PONE-D-20-31546

Prevalence and associated factors of needle stick and sharp injuries among Healthcare workers in northwest Ethiopia

PLOS ONE

Dear Dr. Adane (PhD),

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please face all suggestions and reply them. If not make the changes, please justify.

Please submit your revised manuscript by Feb 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Ricardo Q. Gurgel, PhD

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have made rigorous corrections based on previous reviewers' comments. However, there are still several major issues presented in the new manuscript.

1. line 110-112: In the 2007 census report, South Gondar Zone had an estimated total population of... The study was conducted in 2019, can the author provide recent data of South Gondar population?

2. line 167: operational definition of universal precaution: Avoiding contact with patients’ bodily fluids. It should be the "the practice in medicine to avoid contact with patients' bodily fluids". Please provide reference as other operational definition

3. line 222-223: How did you define patient who did not recover from the already existing NSSI? Is it patient that still have wound injury, develop hepatitis B or HIV?

4. Why did you combine internist, ophthalmologist, and other specialist in the same group with health officers who might not have the same chance of exposure to patients' bodily fluid? Why not combine with medical doctor? Please clarify the classification or reclassify as other writers do.

5. line 241-242: How did you define that universal precautions were posted in the institutions? Is it poster or education of universal precaution? Please clarify

6. Table 1. What kind of health care profession that need Master of Science degree in these sites?

7. Table 2: What does it mean by presence of universal precaution in health care setting? Can you clarify why there were health care setting that do not intend to practice universal precaution?

8. Table 2: Work department: Did surgical, medical, and obgyn department mean surgical ward, adult medical ward, and obgyn ward?

9. Table 2: Please clarify other location of sharps container in the bottom of the table.

Table 3: receive HBV prophylaxis. Is it HBV immunoglobulin or HBV vaccination before working in health care institution? Did you consider their knowledge of their own anti HBs level? Please clarify in method section.

10. Table 4: How do you define participants' knowledge about prevention of NSSI? Please clarify items and scoring used in method section.

11. Table 5: IPPS room as place of care after injury? What kind of room is this? Do you mean where they reported their injury in the first time?

12. It is interesting that 8.1% of NSSI happened while walking in the hospital. Can you explain what kind of situation in the study setting that even when walking in the hospital, someone could get NSSI.

13. Table 6: Almost 30% or health care workers did not have training on IPPS? Wasn't that part of their health care workers curriculum in medical faculty or nursing school? Do you mean special training (at least one or several days for IPPS)? Please clarify

14. abstract: prevent sleepy feeling through minimizing daily clinical activities. You can include the reasonable samples of suggestion in the discussion section. Did you mean minimizing clinical activities and adding more workers?

15. Line 360-361: Health education should emphasize dealing with feeling sleepy at work among HCWs working night shifts. Can you suggested proven method for this suggestion?

16. Line 263-264: Sixty-eight (78.2%) had sustained injury only one time in the previous 12 months and 8.0% recalled three or more injuries. Was there any one had 2 injuries in the previous 12 months?

Reviewer #2: Overall, the issue raised is relevant and the paper is well written. However, there are grammatical and writing errors which has to be corrected in addition to the following specific comments and questions.

Abstract:

• Use structured abstract form.

• Remove the following from abstract as it not your main objective.

“Of these, 46.0% reported that their injuries were moderate, superficial (33.3%) or severe (20.7%). Most injuries (41.4%) were caused by a suture needle or by a disposable syringe (27.6%).”

• Conclude your first objective using general terms by comparing it with other studies or standards. Where is your conclusion regarding associated factors?

Background:

• Move the following sentence before the last paragraph of the background section.

“Needle-stick incidents are associated with a number of different job factors, including heavy workload, working in surgical or intensive care units, insufficient work experience, and young age [3].”

Methods:

• Study setting: Rearrange the flow of writing of the study setting and remove redundancies.

• Study design and source population

Include inclusion and exclusion criteria.

• Operational definitions:

“Healthcare workers (HCWs): A healthcare professional whose activities involve contact with needles and other sharps during the course of their work in a healthcare facility [2].” Mention the types of health professionals involved in the definition.

Results:

• Generally, narrating every category of a variable is not recommended if you have tables. So, modify the narrations of socio-demographic characteristics of healthcare workers, organization-related characteristics, behavioral characteristics, and prevalence of needle stick and sharps injuries. Mention the largest or the lowest percentage as needed.

• Don’t use jargon words like most, majority, great majority and so on.

Discussion:

• Paragraph 2 and 4: Further justification is needed.

• Before the last paragraph of the discussion, write the overall implications of the study

Conclusions:

• Conclude your first objective using general terms by comparing it with other studies or standards.

References

• Reference 12 & 14: Check these references. They are similar except the year.

Reference 12: “Feleke BE. Prevalence and determinant factors for sharp injuries among Addis Ababa hospitals health professionals. Sci J Public Health. 2015;1(5).”

