Knowledge,attitude and behavior of nursing students about needlestick and sharps injuries

Abstract

Background

Nursing students who are majoring to become nurses are under risk with regards to complications and injuries due to practice lack and insufficient clinical experience.

Objective

This research was conducted to determine the knowledge, attitude, and behaviors of nursing faculty students regarding needlestick and sharps injuries.

Methods

This research was planned in a descriptive and correlational study. Attitude 447 students who accepted to take part in the research and suitable to the criterions of inclusion accounted for the sampling of the research. Scale oriented to “Attitude Scale for Safe Use of Sharps by Healthcare Workers” and “Student Information Form’’ were used in the gathering of data.

Results

It was seen that 29.5% of the students experienced at least one NSSIs during their education life and the most common injuries were in the 4^th year. Overall score point average of “Attitude Scale for Safe Use of Sharps” was found to be 118.11 ± 7.33 and according to age, gender, wounding case, wounding area and wounding reason, statistically significant differences were determined as regards to total scale and subscale score averages.

Conclusions

As a result, although the scores that the students knowledge, attitude and behaviours were high, it was seen that there were injuries. The sustenance of trainings oriented to preventing injuries can be suggested.

Keywords

accidents occupational health occupational injury prevention nursing student sharps injuries prevalence

Introduction

Hospitals function not only as healthcare service providers but also as research and educational institutions for the community. For this reason, hospitals have a more complex structure than other workplaces. This situation places healthcare personnel at increased risk of occupational hazards and injuries in clinical settings. The most common occupational accidents and risks that healthcare workers (HCWs) encounter in the hospital environment are infections and needlestick and sharps injuries (NSSIs).^1–3 While performing various invasive procedures such as drawing blood from patients and establishing intravenous access, HCWs may engage in unsafe practices—such as attempting to recap syringe needles or improperly disposing of sharp instruments—which may lead to NSSIs.^1,4 More than 20 different types of bloodborne pathogens are associated with injuries caused by NSSIs.³ The groups at risk of exposure to NSSIs among HCWs are, in order: nurses, physicians, dentists, and cleaning personnel.⁵

The nursing education curriculum includes numerous theoretical and practical courses that complement each other. While clinical practice education is an integral and inseparable component of nursing education, it presents various health risks for nursing students. NSSIs are the most common health risk encountered by nursing students during clinical practice.^3,6,7 Nursing students who are exposed to injuries also experience stress and anxiety related to the risk of infectious diseases.^3,5 Determining nursing students’ exposure to NSSIs during clinical practice, investigating the causes of these injuries, and evaluating post-incident reporting behaviors are essential.

However, it was found that there are limited recent studies on this topic in the literature. In this context, the present study was conducted to determine nursing students’ knowledge, attitudes, and behaviors regarding NSSIs.

Research questions

What are the sociodemographic characteristics of the students?

What are the characteristics of the injuries sustained by students due to NSSIs?

What are the students’ levels of knowledge, attitudes, and behaviors regarding NSSIs?

Do students’ knowledge, attitudes, and behaviors regarding NSSIs differ according to their sociodemographic characteristics?

Methods

Study design

This study was designed as a descriptive and correlational study to assess the knowledge, attitudes, and behaviors of nursing students regarding NSSIs.

Setting and participants

The study population consisted of 2^nd, 3^rd, and 4^th-year students (n = 839) enrolled in the spring semester of the 2019–2020 academic year at the Faculty of Nursing of a public university. The sample size for the study was determined using the known population sample calculation method. In the sample size calculation, prevalence (31%) was based on the NSSIs reported by nursing students in a study with a similar sample group conducted in Türkiye.⁸ According to the calculation, it was determined that a minimum of 237 nursing students should be included in the sample. The minimum number of students to be included in the study from each class was determined using the stratified random sampling method (2^nd year n = 80, 3^rd year n = 86, 4^t^h year n = 71). The study was completed with a total of 447 students, including 152 2^nd year, 175 3^rdyear, and 120 4^t^h year students, who were randomly selected as volunteers. 1^st year students were not included in the study as they had no clinical experience yet.

Inclusion/exclusion criteria

The inclusion criteria for the study consisted of students aged 18 and above, enrolled in the 2^nd, 3^rd, and 4^th years, who volunteered to participate, excluding 1^st year students due to their lack of clinical experience.

Data collection

Data for the study were collected between February and September 2020. Some data were collected face-to-face outside of class hours, while the remaining data were collected online via Google Forms due to the COVID-19 pandemic.

Data collection tools

Data for the study were collected using the “Student Information Form” and the “Attitude Scale for Safe Use of Sharps by Healthcare Workers”.

Student information form

According to the literature^8–12 this form, prepared by the researcher, includes questions about nursing students’ age, gender, year of study, previous injuries from NSSIs, how the injury occurred, actions taken afterward, and whether the injury was reported.

Attitude scale for safe use of sharps by healthcare workers

The scale developed by Uzunbayır (2009), for which validity and reliability were established, was designed to measure HCWs’ attitudes toward the safe use of sharps. The scale is a 5-point Likert-type instrument (1–5) consisting of a total of 25 items, including both positively and negatively worded statements. The minimum possible score is 25, and the maximum possible score is 125. The scale comprises three subdimensions — knowledge, attitudes, and behaviors — reflecting attitudes toward the safe use of sharp medical instruments. Scores on the cognitive subdimension range from 12 to 60, scores on the affective subdimension range from 6 to 30, and scores on the behavioral subdimension range from 7 to 35.^13–17 A low total score indicates unsafe use of sharps, whereas a high total score indicates safe use of sharps. The Cronbach's alpha coefficient of the scale was reported as 0.80 by Uzunbayır (2009),¹⁸ while subsequent studies using the same scale reported values ranging from 0.71 to 0.89.^13–16 In the present study, consistent with previous research, the Cronbach's alpha coefficient was calculated as 0.883.

Data analysis

The data were analyzed using SPSS version 14.0. To determine the distribution of the data, measures of central tendency, including the arithmetic mean, median, skewness, and kurtosis, were examined. The closeness of the median (118.11) and the arithmetic mean (121.00), together with skewness (–1.042) and kurtosis (0.162) values within ±2, indicated that the data followed a normal distribution. Descriptive analyses, including frequencies and percentages, were used to present the distribution of participants’ demographic characteristics. Descriptive statistics for the scale were presented as means and standard deviations. An independent samples t test was used to examine differences between two groups. One-way analysis of variance (ANOVA) was used for comparisons involving more than two groups. Chi-square analysis was conducted to examine relationships between categorical variables, while Pearson correlation analysis was used to explore relationships among the subscales of the scale. Results were evaluated at a 95% confidence interval with a significance level of p < 0.05.

Ethical considerations

Ethical approval was obtained from the Social and Human Sciences Research Ethics Committee of a public university (January 13, 2020; Ref. No: 2217). Approval was also obtained from the Faculty of Nursing (December 25, 2019; Ref. No: 198123). Written informed consent was obtained from all nursing students who agreed to participate in the study. Permission to use the scale was obtained from the author who established its validity and reliability. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Results

Of the students participating in the study, 68.9% (n = 308) were younger than 21 years and 31.1% (n = 139) were aged 21 years or older, with a mean age of 21.18 ± 1.71 (min=18, max=35). It was found that 82.8% (n = 370) of the students were female and 17.2% (n = 77) were male. Regarding year of study, 34.1% (n = 152) were in the 2^nd 39.1% (n = 175) were in the 3^rd and 26.8% (n = 120) were in the 4^th year. It was determined that 29.5% (n = 132) of the students had experienced NSSI.

When examining the injury characteristics of students who had experienced NSSIs. 70.5% (n = 93) reported experiencing an injury once, 22% (n = 29) reported experiencing an injury twice, and 7.6% (n = 10) reported experiencing an injury three to five times during their period of study. Of these injuries, 87.9% (n = 116) occurred in the hospital settings, while 12.1% (n = 16) occurred during course- related laboratory practice. Regarding the causes of injuries 71.9% (n = 95) occurred while breaking an ampoule or opening a vial, and 28.1% (n = 37) occurred due to other reasons (e.g., recapping after an injection, using a blood glucose lancet, or opening a needle) (Table 1).

Table 1.

Characteristics of students’ NSSIs.

Injury Characteristics	n	%
Injury Location
Hospital	116	87.9
Laboratory	16	12.1
Number of Injuries
Once	93	70.5
Twice	29	22.0
3-5 times	10	7.6
Cause of Injury
Breaking an ampoule /Opening a vial	95	71.9
Other reasons (while recapping after an injection, blood glucose lancet, or opening needle etc.)	37	28.1
First Action Taken After Injury
Washed with soap and water	47	35.6
Covered with dressing material	43	32.6
Reported to the clinical instructors	42	31.8
Reporting the Injury
Yes	11	8.3
No	121	91.7
Reason for Not Reporting the Injury
Unaware of the procedure	14	11.6
NSSI did not contact the patient	82	67.8
Other (the patient did not have an infectious disease, fear, etc.)	25	20.7
Total	132	100

Note: NSSI: Needlestick and sharps injuries.

