Sharp injuries to blood-borne pathogens among healthcare workers and influencing factors in a tertiary specialist hospital (2019–2022): a retrospective study

Abstract

To assess the prevalence of sharp injuries among healthcare workers (HCWs) in a tertiary specialist hospital and analyze the influencing factors to improve protective measures and mitigate exposure risks. A retrospective study was conducted using occupational exposure data from 2019 to 2022. Descriptive statistics, univariate analysis, and multivariate logistic regression were used for statistical analysis, focusing on factors such as gender, years of service, occupation, and exposure department. Among 151 reported occupational exposures, 76.16% (115/151) were sharp injuries. Significant differences were observed in age (P < 0.05), years of service (P = 0.04), and year of exposure (P = 0.02). Multivariate analysis revealed that healthcare workers with 1–5 years of service had a lower risk of sharp injuries compared to those with ≤ 1 year of service or > 5 years of service (OR 0.26, 95% CI 0.09–0.76). The risk of sharp injuries was significantly higher in 2021 (during the COVID-19 pandemic) compared to 2019 (OR 4.32, 95% CI 1.23–18.25). Most injuries occurred on the hands, with HBV being the primary blood-borne pathogen. No infections were reported during follow-up. This study highlights the need for tailored interventions and comprehensive protective measures for HCWs with varying years of service, particularly during public health emergencies like COVID-19, to mitigate sharp injuries and enhance occupational safety.

Introduction

Occupational exposure among HCWs is defined as the contact with blood, bodily fluids, or other potentially infectious materials through broken skin, mucous membranes, or ingestion during clinical activities¹. Such exposures pose significant health risks, including the potential for severe infections and life-threatening consequences². With the advancement of medical technologies and increased clinical workloads, the incidence of occupational exposure has increased globally. According to the World Health Organization (WHO), approximately 3 out of every 35 HCWs experience blood-borne occupational hazards annually, with sharp injuries being the most common form, affecting 8.57% of HCWs worldwide³.

In China, the prevalence of occupational exposure among HCWs is alarmingly high, with a reported rate of 74.6%, largely attributable to heavy workloads and extended working hours.

Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are the most common blood-borne pathogens associated with occupational exposure. HBV infection rate among HCWs is 2–10 times greater than that observed in the general population, ranging from 5.78 to 69.03%⁴. Despite widespread implementation of safety measures and training programs, sharp injuries remain a persistent and critical concern⁵.

While previous studies have explored occupational exposure risks, few have examined the impact of experience levels and public health emergencies on sharp injuries. This study aims to address this gap by analyzing data from a tertiary specialist hospital during the COVID-19 pandemic.

Methods

Study design and data collection

This retrospective study utilized data from the Occupational Exposure Case Registry of a tertiary care specialty hospital between 2019 and 2022. The registry collected data on (1) basic information, such as name, gender, and length of service. (2) Occupational exposure details, including time, place, reason, and mode of exposure, and results of the patient’s transfusion and immunization tests results (hepatitis B virus, hepatitis C virus, human immunodeficiency virus (HIV), syphilis, etc.). (3) Post-exposure emergency treatment measures, post-exposure prophylactic medication, and follow-up protocols. Occupational exposures among HCWs generally fall into two main categories: sharp injuries, and skin or mucous membrane exposures. In this study, we focus more on sharp injuries.

Prior to the study, informed written consent was obtained from all participants. Ethics approval was granted by the Medical Ethics Committee of West China School of Public Health and West China Fourth University Hospital. The Committee confirmed that all research was performed in accordance with the Standard for Healthcare-Associated Infection Surveillance (WS/T 312-2023)⁶.

Statistical analysis

Data from the Occupational Exposure Case Registry were systematically coded and entered into EpiData version 3.1 (http://www.epidata.dk) to ensure consistency and accuracy. Statistical analysis was performed using R version 4.2.2 (https://www.r-project.org/). For qualitative data, component ratios were employed for statistical description; for quantitative data, the mean ± standard deviation was utilized. For one-way analysis, the t-test, χ²-test, or Fisher’s exact probability method was employed, while multivariate analysis utilized logistic regression. The level of significance was set at α = 0.05.

Results

Characteristics of sharp injuries

A total of 151 occupational exposures were reported by the hospital between 2019 and 2022. Of these, 115 were sharp injuries and 36 were non-sharp injuries. These figures are detailed in Table 1. The mean age of affected HCWs was 28.7 ± 7.46 years. There was a higher proportion of occupational exposure among females, those with less than 1 year of service, and clinicians, accounting for 92.72%, 39.74%, and 29.80%, respectively, of each group. In terms of the occurrence of occupational exposures, the majority of incidents occurred in patient rooms (58.94%); other departments, including Rehabilitation Medicine, Occupational Disease, and Palliative Medicine, exhibited the highest number of occupational exposures (49.67%); and the number of occupational exposures in 2022 was the highest in 4 years (43.38%).

