Analytical hierarchy process (AHP) application in the development of safety module for sharps management

Abstract

The increasing number of healthcare services facilities to accommodate the needs of population growth especially in developing countries including Malaysia has increased the prevalence of sharps injury among the healthcare workers (HCWs). The role of HCWs to ensure the safety standards and practices are implemented is crucial due to the high risk of becoming infected with HBV, HCV, and HIV at 30%, 1.8%, and 0.3%, respectively. However, preliminary study has revealed that until currently, there is no national guidelines on how to handle sharps to avoid injury during various procedures in Healthcare Establishment (HCEs). Therefore, a study was conducted to develop a sharps safety module by considering various factors to ensure that the module is systematic and comprehensive for the basis of national guidelines. The study was conducted through a qualitative study by exploring the current practices and technical methods in managing sharps at selected HCEs in Malaysia, a quantitative study by measuring the prevalence of knowledge, attitude, and practices on sharps management among HCWs in HCEs in Malaysia and an Analytical Hierarchy Process (AHP) method as a multi-criteria decision-making tool to help HCEs stakeholders in making the right decisions. The qualitative study revealed two main themes: organisational factor and employee factors. Seven codes that influenced the cause of sharps injury in these two themes were cost, policy and guideline, training, technology, safety, reporting issues and handling. The quantitative study results revealed that even though most of the participants had a good knowledge level, the attitude, and practices of the participants toward sharps management were only at moderate and poor attitude, and moderate to fair level of practices. All factors identified in qualitative and quantitative study were then included as the criteria in AHP. A three- tier hierarchy structure was established for this study. The first tier stated that the goal of the AHP was to select the best safety module to reduce the risk of sharps. The second tier included the criteria that made up of the six factors: policy, and training, reporting issue, safety, technology, and handling. Finally, the third tier included three alternatives, namely Module A: Basic Integrated Sharps Management Safety Module; Module B: Intermediate Integrated Sharps Management Safety Module and Module; and Module C: Advanced Integrated Sharps Management Safety Module. Once the hierarchy was established, pairwise comparisons were made to formulate the final weights for each criterion and the selection of the alternative. AHP recommended Module C (Integrated Safety Sharps Management Module), with the overall priority at 42.3% as the best safety module to reduce the risk of sharps injury among HCWs in HCEs. Based on the Module C and elements identified in earlier phase of the study, a model of sharps safety management module was established, in conclusion, this study findings provide a comprehensive framework of model for sharps safety management module as the basis for national guidelines on sharps management to ensure the safety of HCWs in HCEs in Malaysia.

Keywords: Healthcare workers, Malaysia, NSI, Sharps management