Regarding the first action taken after the injury, 35.6% (n = 47) reported washing the injured area with soap and water, 32.6% (n = 43) reported covering it with a dressing, and 31.8% (n = 42) reported informing their clinical instructors. It was found that 91.7% (n = 121) of the injured students did not report the injury, whereas 8.3% (n = 11) did. The reasons for not reporting the injury included the belief that the NSSI did not involve contact with a patient 67.8% (n = 82) and lack of awareness of the reporting procedure 11.6% (n = 14) (Table 1).

Chi-square analysis examining the relationship between the students’ year of study and NSSI status showed that the incidence of NSSIs and repeated injuries increased with advancing year of study. Regarding injury location, 4^th year students experienced more NSSIs in the hospital settings compared with 2^nd and 3^rd year students, wheras 2^nd year students experienced more NSSIs during laboratory sessions compared with 3^rd and 4^th year students (Table 2).

Table 2.

Comparison of students’ injury characteristics by year level.

Injury Characteristics	2nd year		3rd year		4th year		Test; p
Injury Characteristics	n	%	n	%	n	%	X²;p
NSSIs status
Yes	34	22.4	50	28.6	48	40.0	11.709;0.003*
No	118	77.6	125	71.4	72	60.0	11.709;0.003*
NSSIs number							14.739;0.005*
Once	29	85.3	39	78	25	52.1
Twice	5	14.7	7	14	17	35.4
3–5 times	0	0	4	8	6	12.5
Injury Location							11.113;0.004*
Hospital	25	73.5	44	12	47	97.9
Laboratory	9	26.5	6	88	1	2.1
Cause of Injury
Breaking an ampoule /Opening a vial	20	58.8	38	76	37	77	3.900;0.142
Other reasons (while recapping after an injection, blood glucose lancet, or opening needle etc.)	14	41.2	12	24	11	23	3.900;0.142
First Action Taken After Injury
Washed with soap and water	12	35.3	17	34	18	37.5	1.754;0.781
Covered with dressing material	10	29.4	15	30	18	37.5
Reported to the clinical instructors	12	35.3	18	36	12	25
Reporting the Injury
Yes	4	11.8	3	6	4	8.3	0.880;0.644
No	30	88.2	47	94	44	91.7	0.880;0.644
Reason for Not Reporting the Injury
Unaware of the procedure	5	16.7	5	10.6	4	9.1	3.72;0.529
NSSI did not contact the patient	17	56.7	35	74.5	30	68.2
Other (the patient did not have an infectious disease, fear, etc.)	8	26.7	7	14.9	10	22.7

Note: NSSI: Needlestick and sharps injuries; X²: Chi-square; *p < 0.05.

When examining the distribution of scores obtained by the students on the Attitude Scale for Safe Use of Sharps it was found that they had a mean total score of 118.11 ± 7.33 (min-max: 94–125) (Table 3).

Table 3.

Students’ scale for safe use of sharps attitude scale scores.

Scale and subscales	Min.	Max.	$\bar{X}$	SD
Knowledge	46	60	57.00	3.52
Behavior	23	30	28.51	1.88
Attitude	21	35	32.60	3.04
Overall Total	94	125	118.11	7.33

Note: Min: Minumum; Max: Maksimum, X ̅: Mean; SD: Standard Deviation.

When examining the relationships between sociodemographic variables and total and subscale scores, it was found that students younger than 21 years scored higher on the behavioral subscale than those aged 21 years and older (p < 0.031). Female students scored significantly higher than male students on the total scale (p < 0.004), as well as on the knowledge (p < 0.015), attitude (p < 0.023), and behavior (p < 0.005) subscales. Students who had not experienced NSSIs scored significantly higher on the total scale (p < 0.041), and on the attitude (p < 0.041) and behavior (p < 0.002) subscales, compared with those who had experienced an injury. Additionally, students injured for reasons other than opening an ampoule or vial scored higher on the total scale (p < 0.004), and on the knowledge (p < 0.024), attitude (p < 0.009), and behavior (p < 0.005) subscales. Students injured in hospital settings also scored higher on the total scale (p < 0.044) and the knowledge subscale (p < 0.009) than those injured in laboratory settings (Table 4).

