Background: Needlestick injuries (NSIs) are a major job hazard for nursing students who are at risk of exposure to blood-borne pathogens, such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV). It’s common in low- and middle-income countries due to a lack of resources, training, and adherence to infection control procedures.
Aim: To determine the frequency and associated factors of needlestick injuries in nursing trainees in the Saidu Group of Teaching Hospitals in Mingora, Swat.
Methodology: We conducted a cross-sectional survey of 200 nursing trainees over six months (April-October 2024). Data were collected using a questionnaire. Data was analyzed using descriptive statistics and presented as frequencies and percentages using the Statistical Package for the Social Sciences (SPSS) 26. Chi-square tests were used to explore associations between needlestick injuries and selected variables (e.g., age, sex, training level), with significance set at p ≤ 0.05.
Results: Needlestick injuries had a prevalence of 75.5%. Key associated factors included male gender (80% of the injured), age 21-23 years (49%), and second-year academic status (34%). The most common symptoms were bleeding (57.5%) and pain (33%). The majority experienced one incident (57.5%), and 53.5% experienced their most recent injury in the last month. Most injuries occurred in hospitals (89.5%). A total of 64% received medical care, 47% had blood-borne pathogen testing, and 43.5% had long-term effects.
Conclusion: Our research demonstrates a high level of NSIs and a failure to provide post-exposure treatment for nursing students. Better training in infection control and reporting is needed.

Needlestick injury, Nursing trainees, Prevalence, Occupational exposure, Infection control.

Needle stick injuries (NSIs) are a significant occupational risk in health care worldwide, especially for nurses who are often exposed to blood and other bodily fluids in caring for patients.[1] NSIs may transmit over 20 blood-borne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV), and can result in poor health outcomes for the health-care worker and health system.[1] The World Health Organization estimates millions of health-care workers experience percutaneous injuries every year, including many nurses who are involved in patient care and invasive procedures.[2] While infection prevention measures and safer devices are in place, the impact of NSIs as a patient and worker safety issue is still significant globally.[3]

NSIs are widespread worldwide among nurses and nursing students, with reports of almost half of nurses and up to 80% of nursing students experiencing at least one NSI while training or in practice.[4] A recent meta-analysis in Pakistan reported a pooled prevalence of 48% among nurses and 43% among nursing students, which indicates that the prevalence is high in South Asia.[5] This data suggests that NSIs are not uncommon but occupational risks that relate to a lack of training, hazardous workplaces, high workloads, and non-adherence to standard precautions. These figures, despite awareness raised, indicate a gap between knowledge and practice among health-care workers.[6]

In South Asia, particularly Pakistan, the rates of NSIs are compounded by limited health resources, overcrowding in hospitals, inadequate staffing, and inconsistent follow-up of infection control measures. Evidence suggests there is significant underreporting of NSIs, and many exposures are not reported due to fear of retaliation or lack of opportunities to report or “normalization of risk” among health-care workers.[6,7] Nursing students are especially at risk because of their lack of psychomotor skills, supervision of invasive procedures, and procedures during stress. Several studies from teaching hospitals in Pakistan have suggested low adherence to standard precautions, which can also increase the risk of infection.[8]

In our institution, Saidu Group of Teaching Hospital, Swat (Khyber Pakhtunkhwa), nursing students are a high-risk group due to their inexperience, lack of supervision, and variable compliance with infection prevention practices. In our institution, a recent study found medium to low levels of knowledge and practice about prevention of NSI in nursing interns, with only 28.3% having good preventive practices.[9] This affects their ability to practice safe procedures, even though they have been given theoretical training. Such findings raise concerns about the current nursing education and mentoring in clinical practice for injury prevention.[10]

Theoretically, NSIs can be explained through occupational health and safety behavior, which suggests the role of knowledge, attitude and practice (KAP) for using preventive measures. The health belief model and other behavior theories also highlight the role of perceived risk, severity, and barriers in the decision-making process to use these measures. In the educational setting, a lack of safety culture, absence of teaching about universal safety measures, and lack of safety devices in the institution result in unsafe practices and injury.[11]

While there are increasing global studies on NSIs, there is a dearth of local studies of undergraduate nursing students in teaching hospitals in Khyber Pakhtunkhwa. The local studies are either hospital-specific or nurse-focused, and few have explored the incidence and risk factors of NSIs in the teaching environment. In addition, inconsistent reporting systems and reporting pose challenges for incidence rates. This results in a lack of knowledge about incidence and risk factors of NSIs among nursing students at Saidu Group of Teaching Hospital.[12]

So, this study is imperative to obtain site-specific incidence of needle-stick injuries among undergraduate nursing students at Saidu Group of Teaching Hospital, Swat. This knowledge is essential to inform mitigation strategies for reducing the burden and recognizing patterns of risk to improve clinical teaching settings and occupational health strategies in nursing education. In summary, this gap in knowledge is crucial to fill for the sake of future nurses, patients, and quality of care in resource-poor communities.

This study used a quantitative cross-sectional design to explore the incidence of NSIs among nursing trainees at Saidu Group of Teaching Hospital, Mingora, Swat. The study was conducted in a tertiary teaching hospital with a high patient flow and diverse clinical exposure, which provided an appropriate setting to assess risk factors among nursing trainees. Nursing trainees on clinical rotations during the study period were included in the study. The study was carried out over six months (April 2024 to October 2024). It provided context-specific data on the prevalence and associated factors of NSIs among nursing trainees at Saidu Group of Teaching Hospital, Swat, addressing a gap in local evidence.

Data collection procedure: Data were collected using a self-administered questionnaire developed after an extensive literature review and adapted from previous studies. The questionnaire included socio-demographic characteristics, NSI prevention practices, occurrence of injuries, nature of injuries, and reporting practices. The questionnaire was pre-tested among a group of nursing students before the main survey. It was distributed during clinical postings after obtaining informed consent. Anonymity was ensured to reduce bias and encourage honest responses. Nursing administrators assisted in scheduling the data collection process to minimize disruption to clinical practice.

Data analysis procedure: Data were coded and analyzed using the Statistical Package for Social Sciences (SPSS) version 26. Descriptive statistics such as frequencies, percentages, mean, and standard deviation were used to describe participants’ demographics and the prevalence of needle stick injuries. Prevalence was calculated as the proportion of students who experienced one or more NSIs during their clinical training. Inferential tests such as the chi-square test were applied to examine associations between NSIs and selected variables such as age, gender, and training level. The level of significance was set at p ≤ 0.05, and results were presented in tables and figures for clear presentation. Ethical approval was obtained from the supervisor and Saidu Group of Teaching Hospitals before the commencement of the study.

Demographic characteristics of participants: The characteristics of the participants are shown in Table 1. The majority were male (80%), with 20% being female. Most participants were aged 21-23 years (49%), followed by 18-20 years (31%) and 24-26 years (20%). Academically, second-year students were the most represented (34%) and fourth-year students were the least (10%).

Table 1: Demographic characteristics of participants (n = 200)

Prevalence and characteristics of needlestick injury: As Table 2 reveals, many (75.5%) participants had reported a needlestick injury while on clinical placement. The most frequent physical symptoms included bleeding (57.5%), pain (33%), swelling (6.5%), and numbness (3%). In terms of frequency, most reported a single injury (57.5%), while 29% reported 2-3 injuries and 13.5% reported four or more injuries. This suggests a high incidence of occupational injury among nursing students.

Table 2: Prevalence and clinical features of needlestick injury

Timing and location of needlestick injury: Table 3 shows more than half (53.5%) of the subjects had their last needlestick injury in the last month. A smaller percentage of injuries occurred 1-3 months previously (16%) and more than six months (30.5%) previously. A large proportion of injuries (89.5%) occurred in hospitals, compared to clinics (6%) and the community (4.5%). This identifies hospitals as the key risk location.

Table 3: Timing and setting of last needlestick injury

Post-injury medical care and testing: Table 4 indicates 64% of the participants received medical care after a needlestick injury, while 36% did not. Concerning laboratory investigation, 47% had blood-borne pathogen testing, while 53% did not. These findings suggest deficiencies in post-injury management and follow-up. In summary, the results indicate poor adherence to post-injury guidelines among nursing students.

Table 4: Post-injury medical care and testing

Inferential analysis using the chi-square test showed no statistically significant association between needlestick injury and age (χ² = 2.34, p = 0.31), sex (χ² = 1.02, p = 0.60), or year of study (χ² = 3.45, p = 0.33), although descriptive patterns were observed (e.g., higher prevalence among males and second-year students).