Table 1.

Basic situation of occupational exposure of medical personnel [n (%)].

Variable	In totala	Sharp injury	Non-sharp injury	P valueb
	151	115	36
Age	28.7 ± 7.46	28.30 ± 7.52	29.97 ± 7.19	< 0.01**
Sex
Man	11 (7.28)	9	2	1.00
Woman	140 (92.72)	106	34
Years of service
≤ 1	60 (39.74)	51	9	0.04*
2–5	40 (26.49)	25	15
> 5	51 (33.77)	39	12
Occupational category
Clinician	45 (29.80)	33	12	0.52
Nurse	85 (56.29)	64	21
Others	21 (13.91)	18	3
Exposure location
Sickroom	89 (58.94)	71	18	0.52
Outside the sickroom	15 (9.93)	11	4
Operating rooms	14 (9.28)	9	5
Other locations	33 (21.85)	24	9
Exposure department
Internal medicine department	33 (21.85)	27	6	0.59
Surgical department	29 (19.21)	23	6
Technical departments	14 (9.27)	9	5
Other departments	75 (49.67)	56	19
Year of exposure
2019	40 (26.49)	28	12	0.02*
2020	32 (21.19)	19	13
2021	36 (23.84)	32	4
2022	43 (23.38)	36	7

^aQuantitative data (e.g., age) indicate mean ± standard deviation, and qualitative data (e.g., gender, length of service, etc.) indicate number and composition ratio.

^b*indicates P < 0.05, **indicates P < 0.01.

Following univariate analysis, the results demonstrated that the differences between the groups in terms of age (P < 0.001), years of service (P = 0.04), and year of exposure (P = 0.02) were statistically significant for medical personnel with sharps injuries. Conversely, the differences between the groups in terms of occupation (P = 0.52), exposure location (P = 0.52), and exposure department (P = 0.59) were not statistically significant.

As shown in Table 2, sharp injuries constituted 76.16% (115/151) of all occupational exposures, with all incidents involving hand exposure. HBV was the most common blood-borne pathogen (15.65%), followed by syphilis (1.74%) and unknown pathogens (43.48%). The results demonstrated that the instruments responsible for causing sharps injuries were predominantly needles (86.09%), with a significant proportion being syringe needles (43.43%) and scalp needles (20.20%). The highest number of sharps injuries among medical personnel occurred after the removal of needles, with 36 cases (31.30%), followed by organizing items and during patient treatment. Further details regarding the incidence of sharps injuries among medical personnel can be found in Table 2.

Table 2.

Analysis of the incidence of sharp force injuries among medical personnel.

Variable	N	%
Exposure site
Hand	115	100
Pathogen species
Unknown pathogen	50	43.48
Negative	44	38.26
Hepatitis B	18	15.65
Syphilis	2	1.74
Hepatitis C	1	0.87
Types of occupational exposure
Needle	99	86.09
Syringe needle	43	43.43
Scalp needle	20	20.20
Blood collection needle	10	10.10
Intravenous needle	8	8.08
Insulin needle	7	7.07
Acupuncture needle	6	6.06
Suture needle	5	5.05
Cutters	6	5.21
Other equipment	10	6.70
Exposure time
After removing the needle	36	31.30
When sorting out items	26	22.61
During the course of treatment	19	16.52
When covering the needle cap	16	13.91
When separating or transferring instruments	8	6.96
Others*	10	8.70

*Indicates pathological tissue sampling, blood collection, loss/retrieval of equipment, at the time of injection, etc.

Risk factors for sharp injuries

A multi-factorial logistic regression model was constructed for the purpose of examining the incidence of sharps injuries among HCWs. The independent variables identified for inclusion in the model were age at work, gender, occupation, years of service, place of exposure, year of exposure and department of exposure.

The results demonstrated that two factors influenced the likelihood of HCWs member sustaining a sharps injury: length of service and year of exposure. HCWs with 1–5 years of service exhibit a significantly lower risk of occupational exposure compared to those with ≤ 1 year or > 5 years of service (OR 0.26, 95% CI 0.09–0.76). Additionally, the risk of sharps injuries in 2021 was higher than the risk of sharps injuries in 2019. As detailed in Table 3, the risk of sharps injury was found to be high (OR 4.32, 95% CI 1.23–18.25).

Table 3.

Logistic regression analysis of sharps injuries among medical personnel.