Reference 14: Feleke BE. Prevalence and determinant factors for sharp injuries among Addis Ababa hospitals health professionals. Sci J Public Health. 2013;1(5):189-93.

Table 2: Other than safety box: what do you mean? Mention those you found. Other in the last row of the table is not defined.

Table 6: Why you include those variables which are not significant in the final model?

Minor comments

• Line 142: Delete the phrase “for each own profession”. It is repetition.

• Line 161: Delete “study participant”.

• Line 201: Change “bivariate” by “bi-variable”

• Line 229: Change “Socio-demographic characteristics of the study participants” to (Socio-demographic characteristics of healthcare workers”.

• Line 234: Delete this sentence. It is repetition.

“One hundred twenty-four (42.0%) were nurses.”

• Line 301: Delete “of these findings to ours”

• Line 303: Delete “found by”

• Line 316: Delete “(P<0.01)”

• Table 1: Include keys for HCW, BSc. MSc. And MD

• Table 2: Include key for HCW

• Table 5: Include key for NSSI

• Table 6: Include keys for HCW, BSc, MSc, MD, and USD

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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PONE-D-20-31546R1

Prevalence and associated factors of needle stick and sharp injuries among Healthcare workers in northwest Ethiopia

PLOS ONE

Dear Dr. Adane,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by May 15 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Ricardo Q. Gurgel, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Authors revised the manuscript.Some have been addressed, but some modifications still required.

1. line 167: operational definition of universal precaution: Avoiding contact with patients’ bodily fluids. It should be the "the practice in medicine to avoid contact with patients' bodily fluids". Please provide reference as other operational definition

Response: We cited reference for the definitions of universal precaution (see in page 8 line 182).

Comments: As suggested before, the author need to use more standard definition and cite from appropriate reference. The citated reference is not easy to find and wrongly written.

2. Why did you combine internist, ophthalmologist, and other specialist in the same group with health officers who might not have the same chance of exposure to patients' bodily fluid? Why not combine with medical doctor? Please clarify the classification or reclassify as other writers do.

Response: This is because of the frequency of the data. In each hospital the number of internist, ophthalmologist, and other specialist is mainly one or two or three and even sometimes no in the specific category. To make the model suitable during the data analysis, we merged that very less frequent profession in the same category regardless of the exposure level.

Comments: I still found the reason of combining these specialists with health officers not reasonable. Especially, it was just based on suitable data analysis.

3. Table 3: receive HBV prophylaxis. Is it HBV immunoglobulin or HBV vaccination before working in health care institution? Did you consider their knowledge of their own anti HBs level? Please clarify in method section.

Response: Thank you for this important questions. We mean that HBV vaccination before working in health care institution. We noted this in Table 2 foot note and please see Table 2.

Comment: It is better to call as HBV vaccination (completed or not-completed). I assumed the author did not have data on HBV vaccine completion.

4. Table 4: How do you define participants' knowledge about prevention of NSSI? Please clarify items and scoring used in method section.

Response: Thank you for this key questions. We made error by saying knowledge, but our study was either the know NSSI can be prevented or not, we updated Table 4. We did not study knowledge using different items of questions.

Comment: Does it mean prevention NSSI or prevention of infection caused by NSSI? These are two different terms

5. It is interesting that 8.1% of NSSI happened while walking in the hospital. Can you explain what kind of situation in the study setting that even when walking in the hospital, someone could get NSSI.

Response: Thank you for your concern. Walking in the hospital means that when going to toilet, during moving from one ward to the other ward, during moving from one location to other location during tea break time and etc.

Comment: If this was the situation in that hospital, I would suggest the author describe with more data and emphasize more in the discussion. Please also include realistic suggestion to this horrible situation.

6. It is interesting that 8.1% of NSSI happened while walking in the hospital. Can you explain what kind of situation in the study setting that even when walking in the hospital, someone could get NSSI.

Response: Thank you for your concern. Walking in the hospital means that when going to toilet, during moving from one ward to the other ward, during moving from one location to other location during tea break time and etc.

Comment: If this was the situation in that hospital, I would suggest the author describe with more data and emphasize more in the discussion. Please also include realistic suggestion to this horrible situation.

Reviewer #2: The authors have improved the paper very well. All the comments are properly addressed.

•The abstract is well structured,

•The background section is rearranged,

•The methodological issues are corrected,

•The write up of the results, discussion and conclusion section are improved,

•The implications of the study are indicated,

•Corrections are properly made on references,

•Writing and grammatical errors are corrected and

•Key notes of tables are properly defined and written.

By now, I will be happy if the paper is published at PLOS ONE.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Evy Yunihastuti, MD, PhD

Reviewer #2: Yes: Getaw Walle Bazie

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Prevalence and associated factors of needle stick and sharp injuries among Healthcare workers in northwest Ethiopia

PONE-D-20-31546R2

Dear Dr. Adane,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

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Kind regards,

Ricardo Q. Gurgel, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: