Prevalence of needlestick injuries among nurses and nursing students in Pakistan: a meta-analysis of observational studies

Abstract

Background

Needlestick injuries (NSIs) pose a serious occupational risk to healthcare workers. In Pakistan, nurses and nursing students are especially vulnerable, with potential exposure to infections such as HIV and hepatitis B/C. This meta-analysis aimed to estimate the prevalence of NSIs in these groups using data from observational studies conducted across the country.

Methods

A systematic search was conducted in Medline, EMBASE, CINAHL, Scopus, and Web of Science for studies published between 2000 and 2025. Observational studies reporting NSI prevalence among nurses and nursing students in Pakistan were included. Quality assessment was done using the Joanna Briggs Institute (JBI) tool. A meta-analysis was conducted using a random-effects model due to high heterogeneity. Subgroup analysis, meta-regression, and publication bias assessment were also performed.

Results

A total of 25 studies with 27 reports were included. The pooled prevalence of NSIs was 48% (95% CI: 35–61%) among nurses and 43% (95% CI: 31–54%) among nursing students. Significant regional differences were found in NSI prevalence among nurses (p = 0.04) and nursing students (p = 0.025) across Sindh, Punjab, and other provinces. Meta-regression showed a significant increase in NSI prevalence among students over time (p = 0.003), with publication bias detected (p = 0.001). The Trim-and-Fill method adjusted the prevalence from 42.8 to 40.4%.

Conclusion

This meta-analysis provides an estimate of NSI prevalence among nurses and nursing students in Pakistan. The findings highlight the need for effective preventive measures and further research to address the high prevalence of NSIs.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-03812-4.

Introduction

Needle stick injuries (NSIs) are recognized as one of the most critical occupational safety challenges in the nursing profession. These injuries, which primarily result from accidental contact with contaminated needles and other sharp instruments, pose a dual threat: they endanger nurses’ personal health and compromise the overall safety of healthcare systems [1]. According to estimates by the World Health Organization (WHO), approximately three million occupational exposures to blood borne pathogens occur annually among healthcare workers, with 37% related to hepatitis C virus (HCV), 39% to hepatitis B virus (HBV), and 4.4% to human immunodeficiency virus (HIV) [2].

Epidemiological studies indicate that nurses, as the largest group of direct patient care providers, account for more than 50% of all NSIs [3]. Nursing students, however, are considered an even higher-risk group due to the educational nature of their training and their limited clinical experience. Research has shown that between 50% and 80% of nursing students experience at least one NSI during their academic training [4, 5]. Thus, NSIs are considered one of the most significant occupational hazards for healthcare workers, particularly nurses and nursing students. These injuries not only pose a threat to individual health but also impose considerable economic and psychological burdens on healthcare systems [4]. NSIs are among the most common routes of transmission for blood borne infections such as HIV, hepatitis B, and hepatitis C. Despite technological advances in safety-engineered devices and the development of preventive protocols, numerous studies report that NSIs still occur frequently in clinical settings [6]. Moreover, in many cases, these injuries go unreported, hindering accurate assessment of the actual risk and impeding the development of effective interventions. Several factors contribute to underreporting, including fear of social stigma, belief in the low risk of exposure, complex reporting procedures, and concerns about administrative consequences [7].

In addition to physical risks, NSIs can lead to serious psychological consequences such as stress, anxiety, and fear of contracting infectious diseases. These effects are particularly pronounced among nursing students, who may have limited clinical exposure and inadequate awareness of post-exposure prophylaxis protocols [8]. Furthermore, the costs associated with diagnostic testing, preventive treatments, and work absenteeism place a significant financial burden on healthcare systems [8]. Due to the nature of their responsibilities—including administering injections, collecting blood samples, and disposing of sharp waste—nurses and nursing students are at high risk of NSIs. However, reported prevalence rates vary significantly across countries and healthcare settings. Some studies have reported a lifetime NSI prevalence of up to 49.9% among nurses [1], while others have found substantially lower rates. These differences may stem from variations in reporting systems, workplace safety culture, or access to protective equipment [9].