Table 4.

Comparison of students’ students’ scale for safe use of sharps attitude scale scores by sociodemographic characteristics.

Variables	Knowledge	Behavior	Attitude	Overall total
Age
Under 21	57.17 ± 3.46	28.52 ± 1.90	32.81 ± 2.94	118.50 ± 7.19
21 and over	56.63 ± 3.64	28.47 ± 1.84	32.14 ± 3.20	117.25 ± 7.58
t;p	1.481; 0.139	0.249; 0.804	2.160; 0.031*	1.670; 0.096
Gender
Female	57.18 ± 3.39	28.60 ± 1.82	32,79 ± 2,95	118.57 ± 7.04
Male	56.12 ± 4.00	28.06 ± 2.10	31,73 ± 3,30	115.91 ± 8.28
t;p	2.431; 0.015*	2.279; 0.023*	2.805; 0005*	2.293; 0.004*
Year Level
2nd Year	56.98 ± 3.62	28.54 ± 1.99	32.91 ± 2.94	118.43 ± 7.57
3rd Year	57.02 ± 3.46	28.45 ± 1.80	32.66 ± 2.56	118.14 ± 6.81
4th Year	56.99 ± 3.52	28.55 ± 1.87	32.13 ± 3.70	117.67 ± 7.78
f;p	0.006; 0.994	0.130; 0.879	2.333; 0.098	0.368; 0.692
NSSIs status
Yes	56.87 ± 3.38	28.60 ± 1.82	31.92 ± 3.11	117.01 ± 7.45
No	57.05 ± 3.58	28.06 ± 2.10	32.89 ± 2.96	118.56 ± 7.24
t;p	−0.502; 0.616	−2.055; 0.041*	−3.099; 0.002*	−2.047; 0.041*
NSSIs number
Once	56.97 ± 3.41	28.32 ± 1.92	32.24 ± 2.83	117.53 ± 7.33
Twice	56.34 ± 3.54	27.90 ± 2.08	31.28 ± 3.83	115.52 ± 8.07
3–5 times	56.40 ± 3.75	27.90 ± 1.85	30.10 ± 2.88	114.40 ± 7.17
f;p	0.425; 0.655	0.651; 0.523	2.850; 0.062	1.375; 0.256
Injury Location
Hospital	57.08 ± 3.11	28.29 ± 1.90	31.97 ± 3.08	117.34 ± 7.00
Laboratory	54.69 ± 4.92	27.50 ± 2.22	31.13 ± 3.40	113.31 ± 10.05
t;p	2.658; 0.009*	1.535; 0.127	1.009; 0.315	2.034; 0.044*
Cause of Injury
Breaking an ampoule /Opening a vial	56.43 ± 3.49	27.95 ± 2.03	31.42 ± 3.18	115.80 ± 7.60
Other reasons (while recapping after an injection, blood glucose lancet, or opening needle etc.)	57.97 ± 2.99	28.94 ± 1.37	33.15 ± 2.50	120.06 ± 5.97
t;p	-2.287; 0.024*	-2.640; 0.009*	-2.861; 0.005*	-2.955; 0.004*
First Action Taken After Injury
Washed with soap and water	56.91 ± 3.59	28.13 ± 2.19	32.02 ± 3.05	117.06 ± 8.10
Covered with dressing material	56.35 ± 3.75	28.21 ± 1.83	31.91 ± 3.15	116.47 ± 7.79
Reported to the clinical instructors	57.10 ± 2.98	28.26 ± 1.81	31.64 ± 3.24	117.00 ± 6.63
f;p	0.543; 0.582	0.053; 0.948	0.167; 0.847	0.083; 0.921
Reporting the Injury
Yes	57.18 ± 2.52	28.73 ± 1.49	33.09 ± 2.26	119.00 ± 5.85
No	56.75 ± 3.53	28.15 ± 1.98	31.75 ± 3.17	116.65 ± 7.63
t;p	0.394; 0.694	0.943; 0.348	1.366; 0.174	0.993; 0.323
Reason for Not Reporting the Injury
Unaware of the procedure	56.00 ± 4.79	27.57 ± 2.31	30.86 ± 3.72	114.43 ± 9.61
NSSI did not contact the patient	56.90 ± 3.26	28.16 ± 1.95	32.07 ± 2.84	117.13 ± 7.04
Other (the patient did not have an infectious disease, fear, etc.)	57.68 ± 3.67	28.44 ± 1.92	31.20 ± 3.80	116.32 ± 8.35
f;p	0.394; 0.675	0.863; 0.425	1.363; 0.260	0.779; 0.461

Note: NSSI: Needlestick and sharps injuries; t: Independent t-test; f: One-Way ANOVA.

