4 Discussion
The four major factors responsible for accidents at work were the same for both doctors and nurses (Table 2). These four major factors were: non-availability of protective measures; type of procedure; use of inadequate/inappropriate equipment; and desire to speed up the procedure.
Non-availability of protective measures was the major factor specified by doctors (52.8%) and laboratory workers (29.4%) as being responsible for occupational accidents (Table 2).
Combining all the health workers (doctors, nurses and laboratory workers), the four main factors responsible for accidents were: non-availability of protective measures; desire to speed up the procedure; type of procedure; and use of inadequate/inappropriate equipment (Table 2). The major factor responsible for accidents at work among health workers was non-availability of protective measures. This finding compares with a study in Tanzania where a high incidence of percutaneous injury was found and insufficient staff training, inadequate equipment and a poor waste-disposal system were the reasons given.10 Lack of materials and equipment was found to be the major cause of job dissatisfaction among nurses and doctors in a study carried out in Nigeria by Ofili.12 This point is further buttressed by a study carried out in Nigeria by Erinosho who found that nearly one-third of the equipment in a series of healthcare institutions was out of order.13 African leaders' lack of political commitment to better health, and the poor economic conditions clearly play a role in the poor funding of health services. Publicly owned and operated infrastructure and equipment are visibly ageing and breaking down in many countries resulting in inadequate equipment. The unstable political atmosphere of many African countries and their rapid population growth may also be contributing to the poor funding of health services.
Long duration of procedure, although mentioned as a factor responsible for accidents at work, ranked low on the list of causes (10.3%) (Table 2). Sim and Dudley1 found that the incidence rate of contamination of glasses used for operations was higher when the operation was long and complex, but Lowenfels et al.2 did not find any correlation between puncture injury rates and number of hours spent in the operating room.
Desire to speed up the procedure (34.3%) ranked second while fatigue ranked fifth on the list of factors responsible for accidents at work. This is similar to the findings in the study carried out by Efem5 where fatigue and the desire to speed up the surgical operation were identified as factors responsible for injuries during surgery.
Type of procedure ranked third (23.1%) as a factor responsible for accidents at work among all health workers. It has been documented that a high injury rate was found during gynaecologic procedures. This was attributed to performing deep pelvic surgery where visibility is poor, and to quilting or palpating suture needles with fingers.3. and 4. Use of inadequate/inappropriate equipment ranked fourth as a factor responsible for accidents at work. The inadequate funding and lack of maintenance of existing equipment in our hospitals could be an explanation for this. Other factors mentioned which were responsible for accidents at work, although low on the list, are important. These were: lack of time; distraction by others; lack of co-ordination; long duration of procedure; amount of blood loss; improper utilization of adequate protection; inadequate knowledge; and lack of concentration.
Based on the findings of the study, it is recommended that there should be provision of adequate materials and equipment. Employers should be made liable if they fail to provide appropriate and/or effective safety equipment in the work place. More health workers should be employed so that they would not be overworked and also to reduce fatigue. This will provide health workers with adequate time devoid of haste to enable them to carry out procedures in a tension-free atmosphere. This study could be further validated using a qualitative study design (focus group discussions) or by careful investigations following accidents.