Numerous studies have explored the prevalence and contributing factors of NSIs in nurses. For example, a study in the United States found that 26.3% of nurses experienced at least one NSI within a year [1], whereas a study in Iran reported a lifetime prevalence of 46% [9]. NSIs represent a global public health concern, affecting both developed and developing countries. However, the burden is considerably higher in regions with limited healthcare resources [10]. Studying the prevalence of NSIs in developing countries such as Pakistan is especially important, as these nations often face multiple challenges, including a lack of safety-engineered devices, inadequate reporting systems, and limited access to preventive training [11]. In Pakistan, studies indicate that the reporting rate of NSIs among nurses and nursing students remains significantly low, largely due to fear of social stigma, lack of supportive policies, and burdensome reporting procedures [12]. In addition, insufficient financial resources and inadequate healthcare infrastructure have contributed to the continued use of unsafe sharp instruments, increasing the risk of transmitting blood borne infections such as hepatitis B and C [13].

Various studies conducted in Pakistan have reported highly variable NSI prevalence rates among nurses. These discrepancies highlight the urgent need for a systematic meta-analysis to produce more generalizable and reliable findings [13, 14]. To date, no systematic review or meta-analysis has been conducted on this topic in Pakistan. The presence of multiple primary studies reporting inconsistent prevalence rates underscores the need for a cumulative prevalence estimate of NSIs to better understand the scope of the problem and guide evidence-based policy and prevention strategies. Given these inconsistencies and the absence of a comprehensive estimate of NSI prevalence among nurses and nursing students in Pakistan, this meta-analysis was conducted to synthesize existing data and provide a more accurate and representative estimate.

Methods

This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [15, 16] (Supplementary Table 1).

Search strategy

To identify eligible studies, the databases Medline, EMBASE, CINAHL, Scopus, and Web of Science were searched for articles published between 2000 and 2025 using the following keywords: NSIs, needlestick, needle stick, needle injur, sharp* injur*, Pakistan*. The search strategy for Medline was structured as follows: (exp NSIs/ OR (needlestick OR “needle stick” OR “needle injur” OR “sharp* injur*”)) AND (exp Pakistan/ OR Pakistan.in. OR Pakistan*). The search strategy was developed and conducted in collaboration with a medical education specialist to ensure the sensitivity and specificity of the search across multiple databases. Since some studies reported the prevalence of NSIs among nurses and nursing students alongside other healthcare professionals, the search was not restricted to nurses and nursing students to ensure comprehensive coverage of all relevant studies. Consequently, all retrieved articles were carefully reviewed regardless of the professional group studied. Only articles published in English were included in this review. Additionally, the reference lists of selected articles were screened to identify further relevant studies.

Inclusion and exclusion criteria

All observational studies meeting the following criteria were included in this review: reporting the prevalence or frequency of NSIs among nurses and nursing students, published in English, conducted in Pakistan, and providing full-text access. The timeframe was limited to studies published between January 1, 2000, and March 23, 2025, to ensure the inclusion of contemporary data reflecting recent clinical practices, safety policies, and healthcare system developments. Eligible study designs included cross-sectional, cohort, and case-control studies. Some studies reported NSI prevalence among different healthcare professionals. In such cases, if the data were separately available for nurses or nursing students, they were extracted accordingly. However, if the prevalence was not differentiated by professional group, the study was excluded from the analysis. Additional exclusion criteria included review articles, qualitative or interventional studies, letters to the editor, studies that did not report the prevalence or frequency of NSIs, and studies with a sample size of fewer than 50 participants. The rationale for excluding studies with fewer than 50 participants was to minimize the influence of very small studies, which are more likely to produce unstable prevalence estimates with wide confidence intervals, and to disproportionately increase heterogeneity in meta-analysis. Small sample studies also carry a higher risk of selection and reporting bias. Similar thresholds have been used in epidemiological meta-analyses to enhance the robustness of pooled estimates [17].

Data extraction

Two researchers independently extracted key information from the included studies, including the first author’s name, year of publication, sample size of nurses and nursing students, study location, and the prevalence or frequency of NSIs. The extracted data were recorded in a pre-designed data extraction form. No automation tools were used in this process.

