the risk of occupational exposure to blood borne pathogens ( including hepatitis b , hepatitis c and hiv ) via sharp injuries such as needle stick injuries ( nsis ) among health care workers , especially dental , nursing and midwifery students , is a challenging issue , , , , , .
inadequate staff , lack of experience , insufficient training , duty overload and fatigue may lead to occupational sharp injuries , .
it is estimated that approximately 600,000 to 800,000 nsis occur each year among health care workers in the united states ( one injury every ten seconds ) .
the risk of pathogen transmission from infected persons through an injury with a sharp object have been estimated to be 630% for hbv in non - immune individuals , 510% for hcv , and 0.3% for hiv .
administration of pre - exposure vaccination or post - exposure prophylaxis is effective in preventing hbv and hiv infections , respectively , but is not available or not effective in preventing hcv infection .
the aim of this study was to evaluate the frequency of nsis in iranian dental , nursing and midwifery students and their knowledge , attitude and practices regarding the use of protective strategies against exposure to blood borne pathogens ) .
a cross - sectional survey of 264 dental and 435 nursing and midwifery students during their under graduate clinical training at the shiraz university of medical sciences , iran , was conducted . a questionnaire that included demographic data , frequency and reporting of nsi , protective practices and knowledge , attitude , and concerns regarding blood - borne pathogens was administred to all participants .
the questionnaire was pre - tested for reliability on 9.2% of the 55 sample population and found to have a high ( r=0.812 ) test - retest reliability .
the data was entered in to a computer using the software package epi - info ( version 2000 ) .
descriptive and significant tests , duncan test , spearman s correlation coefficient and student t - test were performed using spss - version10 .
the survey was completed by 137 ( 51.9% ) dental students and 208 ( 47.8% ) nursing and midwifery students .
there was a significant female predominance among the nursing and midwifery students when compared to dental students ( 67.3% vs. 50% ; p=0.002 ) .
the majority of the students ( 85% ) reported to have received information about standard precautions .
since entering their clinical year , 72.1% ( 150/208 ) of the nursing and midwifery students , and 73.7% ( 101/137 ) of the dental students experienced a total of 424 and 268 nsis , respectively , giving a ratio of 1:1.9 and 1:2 nsis among students in their undergraduate clinical practice over an average of a 12 months period ( maximum 17 months ) .
differences were noted in the situation of injury among nursing and midwifery students : 31.4% ( 133/424 , p<0.005 ) of all nsi occurred at the delivery room , 26.9% in patient rooms , 22.9% in the operation theatre , 17.9% in the emergency room , and 0.9% at unknown instances . in dental students , 53% ( 142/268 , p<0.001 ) of all nsis occurred during patient treatment , 9.3% in surgical wards , 3.3% in the emergency room , 1.1% in the operation theater , and 3.3% at unknown instances .
the clinical activities most frequently associated with injuries involved a hollow - bore needle used during venous sampling or iv injection in both groups , followed by wound suturing , in nursing and midwifery , and recapping in the dental students .
the 3 most common activity associated with nsis in nursing and midwifery students was recapping ( 7.6% ) and wound suturing ( 17% ) in dental students ( table 1 ( tab .
1 ) ) . the majority of the last injury recalled involved the students injuring themselves : 93% nursing and midwifery students and 96% dental students , respectively .
75% of nursing and midwife students , and 85% of dental students did not report there injury .
the reason for not reporting in decreasing frequency included not knowing the reporting mechanism , did not realize that all nsis required reporting and evaluation or they did not know to whom to report the injury .
the majority of students ( 85% ) reported to have received information about standard precautions , yet most had not been encouraged by clinical staff to double glove while using needles .
glove use behaviors were examined by clinical activities and almost all ( 95.2% ; 198/208 ) students reporting to routinely wear gloves for wound suturing .
glove use for all other activities was poor with 24.1% of nursing and midwifery students wearing gloves while performing venous sampling or iv injection , 2% always wearing double gloves while scrubbed in the or , 1% double gloved while in the er , and 1% during iv injection . for dental students , glove use was slightly better while performing venous sampling or iv injection , 9.5% always wore double gloves while in the er . the reasons given by students who did not routinely wear double gloves was decreased tactile sensitivity during manipulation , followed by inadequate facilities not providing gloves at the point of care . among nursing and midwifery students
the use of sharp containers was higher ( 59.1% ) when compared to dental students ( 35% ) with more than 2/3 of all students practicing needle recapping .
eye protection in the operating room was not used by the majority ( 97% ) of nursing and midwifery students while 47% of the dental students used eye protection .
95% of all dental students and 75% of all nursing and midwifery students were vaccinated .