Discussion

The prevalence and characteristics of NSSIs

Nursing students undergoing training to become nurses may be at greater risk of NSSIs than licensed nurses due to insufficient clinical experience and limited practical training.¹¹ Recent studies have reported that the prevalence of sharps injuries among students ranges from 23.4% to 65.1%, while the proportion of students who experienced multiple injuries ranges from 27.6% to 53%.^4,8,11,19 In the present study, it was found that 29.5% of the students experienced an injury, and 29.6% reported experiencing more than two injuries. These findings are consistent with those of previous studies and underscore the importance of repeated laboratory practices conducted under instructor supervision to reduce the risk of injuries encountered by students during clinical practice.

In this study, most students who experienced an injury were injured in hospital settings, although some injuries also occurred during laboratory practice. Injuries most frequently occurred while breaking an ampoule or opening a vial. Hambridge et al. (2021) conducted a study with nursing students in the United Kingdom and reported that students most frequently sustained injuries with glass ampoules.²⁰ Similarly, Handiyani et al. (2018) found that nursing students most commonly experienced injuries while opening ampoules (53.15%).⁹ The literature indicates that improper breaking of ampoules and vials is a common cause of needlestick and sharps injuries among HCWs.^21,22 This situation not only causes cuts and hand injuries among HCWs during the opening of glass ampoules, thereby increasing the risk of infection,²² but also poses risks to patients, as glass fragments from improperly opened ampoules may be injected during intramuscular or intravenous administration, potentially leading to harmful outcomes.²³ Nursing students may be at high risk of injury in both hospital and laboratory settings when breaking ampoules or opening vials due to insufficient clinical experience, rushing during procedures, and lack of adequate attention.⁸ Therefore, to prevent injuries associated with glass ampoules and vials, it is essential to demonstrate proper breaking techniques in laboratory training and to provide students with hands-on practice using ampoule breaker devices.

The Centers for Disease Control and Prevention (CDC) (2019) recommends washing the injury site with soap and water as the first response following NSSIs among HCWs.²⁴ Consistent with the literature, this study found that most students washed the injured area with soap and water.^6,11,19

The study found that a high proportion of injured students did not report their injuries. A review of the literature indicates that injury reporting rates among students range from 32.4% to 86.9%.^{2,5,8,11,12,19} Consistent with the findings of the present study, previous studies have shown that the most common reasons for not reporting injuries were, in order, the belief that the sharp object did not come into contact with the patient, the perception that the patient did not have an infectious disease, the injury occurring with a sterile instrument, the injury not being considered important, fear of being reprimanded, and lack of awareness of reporting procedures.^{2,5,8,11,12,19} In this context, to increase the reporting of NSSIs among students and reduce the risk of bloodborne infections, it is essential to explain infection control measures before each clinical experience, clearly describe the reporting process and post-injury follow-up and integrate these topics into nursing education and training programs.

As the students’ year of study increased, the incidence of NSSIs also increased. Similarly, Doğru and Akyol (2018) reported that the incidence of NSSIs among students increased with advancing year of study,⁸ which they attributed to the higher number of clinical practice days during the final year internship. In a systematic review conducted by Chen and Zhang (2021), nursing students aged 25 years and older were found to have a higher likelihood of experiencing NSSIs compared with those aged 25 years and younger.³ In contrast, some studies have indicated that injuries are more prevalent among lower-year students. Rubbi et al. (2018) found that first-year students experienced a higher number of injuries, whereas Asmar et al. (2025) reported a higher incidence of injuries among second-year students.^10,19 In the present study, the increase in injury rates with advancing year of study may be related to the greater number of clinical practices in which students participate.

Knowledge, attitudes, and behaviors regarding NSSIs

Students’ scores on the knowledge, attitude, and behavior subscales of the Attitude Scale for the Safe Use of Sharps were high. The literature similarly indicates that students’ total scale scores range from 62 to 114, and their awareness of the subject is high.^16,17,25 These high mean scores are considered evidence of the increasing emphasis placed on occupational health and safety within nursing education curricula.