Quality assessment

The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist for analytical cross-sectional studies [18]. The checklist consists of nine items rated as “Yes,” “No,” “Unclear,” or “Not applicable.” A score of 1 was assigned to “Yes” responses and 0 to all others. Total scores ranged from 0 to 8, and studies were categorized as low quality (≤ 3), moderate quality [4–6], or high quality [7–9, 18]. Two authors conducted the assessment independently, and any disagreements were resolved by consensus (Supplementary Table 2).

Strategies to enhance rigour

To strengthen the methodological rigour of this review, several strategies were employed. A comprehensive search strategy was developed and implemented across five major databases, supplemented with manual searches to ensure broad coverage. Study selection, data extraction, and quality appraisal were performed independently by two reviewers, with discrepancies resolved through discussion and consensus. The Joanna Briggs Institute (JBI) tool was used for standardized quality assessment. Sensitivity analyses were conducted to test the stability of the results, and subgroup analyses and meta-regression were performed to explore sources of heterogeneity. Publication bias was assessed using funnel plots, Egger’s test, and corrected using the Trim-and-Fill method when necessary. The review was conducted and reported in accordance with the PRISMA guidelines, thereby ensuring transparency and reproducibility.

Data synthesis

All statistical analyses were conducted using Stata version 17. Heterogeneity among studies was assessed using Cochrane’s Q test and the I² statistic, which quantifies the proportion of variability due to heterogeneity rather than chance. The I² values were categorized into three levels: low (< 25%), moderate (25%-75%), and high (> 75%). If heterogeneity was high, a random-effects model was used for pooling the results; otherwise, a fixed-effects model was applied. The overall prevalence of NSIs was presented as point estimates with 95% confidence intervals (CIs) and displayed using a forest plot. To assess the impact of individual studies on the overall findings and evaluate the stability of the results, a sensitivity analysis was performed. This involved systematically removing studies one by one to determine whether any single study significantly influenced the meta-analysis results. If a substantial change occurred after removing a specific study, it was considered to have a high impact on the findings.

To identify potential sources of heterogeneity, subgroup analysis and meta-regression were conducted. In the subgroup analysis, data were stratified based on geographical region (province or city) to explore whether location-related factors influenced the prevalence of NSIs. Additionally, meta-regression was used to examine the relationship between NSI prevalence and study characteristics, such as publication year and sample size, to determine whether these variables affected the reported prevalence across different studies.

Publication bias was assessed using Egger’s test and funnel plots. Egger’s test statistically evaluated whether smaller studies (with smaller sample sizes) reported different prevalence estimates compared to larger studies. If publication bias was detected, the Trim-and-Fill method was applied for correction. This method estimates and adjusts for missing studies due to publication bias, providing a more accurate pooled prevalence of NSIs.

Results

Study search and selection results

In the initial search of five international databases, 233 articles were identified. Additionally, 34 more articles were found through manual searching in Google Scholar, resulting in a total of 267 articles. After removing 132 duplicates, the titles and abstracts of the remaining 135 articles were independently screened by two authors based on inclusion and exclusion criteria. At this stage, 98 articles were excluded for not being relevant to the study’s objective. The full texts of the remaining 37 articles were then reviewed by the same two authors, and the necessary data were extracted. Any disagreements between the two authors during the selection and extraction process were resolved through consultation with a third author. Twelve studies were excluded due to not reporting the prevalence of NSIs, and 25 studies were included in the final analysis across 27 groups. Two of these studies reported data on two separate groups of nurses (Fig. 1).

Fig. 1.

Literature screening process diagram

Summary of included studies

Overall, 25 studies encompassing 27 groups were included in the analysis, involving 2,991 nurses and 1,265 Pakistani nursing students. The studies were published between 2008 and 2025. The sample sizes in studies involving nurses ranged from 77 to 262, while for nursing students, they ranged from 54 to 214. Nine studies were conducted in Sindh Province and eleven in Punjab Province. The prevalence of NSIs among nurses ranged from 12.1 to 93%, and among nursing students, it ranged from 12.8 to 64.5%. Eleven studies were of good methodological quality, and the remaining studies were of low quality. Further details are provided in Table 1.

Table 1.