Variable	Β	SE	P value	OR (95% CI)
Sex
Man	Control subjects
Woman	0.07	0.90	0.94	1.07(0.14–5.45)
Years of service
≤ 1	Control subjects
1–5	− 1.33	0.55	0.05*	0.26 (0.09–0.76)
> 5	− 0.53	0.55	0.33	0.58 (0.19–1.72)
Occupational category
Doctor	Control subjects
Nurse	− 0.29	0.55	0.58	0.74 (0.24–2.14)
Others	− 0.40	0.91	0.66	0.67 (0.11–4.42)
Exposure location
Sickroom	Control subjects
Outside the sickroom	− 0.81	0.73	0.26	0.44 (0.11–1.98)
Operating rooms	− 0.86	0.83	0.30	0.42 (0.08–2.26)
Other locations	− 0.35	0.64	0.58	0.07 (0.20–2.53)
Exposure department
Internal medicine department	Control subjects
Surgical department	− 0.58	0.71	0.41	0.56 (0.14–2.26)
Technical departments	− 0.22	0.93	0.82	0.80 (0.13–5.16)
Other departments	− 0.41	0.58	0.48	0.66 (0.20–2.00)
Year of exposure
2019	Control subjects
2020	− 0.56	0.55	0.31	0.57 (0.19–1.69)
2021	1.46	0.67	0.01**	4.32 (1.23–18.25)
2022	0.98	0.58	0.09	2.66 (0.87–8.74)

*Indicates P < 0.05, **indicates P < 0.01.

Post-exposure management

When HCWs encounter occupational exposure, a comprehensive and standardized blood sample collection and testing protocol will be swiftly initiated. Among the 151 cases of occupational exposure, all the affected personnel received immediate post-exposure emergency treatment, which included thorough irrigation, disinfection, and proper bandaging (Table 2). Subsequently, a series of pre-transfusion immunization tests, covering HBV, HCV, Syphilis, and HIV, were promptly carried out. Simultaneously, an occupational exposure risk assessment was conducted, taking into account the type of occupational exposure, the auto-immunity of the exposed HCWs, and the pathogens carried by the source patient. The results of this assessment serve as a crucial basis for the targeted prophylactic use of medications. In the event that HCWs member has an occupational exposure to the HIV pathogen, aside from the aforementioned virus-related tests, they are required to strictly adhere to clinical guidelines and the determined exposure risk levels. They must take HIV post-exposure prophylaxis (PEP) and also undergo additional tests for blood routine, as well as liver and kidney functions. When an occupational exposure to hepatitis B is confirmed, HCWs should receive immunoglobulin injections in line with their individual immune status. Likewise, for cases of confirmed syphilis occupational exposure, penicillin or other appropriate drugs should be administered based on the degree of exposure risk.

Overall, the health records of those who have experienced occupational exposure are established in a timely fashion. Regular follow-up and monitoring visits are meticulously arranged. Up to now, there have been no reported cases of disease contraction resulting from occupational exposure.

Discussion

This study found that HCWs with 1–5 years of service had a significantly lower risk of occupational exposure compared to those with ≤ 1 year or > 5 years of service. This U-shaped relationship contrasts with findings from previous studies. One research indicated that HCWs with <1 years of experience had the lowest rate of sharps injuries⁵. Similarly, another reported that workers with > 10 years of experience were more likely to disregard safety protocols, leading to an increased risk of occupational exposure⁷. However, our study uniquely highlights the intermediate experience group (1–5 years) as a critical target for optimizing occupational safety programs. This shows that different studies have presented diverse associations between years of service and the occurrence of sharps injuries, highlighting the complexity of this relationship. For novice HCWs (≤ 1 year of service), the higher risk of occupational exposure is likely attributed to their limited technical proficiency and lack of experience in handling sharp instruments. Novice workers may also be less familiar with hospital protocols and safety measures, increasing their vulnerability to accidents⁸. Additionally, the psychological stress associated with adapting to a new work environment may further contribute to their risk⁹. In contrast, HCWs with 1–5 years of experience have likely developed sufficient technical skills and familiarity with safety protocols, reducing their risk of occupational exposure. This period represents a “sweet spot” where workers are neither overwhelmed by inexperience nor burdened by complacency¹⁰. Moreover, these workers may benefit from ongoing training and supervision, which reinforce safe practices and minimize errors. However, the increased risk among workers with > 5 years of service may be linked to complacency and fatigue. Over time, experienced workers may become less vigilant in adhering to safety protocols, assuming their expertise protects them from accidents¹¹. Additionally, long-term exposure to high workloads and repetitive tasks may lead to physical and mental fatigue, further increasing their risk of occupational exposure¹².