In this study, the findings were consistent with those in the literature, showing that students younger than 21 years exhibited better injury prevention behaviors than students aged 21 years and older.¹⁶ However, some studies have reported no age related differences.^11,25,26 In the present study, the higher behavior scores of students younger than 21 years regarding the safe use of NSIs may be related to stress associated with their limited clinical practice experience. The study also found that female students demonstrated better knowledge, attitudes, and behaviors related to injuries compared with male students. While some studies have reported similar findings,^4,16 others have shown that gender does not affect attitudes toward injuries.^11,25–27 Overall, female students may exhibit greater sensitivity toward the safe use of NSIs.

Students who did not experience needlestick and sharps injuries (NSSIs) exhibited more positive attitudes and behaviors compared with those who had been injured. In contrast, Atan et al. (2025) reported that experiencing injuries did not affect nursing students’ attitudes.¹⁷ Parallel to the findings of the present study, Elfarra et al. (2024) found, in a study conducted with nursing and dental students, that students who had not experienced injuries had higher levels of knowledge than those who had experienced injuries.²⁸ Likewise, studies conducted with nurses have shown that those who had not been exposed to injuries demonstrated more positive knowledge, attitudes, and behaviors than those who had experienced injuries.^29,30 Taken together, these findings suggest that providing education to students beginning in the first year may reduce injury rates by enhancing their knowledge, attitudes, and behaviors. Additionally, students who experienced injuries due to other causes (e.g., recapping after an injection, using a blood glucose lancet, or opening a needle) demonstrated higher knowledge, attitudes, and behaviors compared with those injured while breaking ampoules or opening vials. In a study conducted by Araldağ (2019) with nurses, those who experienced an injury with a contaminated instrument demonstrated more positive attitudes toward the safe use of sharps compared with those injured with a non-contaminated instrument.³¹ In the present study, it is suggested that students who experienced injuries due to other causes may have adopted more positive attitudes toward the safe use of sharps because of uncertainty regarding potential risks, which may have led them to monitor the injury process more closely.

Nursing students are required to continue practical training in addition to theoretical education. Some practical training is conducted in the laboratory settings, while the remainder takes place in hospitals.⁴ Clinical practice settings involve a higher level of risk than laboratory practice and, in the literature, emphasizes that students frequently experience injuries in clinical environments.^4,11,19 In the present study, students who experienced a needlestick or sharps injury in the hospital settings demonstrated higher knowledge levels than those injured during laboratory practice. A review of the literature revealed no studies examining the relationship between the location of students’ injuries and their attitudes toward the safe use of sharps. In this study, the higher cognitive scores among students injured in hospital settings may be attributed to their more frequent exposure to health risks in clinical practice and increased opportunities to observe sharps-related procedures (e.g., medication preparation, disposal of syringes in medical waste containers). Consequently, these students may have greater knowledge of injury prevention measures.

Limitations of the study

The results of this study are limited to students from a single nursing faculty in Türkiye. Approximately half of the data were initially collected face-to-face; however, due to the COVID-19 pandemic and the subsequent withdrawal of students from educational institutions, the remaining data were collected via an online survey. This situation affected the research process and delayed the reporting of the manuscript.

Conclusion

According to the results of this study, the number of injuries increased as students’ year of study increased. Students aged 21 years and younger were found to exhibit more positive attitudes toward needlestick and sharps injuries. Female students demonstrated higher levels of knowledge and more positive attitudes and behaviors regarding needlestick and sharps injuries compared with male students. In addition, students who had not experienced injuries showed more positive attitudes and behaviors than those who had experienced injuries, while students who sustained injuries in hospital settings had higher levels of knowledge and more positive attitudes than those injured in laboratory settings. Based on these findings, it is recommended that appropriate measures be implemented to prevent student injuries in both clinical and laboratory environments. Furthermore, to prevent and reduce needlestick and sharps injuries among students, regular training should be provided on universal precautions recommended by the CDC, the safe use of sharp medical instruments, and protection against infections transmitted through blood and body fluids. In addition, further studies employing diverse research designs are needed to more comprehensively examine the factors influencing student injuries.

Footnotes

Acknowledgements

The research team gratefully acknowledges the contributions of the students who assisted in carrying out this study.

Ethical approval

Approval for conducting the research was obtained from the Social and Human Sciences Research Ethics Committee of a public university (Date: January 13, 2020, Reference No: 2217). Approval for conducting the research was obtained from the Faculty of Nursing (Date: December 25, 2019, Reference No: 198123), and written informed consent was obtained from the nursing students who agreed to participate in the study.

Informed consent

After providing information about the purpose and methodology of the study, written informed consent was obtained from the students who voluntarily agreed to participate in the study. However, due to the Covid-19 pandemic, informed consent was obtained through Google Forms from some of the participants for certain data.

