledge on occurrence of NSI, unorganised activities, and limited working space in the treatment rooms were the major reasons for NSIs before the intervention. The QI intervention was effective in reducing incidence of NSI. We recommend HCW trainings on NSI, promotion of socio-behavioral change and workflow re-organisation in order to offset economic efforts directed at managing NSIs.

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