Prevalence and Determinants of Work-Related Injuries Among Healthcare Workers in Jeddah, Saudi Arabia

Background and objective Work-related injuries (WRIs) are a major occupational health issue among healthcare workers (HCWs) worldwide. Unsafe work environments, including physical, chemical, and biological hazards, are significant contributing factors to WRIs. However, the prevalence of WRIs among HCWs in Jeddah, Saudi Arabia, and their associated risk factors remain largely unexplored. In light of this, this study aimed to investigate the prevalence of WRIs and associated risk factors among HCWs in Jeddah, Saudi Arabia. Methods This was an analytic cross-sectional study conducted at secondary hospitals of the Ministry of Health (MOH) in Jeddah by using a self-administered questionnaire to measure the prevalence of WRIs and their related factors. The Chi-squared test was used to compare variables. A p-value <0.05 was considered statistically significant. Results The study involved 387 participants, of whom 283 (73.1%) were female. Most of the participants (n=226, 58.4%) agreed that personal protective equipment (PPE) was always available at their hospitals. Approximately two-thirds (n=251, 64.9%) agreed that they always used PPE. The overall prevalence of WRIs was 52%, with back injuries (32.6%), eye/mouth splashes (20.4%), and needle stick injuries (19.9%) being the most common. Years of work experience (p=0.014), type of profession (p<0.001), training in safety management (p=0.028), working hours (p=0.0001), working shifts (p=0.001), PPE availability (p=0.010), and sharp container availability (p=0.030) were significantly associated with WRIs. Conclusion This study revealed a high prevalence of WRIs among HCWs in Jeddah, Saudi Arabia, with back injuries, eye/mouth splashes, and needle stick injuries being the most common types. The study also found that the injuries were significantly associated with the type of profession, experience, work hours, and shifts as well as the availability of safety management and equipment such as sharp containers and PPE.


Introduction
Healthcare workers (HCWs) encompass direct care providers such as physicians, pharmacists, laboratory technicians, and nurses, as well as indirect providers like healthcare administrators [1]. Work-related injuries (WRIs), for the purpose of this study, refer to self-reported injuries from incidental incidents in the past six months, including needle sticks, splashes to the face, wounds, contact with contaminated substances in the eyes or mouth, falls, rashes on the skin, burns, back injuries, electrical shocks, mechanical injuries, and other types of injuries [2]. HCWs face various health hazards at work, including biological, chemical, physical, and psychological hazards, affecting up to 50% of them [1].
The most significant occupational hazards in hospitals are primarily associated with biological infections caused by blood-borne or body fluid pathogens that can transmit directly from patients or indirectly through body fluids, biopsies, and patient fomites [3,4]. In addition, the coronavirus disease 2019 (COVID- 19) pandemic and influenza outbreaks have been identified as causing major occupational hazards for HCWs [4]. Chemical hazards are also common in healthcare facilities, where several chemical agents are used for infection control or treating patients (e.g., pharmaceuticals, sterilants, and germicidal agents) [5].
Musculoskeletal risks are another significant risk factor for WRIs. About half of all musculoskeletal injuries 1 1 sustained during patient care are caused by heavy and bulky items that need to be lifted and transported [6]. Psychological hazards manifest as deteriorating relationships with colleagues, irritability, indecisiveness, poor performance, increased smoking, alcohol consumption, and drug abuse among workers [7]. As a result, there is an increased rate of absenteeism, customer complaints, decreased satisfaction and morale, lack of engagement at work and in teamwork, and frequent conflicts with others, leading to a deteriorating quality of services [7,8]. An unsafe work environment leads to attrition of the health workforce, impacting the quality of care and outcomes [4]. Therefore, HCWs' work environment should adhere to strict safety policies, procedures, and practices. Providing a safe work climate and implementing safety practices play an essential role in reducing WRIs [9][10][11].
Studies have indicated that training, sleep quality, work experience, and safety protocols are major determinants of WRIs [12][13][14]. Furthermore, a US study has shown that working conditions and ergonomic factors are associated with WRIs [15]. In Malaysia, it was found that the unit of operation, workspace, noise, workload, administrative control, and types of tools used were associated with WRIs [16].
There is a dearth of studies on WRIs among HCWs in Saudi Arabia [17][18][19][20]. Therefore, this study aims to assess WRIs and their impact on HCWs in Jeddah, Saudi Arabia. The study objectives are to determine the prevalence and types of WRIs, their determinants, and organizational factors.

Materials And Methods
We conducted an analytic cross-sectional study from September to  [18]. Using Raosoft with a confidence level of 95% and a margin of error of 5%, a minimum sample size of 387 was calculated from a total number of 18,343 HCWs in Jeddah. A multistage sampling technique was used to select the participants. Data collection was done through a self-administered, validated questionnaire previously used in similar studies [2].
Section A of the questionnaire included questions about sociodemographic characteristics such as gender, age, occupational category, nationality, marital status, profession, years of experience, past medical history, previous safety training, type of hospital, availability of personal protective equipment (PPE), and WRIs. Section B contained questions about the prevalence and frequency of occupational hazards, including physical, chemical, psychosocial, and biological injuries. Section C comprised questions related to different types of occupational hazards, including biological, physical, chemical, and psychosocial injuries.
The study was approved by the IRB of the Research Committee of the Saudi Board for Preventive Medicine in Jeddah city and the Directorate of Health Affairs in MOH (Approval# A01415). Written informed consent was obtained from each HCW participant. To ensure data confidentiality, all information was kept confidential for the sole purpose of this study.
Data were entered and analyzed using IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY). Descriptive statistics such as frequencies and percentages were calculated to summarize nominal and ordinal data, while means and standard deviations (SD) were used to describe numerical variables. The Chi-squared test was applied to evaluate the association between categorical determinants and the outcome variables. Logistic regression analysis was performed to identify significant predictors of WRIs. A p-value <0.05 was considered statistically significant.