44.2% of nursing and midwife students , and 66.4% of dental students stated , that they are extremely or very concerned about the risk of contracting a blood borne virus infection .
students reported patient risk factors on a five - point scale , ranging from extreme to no concern , with aids ( 9199% ) , hbsag - positive ( 9197% ) and injecting drug use ( 76.496% ) causing extreme concerns by the majority of students .
concerns that the type of surgery was a risk factor were not significantly ( p=0.37 ) different for the extreme ( 27.7% ) to moderate ( 23.0% ) levels of concern .
students report risk factors associated with gender ( 32.1% ) , race ( 0.4% ) and age ( 44.7% ) at the very concerned to moderately concerned levels .
this is the first survey of nsi among midwife , nursing and dental students in shiraz , iran .
nsis are a recognized source of exposure to blood borne pathogens for health care workers in high risk occupations   , .
turkish nurses asked on how many times they had been injured by a needle or another sharp object in the past 12 months , reported an average of 1.7 ( range 012 ) nsis .
most of the nurses ( 52.5% ) reported that they had experienced nsis more than once in the last year .
of those , 186 nurses had been injured more than twice in the past year .
61.9% of students in taiwan had at least one nsi and the majority ( 70.1% ) of these nsi occurred in the patient room .
lee et al . reported 56% of emergency medicine students having one or more nsis , 31% of which were due to hollow - bore needles .
30% of medical students in washington had sustained at least one nsi and that these most commonly ( 72.1% ) occurred in the operating room . in our study ,
73% of our students reported at least one nsi , most of which occurred among nursing and midwifery students in the delivery room and patient room during venous blood sampling or iv injection .
lack of experience in many procedures , insufficient training , duty overload and fatigue lead to occupational sharp injuries , , , , .
the high level of non - reporting nsis ( 80% ) suggests that the students need a center of prevention which address the importance of reporting all nsis , , , , , , .
furthermore , regarding that a frequently stated reason for not reporting was not knowing the reporting mechanism or not knowing to whom to report indicates the need for a better reporting management . our study showed that 84.8% of the students reported receiving information about standard precautions and bloodborne pathogen exposure .
this is in contrast to a study performed by patterson et al . , which evaluated nsis among medical students in developed country and found 98% of them reported receiving information about this topic .
these data indicate that students need to be provided structured education on standard precautions for the improvement of occupational safety , ,
. the risk of hbv infection can be avoided by ensuring adequate hepatitis b vaccination .
16% of taiwanese student nurses had not been vaccinated against hbv , a preventable measure .
32.4% ( 45 of 139 ) of turkish nurses had not been vaccinated against hbv .
our study revealed that dental students had higher hbv vaccination when compared to nursing and midwifery students ( 95% vs. 75% ) .
one of the protective strategies against nsi is use of gloves by health care workers , . in this study , most students reported gloving during wound suturing . although some studies showed that one feasible protection strategy is the use of double gloves , , 50% of medical students in a study conducted in strasbourg did not use gloves . in our survey ,
59.1% of nursing and midwifery students used sharps container and only 5.7% of them did not recap needles after use .
our analysis indicates the nursing and midwifery students are at high risk for sharps injuries and bloodborne pathogen exposure . in agreement with ayranci et
we believe that the prevention of nsis through the increase knowledge regarding transmission of bloodborne infections , education about standard precautions and protection strategies against bloodborne pathogens such as wearing gloves , using eye protection , using sharps containers to dispose of needles and not recapping needles . furthermore , an optimization of the management for reporting in warranted .
this study was funded by the deputy for research at the shiraz university of medical science ( grant no .
this study was funded by the deputy for research at the shiraz university of medical science ( grant no .
 background : the risk of occupational exposure to blood borne pathogens ( including hepatitis b , hepatitis c and hiv ) via sharp injuries such as needle stick injuries ( nsis ) among health care workers , especially dental , nursing and midwifery students is a challenging issue . 
 inadequate staff , lack of experience , insufficient training , duty overload and fatigue may lead to occupational sharp injuries . 
 the aim of this prospective cross - sectional study was to evaluate the frequency of nsis in iranian dental , nursing , and midwifery students and their knowledge , attitude and practices regarding prevention of nsis.methods : a questionnaire was provided to 264 dental and 435 nursing and midwifery students during their under graduate clinical training . 
 52% of dental students and 48% of nursing and midwifery students responded to the questionnaire . 
 the questionnaire was pre - tested for reliability on 9.2% of the 55 sample population and found to have a high ( r=0.812 ) test - retest reliability.results : 73% of students reported at least one nsi during the past year . 
 activities most frequently associated with injuries involved use of a hollow - bore needle during venous sampling or iv injection in both groups , followed by wound suturing in nursing and midwifery students and recapping in dental students . 
 nsis and non - reporting of nsis were highly prevalent in these participants . 
 the reason for not reporting injuries included not knowing the reporting mechanism or not knowing to whom to report.conclusion : education about transmission of blood borne infections , standard precaution and increasing availability of protective strategies must be enforced . 
 furthermore , an optimization of the management for reporting is warranted . 
Introduction
Methods
Results
Discussion
Conclusions
Notes
Competing interests
Acknowledgement