Author contributions

YK: Literature Review; methodology; data collection; data analysis and interpretation writing–review; writing–original draft; supervision; project administration. HK: Editing draft; conceptualization; methodology; approval of the final version for publication.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

The data are not publicly available due to restrictions such as information that could compromise the privacy of research participants. The data that support the findings of this study are available on request from the corresponding author.

ORCID iD

Yasemin Kıyak Yorulmaz

References

Elisa

Ssenyonga

Iramiot

, et al. Sharps/needlestick injuries among clinical students at a tertiary hospital in Eastern Uganda. MedRxiv 2023. doi:10.1101/2023.02.01.23285330.

Katsevman

Sedney

Braca

III , et al. Interdisciplinary differences in needlestick injuries among healthcare professionals in training. Work 2020; 65(3): 635–645. doi:https://doi.org/10.3233/WOR-203118.

Chen

Zhang

. Prevalence of needlestick injuries among nursing interns: a systematic review and meta-analysis. Ann Palliat Med 2021; 10(7): 7525–7533. doi:https://doi.org/10.21037/apm-21-703.

Al-Mugheed

Farghaly

Baghdadi

, et al. Incidence, knowledge, attitude, and practice toward needle stick injury among nursing students in Saudi Arabia. Front Public Health 2023; 11: 1160680. doi:https://doi.org/10.3389/fpubh.2023.1160680.

Yin

Wang

, et al. Prevalence of needle-stick injury among nursing students: a systematic review and meta-analysis. Front Public Health 2022; 10: 937887. doi:https://doi.org/10.3389/fpubh.2022.937887.

Çakar

Şişman

Oruç

. Health risks encountered by nursing students in clinical practice/ Hemşirelik öğrencilerinin klinik uygulamalarında karşılaştıkları sağlık riskleri. Dokuz Eylul Univ Nurs Fac Electron J 2019; 12(2): 116–125.

Thomas

. Underreporting of bloodborne pathogen exposures in nursing students. Nurse Educ 2020; 45: 78–82. doi:https://doi.org/10.1097/NNE.0000000000000696.

Doğru

Akyol

. Evaluation of needlestick and sharp injuries in nursing students/Hemşirelik öğrencilerinde kesici ve delici alet yaralanmalarının değerlendirilmesi. Acibadem Univ J Health Sci 2018; 9(1): 59–66.

Handiyani

Kurniawidjaja

, Irawaty

et al. Effective needlestick injury prevention strategies for nursing students in clinical settings: a literature review. Enferm Clin 2018; 28: 167–171. doi:https://doi.org/10.1016/S1130-8621(18)30060-3.

10.

Rubbi

Cremonini

Butuc

, et al. Incidence and type of healthcare-associated injuries among nursing students: an experience in Northern Italy. Acta Biomed 2018; 89(7): 41–49. doi:https://doi.org/10.23750/abm.v89i7-S.7812.

11.

Suliman

Qadireb

Alazzama

, et al. Nursing students' knowledge and prevalence of needlestick injuries in Jordan. Nurse Educ Today 2018; 60: 23–27. doi:https://doi.org/10.1016/j.nedt.2017.09.015.

12.

Zhang

Chen

, et al. Needlestick and sharps injuries among nursing students in Nanjing, China. Workplace Health Saf 2018; 66(6): 276–284. doi:https://doi.org/10.1177/2165079917732799.

13.

Yıldız

. The evolution of the safe usage of sharp devices by the Health care workers/ Sağlık çalışanlarının kesici-delici tıbbi aletleri güvenli kullanımlarının incelenmesi . master’s thesis, Ege Univ, Inst Health Sci, 2011.

14.

Karabela

ŞN

Durdu

Şimşekoğlu

, et al. The evaluation of students’ attitudes towards safe use of medical sharp objects associated with occupational accidents: example of vocational school/ Öğrencilerin iş kazası geçirme durumlarına göre kesici-delici tıbbi aletleri güvenli kullanmalarına yönelik tutumlarının değerlendirilmesi: bir meslek yüksekokulu örneği. UHSJN 2020; 2(3): 151–158. doi:https://doi.org/10.48071/sbuhemsirelik.799346.

15.

Özenir

Ünver

. The analysis of occupational accidents among the healthcare staffs. Eur Res J 2020; 6(3): 216–224. doi:https://doi.org/10.18621/eurj.455476.

16.