Results
A total of 387 participants were included in this study, with the majority being female (n=283, 73.1%). The most common age group was 31-35 years with 149 participants (38.5%). The majority of participants were Saudi nationals (n=372, 96.1%), with 223 (57.6%) having a bachelor's degree. More than 10 years of experience was reported by the majority of participants (n=145, 37.5%). Table 1 shows the detailed demographic characteristics of the cohort.

TABLE 2: Association between work-related injuries and demographic data
Similarly, the association of organizational factors with WRIs was analyzed, and the results revealed that participants who had received training in safety management had a significantly lower risk of WRIs (p=0.028). Moreover, working hours (p=0.0001), working shifts (p=0.001), availability of PPE (p=0.010), and sharp container availability (p=0.030) also showed a significant correlation with WRIs, as presented in Table  3.  The analysis revealed that participants with a lower level of education had higher odds of experiencing occupational hazards compared to those with higher education levels (p=0.001). Moreover, those with lower work experience had 1.349 times higher odds of experiencing occupational hazards compared to those with higher work experience (p=0.037). The results of the multinomial logistic regression analysis examining the association between occupational hazards and demographic data are shown in Table 4.

TABLE 4: Multinominal logistic regression analysis of the association between demographic data and occupational hazard
The results showed that participants who saw more patients per week had 2.4 times higher odds of experiencing occupational hazards compared to those who saw fewer patients (p=0.044). Similarly, participants working the night shift had 1.7 times higher odds of experiencing occupational hazards compared to those working the morning shift (p<0.001) (

Discussion
This study revealed that the prevalence of WRIs was 52%, which is higher than the 36.5% reported in a previous study conducted in Ethiopia [21]. A study carried out in Turkey also found a high injury rate among nurses, with medication administration being the most common cause of injury [22]. In contrast, a study conducted in Ghana reported a lower prevalence (39.7%), with needlesticks and sharp objects being the primary causes of injury. The findings of our study indicate that back injuries were the most common type of injury, reported by approximately one-third of the participants, followed by eye/mouth splash injuries and needlestick injuries [23].
A study conducted in Singapore reported an overall incidence of sharp injuries and splash exposure of 28.9 per 1,000 health workers, with the highest incidence among doctors (43.7%) and nurses (37.7%) [24]. This study also revealed that WRIs were associated with the type of profession and work experience, which may influence the type of injuries sustained. Our study included mostly nurses, which could explain the high rates of back injuries reported, consistent with previous studies that have shown that at least three-quarters of nurses experience back pain at some point in their work [19,25]. The nature of the work of nurses, which involves bending and twisting, lifting and pulling objects, and manually handling patients, maybe the leading cause of low back pain [19]. In another study, nurses with higher education levels, specifically those with master's and doctoral degrees, those employed in internal medicine and pediatric ICUs, and those working in shifts, reported higher rates of back pain [25], likely due to the demanding nature of their work.
A study that assessed the prevalence and risk factors of needlestick injuries reported an incidence rate of at least one event per year of 22.2, with 53.8% of injuries going unreported, and physicians, nurses, and dentists being the most susceptible [18]. While Abalkhail et al. [18] found that HCWs aged 26-30 years were 2.5 times more likely to experience needle injuries than other age groups, our study did not find any statistically significant differences in WRIs based on age. However, our study results are consistent with Abalkhail et al. [18] in finding that the type of work/profession, such as handling needles, and work experience were associated with injuries.
In line with a previous study conducted in Ethiopia [21], our study also found that the absence of PPE and sharp containers, working for more than eight hours per day, and working the night shift were associated with higher risks of WRIs. The absence of PPE is expected to result in injuries, while long working hours and night shifts can lead to fatigue, which causes reduced attention and subsequent injuries [8]. This is supported by a study conducted in Australia, which showed that fatigue and workplace stress were predictors of near misses, and safety control led to reduced incidences. The study also found that fatigue increases the risks of WRIs [10].
It has been suggested that paying attention to safety protocols and providing organizational training to improve the safety-related behaviors of the workforce can decrease WRIs [10]. Our study supports this, as it found a significant association between WRIs and the lack of PPE as well as the lack of sharp containers. Research has indicated that there is a correlation between safety performance and occupational accidents and injuries, as well as safety climate and employees' safety performance [26]. This aligns with our finding that participants trained in safety management were significantly at a lower risk of WRIs. Moreover, studies evaluating the impact of overtime and long work hours on occupational injuries revealed that rates of injuries increase proportionally with the increase in work hours per week [27]. In a recent study conducted to assess the association between working hours and injuries in hospital shift work, the authors found a higher risk of WRIs during evening shifts and the workdays that follow night shifts, with the risk rising with the frequency of evening shifts but not night shifts [28].