This finding has significant implications for occupational safety programs. While novice workers require intensive training and mentor-ship to build their skills and confidence, experienced workers may benefit from refresher courses and psychological support to combat complacency and fatigue¹³. Tailored interventions for different experience levels can thus optimize the effectiveness of occupational safety initiatives^14,15. In conclusion, the U-shaped relationship between years of service and occupational exposure risk highlights the need for experience-specific interventions to protect HCWs. By addressing the unique vulnerabilities of novice and experienced workers, healthcare institutions can create safer working environments and reduce the incidence of occupational exposure.

Our study found that the resurgence of SARS-CoV-2 in 2021 significantly increased the risk of sharp force injuries, likely due to heightened workloads and psychological stress among HCWs, which is consistent with the results of other studies^16,17. In the wake of the significant outbreak of the novel corona-virus disease (Covid-19) in 2020, the virus became a regular occurrence in 2021, with a notable rise in the number of cases, an increase in the number of hospital visits and inpatients, and a significant rise in the physiological burden on medical personnel who were working long hours and at high intensity¹⁸. Furthermore, medical personnel are confronted with the additional burden of apprehension regarding the potential for self- and family infection¹⁹. The propagation and emergence of the SARS-CoV-2 virus has imposed considerable physiological and psychological strain on medical personnel, leading to a spectrum of burnout and physical and mental fatigue¹⁶. It is therefore recommended that the physical and mental health education of medical personnel be reinforced in the event of a similar emergency public health situation, that the necessary psychological guidance and physiological relaxation be provided, and that training be enhanced in order to effectively reduce the incidence of sharp injuries^18–20.

HBV was the most common blood-borne pathogen associated with sharps injuries among medical personnel^21,22. It has been demonstrated that the prevalence of hepatitis B among medical personnel is approximately 10 times higher than that observed in the general population^23,24. Of the more than 20 pathogens that can be transmitted through sharps injuries, hepatitis B is considered the most dangerous²⁵. It is therefore recommended that pathogens for which vaccines are available, such as HBV, should endeavour to achieve full immunization coverage. Furthermore, pathogens for which there are no specific preventative drugs, such as HCV and HIV, should reinforce occupational protection²⁶. A cause for concern is that 50 cases (43.48%) of occupationally exposed patients were exposed to unknown types of blood-borne pathogens. This indicates that the hospital’s pathogen tracking in source patients requires reinforcement, and that the tracking and treatment of occupational exposures subsequent to their occurrence necessitate further enhancement²⁷.

This study has several limitations. First, the study’s sample size was limited, as it included data from a single tertiary hospital in Chengdu. While the findings provide valuable insights, they may not be fully representative of other healthcare settings. Second, the data were derived from the Occupational Exposure Case Registry, which relies on self-reported incidents. This may introduce reporting bias, as HCWs might under-report minor exposures or omit incidents due to time constraints or fear of repercussions. Third, the retrospective design of this study limits the ability to establish causal relationships between risk factors and occupational exposure. For example, while we identified a U-shaped relationship between years of service and exposure risk, the underlying mechanisms (e.g., complacency, fatigue) could not be fully explored. Future studies should adopt longitudinal designs to track changes in exposure risk over time and investigate the causal pathways.

Conclusions

While complete elimination of occupational exposure is unattainable, comprehensive protective measures can significantly reduced its risks. This requires urgent implementation of multifaceted strategies, including enhanced awareness programs for HCWs and the development of robust management systems with tailored training for various experience levels^28–30. Healthcare institutions should prioritize exposure prevention by addressing both physical and mental health needs during public health emergencies, providing psychological support and physiological relaxation measures, while ensuring proper safety equipment usage and optimizing working conditions^31–33. Simultaneously, HCWs should enhance their protective awareness, adhere strictly to safety protocols, and standardize operational procedures—especially in high-risk tasks such as infusion and needle handling—to minimize sharps injuries.

Author contributions

Yuanyi Ji wrote the initial draft of the paper, Xiaoling Liu collected data, These two authors contributed equally to this work and should be considered co-first authors. Guishaung Song and Qiaolan Liu analyzed and verified data, Yongzhong Cheng and Ruixin He revised the initial draft of the paper. These two authors contributed equally to this work and should be considered co-corresponding authors. All authors read and approved the final manuscript.

Funding

This work was supposed by the National Natural Science Foundation of China (No. 82273745) and Revitalization of Research Projects in the Management Discipline of West China Forth Hospital, Sichuan University (No. 2023MS02-02).

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Competing interests

The authors declare no competing interests.