Soylu

Tanrıverdi

, et al. Determination of nursing students’ attitudes towards the safe use of sharp and penetrating medical instruments/ Öğrenci hemşirelerin kesici-delici tıbbi aletleri güvenli kullanımına yönelik tutumlarının belirlenmesi. Acıbadem Univ J Health Sci 2021; 12(2): 370–375. doi:https://doi.org/10.31067/acusaglik.847345.

17.

Atan

Zeray

Batmaz

. Preventing HBV cases caused by sharp-incision injuries with isolation descriptive figure: a cross-sectional study / İzolasyon figüranı ile kesici-delici alet yaralanmaları sonucu oluşan HBV vakalarının önüne geçilmesi: kesitsel çalışma. EBSHealth 2025; 4(2): 110–122. doi:https://doi.org/10.59312/ebshealth.1634980.

18.

Uzunbayır

. Scale for the safe use of sharp and penetrating medical instruments among healthcare workers/Sağlık çalışanlarının kesici-delici tıbbi aletleri güvenli kullanımına yönelik tutum ölçeği . master’s thesis, Ege Univ, Inst Health Sci, 2009.

19.

Asmar

Almahmoud

Abu Zahra

, et al. Prevalence, knowledge, and awareness of needle stick injuries among nursing students in Palestine and associated factors. Infect Dis Health 2025; 30(2): 132–142. doi:https://doi.org/10.1016/j.idh.2024.11.004

20.

Hambridge

Endacott

Nichols

. Investigating the incidence and type of sharps injuries within the nursing student population in the UK. Br J Nurs 2021; 30(17): 998–1006. doi:https://doi.org/10.12968/bjon.2021.30.17.998.

21.

Hut

Yazici

. Glass particle contamination threat in nursing practice: a pilot study. J Adv Nurs 2021; 77(7): 3189–3191. doi:https://doi.org/10.1111/jan.14847.

22.

Gani

Patil

Amashi

. Difficulty in opening glass ampoules. J Eng Educ Transform 2024: 537–543. Available from: https://journaleet.in/index.php/jeet/article/view/2467.

23.

Chiannilkulchai

Kejkornkaew

. Safety concerns with glass particle contamination: improving the standard guidelines for preparing medication injections. Int J Qual Health Care 2021; 33(2). doi:10.1093/intqhc/mzab091.

24.

CDC (Center for Disease Control and Prevention). What to do following a sharps injury. 2019. Accessed: 11.03.2025. https://www.cdc.gov/nora/councils/hcsa/stopsticks/whattodo.html.

25.

Menteşe

HÖ

Karaca

. Knowledge levels of nursing and midwifery students regarding needlestick and sharp injuries/Hemşirelik ve ebelik öğrencilerinin kesici-delici alet yaralanmasına ilişkin bilgi düzeyleri. Klimik J 2021; 34(3): 156–163.

26.

Al Qadire

Ballad

CAC

Al Omari

, et al. Prevalence, student nurses’ knowledge and practices of needlestick injuries during clinical training: a cross-sectional survey. BMC Nurs 2021; 20(1): 87. doi:https://doi.org/10.1186/s12912-021-00711-2.

27.

Alsharari

Kerari

. Factors influencing occupational health and safety among nursing students. Healthcare (Basel) 2024; 12(9): 884. doi:https://doi.org/10.3390/healthcare12090884.

28.

Elfarra

NEA

Alanzi

MAR

Alhazmi

KFJ

, et al. Knowledge and attitude of students regarding needle stick injuries (NSI): a cross-sectional study. Int J Nurs 2024; 6(2): 43–50. doi:https://doi.org/10.33545/26649187.2024.v6.i2a.69.

29.

Çakmak

. Evaluation of the attitudes of healthcare workers towards the safe use of sharp and penetrating medical instruments in a public hospital . master’s thesis, Trakya Univ, Inst Health Sci, 2019.

30.

Yıldızlı

. Determination of nurses’ attitudes towards safe use of cutting tools / Hemşirelerin kesici-delici aletleri güvenli kullanımına yönelik tutumlarının belirlenmesi . master’s thesis, Çukurova Univ, Inst Health Sci, 2020.

31.

Araldağ

. Examination of the reasons of nurses’ sharp and needlestick wounds and their attitudes against injuries/ Hemşirelerin kesici - delici aletlerle yaralanma nedenleri ve yaralanmaya karşı tutumlarının incelenmesi . master’s thesis, Okan Univ, Inst Health Sci, 2019.