We have reported a high incidence of needlestick injuries (75.5%) among the nursing students at Saidu Group Teaching Hospital. This suggests high risks in the clinical environment. Our results are in line with studies conducted among nursing students in resource-poor settings, where the prevalence of exposure to such injuries is generally above 50% due to the absence of safety measures and supervision. Another study from Pakistan reported the prevalence of 43% among nursing students, which is lower than the present finding, perhaps due to differences in educational programs, reporting, and safety measures in the institutions. In Ethiopia and India, the prevalence has been found to be between 50% and 70%, which is partially in agreement with the current findings but also shows variations.[13]

In this study, the most common physical symptoms following needlestick injuries were bleeding and pain. This is in line with other reports from India, which report initial complications of bleeding and superficial injuries. Injuries in tertiary hospitals in India also report bleeding and pain as the most common symptoms, implying similar risks are involved in performing invasive nursing procedures. Several studies from high-income countries have reported fewer symptomatic injuries because of high use of safety technologies, which may be a key differentiating factor in the current study, where these technologies may be available but not optimally used.[14,15]

In this study, more injuries were reported from hospitals (89.5%) than other sites, indicating exposure to risks in hospitals. This is like findings from Pakistan and Nigeria that hospital wards, emergency rooms, and procedure rooms are the most likely exposure sites for nursing students. A study in Saudi Arabia also found most injuries occurred in clinical settings, although the rate was lower due to more stringent infection control and supervision. The hospital setting for injury indicates deficiencies in infection control, including failure to follow standard precautions and lack of training in safe practices.[16,17]

This study also found low rates of post-exposure management, with only 64% of respondents reporting to a healthcare provider and 47% being tested for blood-borne pathogens. Other studies from Pakistan and Ethiopia also report a low reporting and post-exposure management rate, mostly owing to fear of stigma and discrimination, lack of awareness, and lack of reporting and surveillance systems. In high-income countries, studies have shown high reporting and testing rates in the presence of mandatory occupational health measures and institutional reporting and surveillance systems. The low rate of testing in our study indicates a major gap in the occupational health response and risk mitigation for infection among nursing students.[18,19]

Many reported long-term effects of needlestick injuries are reported in other studies from low- and middle-income countries, which commonly report stress, anxiety, and fear of infection. Long-term psychological and occupational consequences have also been reported in studies from India and Iran, but with few confirmed physical infections. The differences in long-term consequences across studies may be explained by the provision of post-exposure prophylaxis, counseling, and early intervention strategies. Our findings highlight the need for more preventive education, reporting, and effective institutional practices among nursing students to reduce occupational risks.

The study finds that the incidence of needlestick injuries experienced by nursing trainees at Saidu Group Teaching Hospital is high, implying a high risk in the work environment. A large majority of the participants reported having suffered at least one injury, some reporting more than one. Hospitals were the most common location of exposure, suggesting a need for better clinical safety practices while providing healthcare services. Bleeding and pain were often reported, suggesting immediate health consequences of injuries.

The study also highlights that there are gaps in the management of exposure events, as a substantial number of trainees don’t seek medical attention and/or have blood-borne pathogen tests. This suggests a lack of awareness, reporting, and management. The symptoms of long-term health effects in many participants also point to the potential long-term clinical and psychological effects of injuries.

The authors would like to express their sincere gratitude to Dr. Shah Hussain, Principal/Associate Professor, Janbar, College of Nursing, Swat, for his invaluable supervision, guidance, and support throughout the course of this study.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Corresponding Author:
Abdur Rahman
Department of Nursing,
Malakand College of Nursing, Swat, Pakistan
Email: [email protected]

Co-Authors:
Muhammad Nisar Khan, Mumtaz Ali Khan, Abubakr Siddique, Ihsan Ali
Department of Nursing,
Malakand College of Nursing, Swat, Pakistan

Shah Hussain
Department of Nursing,
Janbar College of Nursing, Swat, Pakistan

Sajad Ullah
Department of Nursing,
King Faisal Specialist and Research Centre, Madina, Saudi Arabia

Mumtaz Ali Khan and Muhammad Nisar Khan were responsible for data collection and data analysis. Sajad Ullah, Abubakr Siddique, and Ihsan Ali contributed to data collection and conducted the literature review. Dr. Shah Hussain and Abdur Rahman were involved in data interpretation.

Ethical Approval was obtained from the Malakand College of Nursing, Swat, Ref No SGTH/IRB/2026/28.

The authors declare that there is no conflict of interest regarding the publication of this paper.

Abdur Rahman is the guarantor of this study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

https://doi.org/10.63096/medtigo3092323

Rahman A, Khan MN, Khan MA, et al. Prevalence of Needle Stick Injury Among Undergraduate Nursing Students at Saidu Group of Teaching Hospital. medtigo J Emerg Med. 2026;3(2):e3092323. doi:10.63096/medtigo3092323 Crossref