The characteristics of the included studies

No.	Name	Year	Sample size		Location	Prevalence (%)		Quality
			Nurses	Nursing Students		Nurses	Nursing Students
1	Howteerakul [19]	2008	-	196	Baluchistan	-	12.8	Moderate
2	Saleem [20]	2010	-	210	Karachi	-	26.1	Good
3	Manzoor [21]	2010	77		Lahore	71.9		Moderate
4	Waqar [22]	2011	144	-	Islamabad	93	-	Good
5	Khushdil [23]	2013	118	-	Lahore	55	-	Good
6	Fareed [24]	2013	-	100	Panjab	-	44	Moderate
7	Asad [25]	2013	262	-	Karachi	70.6	-	Good
8	Samoon [14]	2014	139	-	Sindh	29.4	-	Moderate
9	Muhammad Yar [26]	2015	135	-	Rahim Yar Khan	37.7	-	Moderate
10	Razzaque [27]	2016	-	150	Karachi	-	33.7	Good
11	Hussain [28]	2016	-	214	Karachi	-	34	Good
12	Hussain [29]	2017	222	-	Lahore	58.1	-	Good
13	Hassnain [30]	2017	193	-	Karachi	44	-	Good
14		2017	193	-		24.4	-
15	Khan [31]	2017	114	-	Peshawar	42.7	-	Moderate
16	Pirwani [32]	2019	179	-	Karachi	26.7	-	Moderate
17	Khan [33]	2020	129	-	Islamabad	76.7	-	Good
18	Zarnigar [34]	2021	93	-	Lahore	53	-	Moderate
19	Janjua [35]	2022	-	76	Lahore		64.5	Good
20	Khan [36]	2023	-	147	Peshawar	-	37	Good
21	Ali [37]	2023	-	67	Karachi	-	53.7	Moderate
22	Gulnaz [38]	2024	100	-	Lahore	48.5	-	Moderate
23	Javed [39]	2024	257	-	Lahore	37.4	-	Moderate
24		2024	257	-	Lahore	12.1	-
25	Huzaifa [40]	2024	-	105	Swat	-	61.9	Moderate
26	Akram [41]	2024	200	-	Lahore	19.5	-	Moderate
27	Mian [13]	2025	179	-	Khyber Pakhtunkhwa	70.1	-	Moderate

Meta-analysis and subgroup analysis

The prevalence of NSIs among Pakistani nurses was 48% (95% CI: 35–61%), while among nursing students, it was 43% (95% CI: 31–54%). The heterogeneity among studies for nurses and nursing students was 98.59% and 95.39%, respectively. Sensitivity analysis indicated that the prevalence of NSIs among nurses ranged from 46 to 51% and among nursing students from 40 to 46%, with no single study having a significant impact on the final results (Fig. 2). In the subgroup analysis, the prevalence of NSIs among nurses in Sindh, Punjab, and other provinces was 39.1%, 43.4%, and 70.9%, respectively, with a significant difference (p = 0.04). Among nursing students, the prevalence in these regions was 35.2%, 57.5%, and 37%, respectively, also showing statistically significant differences (p = 0.025).

Fig. 2.

Forest plot of NSI prevalence and sensitivity analysis for nurses (18 studies) and nursing students (10 studies)

Meta-regression and publication bias

Meta-regression results indicated a decreasing trend in NSI prevalence among nurses from 2000 to 2025 (p = 0.079), and an inverse relationship with sample size (p = 0.19). However, among nursing students, the prevalence significantly increased over the years (p = 0.003), while a larger sample size was associated with a lower prevalence (p = 0.001). Egger’s test revealed no significant publication bias in studies on nurses (p = 0.577), and the funnel plot showed a symmetric distribution. However, publication bias was significant in studies on nursing students (p = 0.001). The Trim-and-Fill method was applied, adding one study to the meta-analysis, which adjusted the prevalence from 42.8% (95% CI: 31.4–54.2%) to 40.4% (95% CI: 29.6–51.2%) (Fig. 3).

Fig. 3.

Meta-regression and publication bias for studies on nurses (18 studies) and nursing students (10 studies)

Discussion

This comprehensive meta-analysis, which systematically reviewed 27 reports from 25 studies in Pakistan, presents a concerning picture of the NSIs among healthcare workers in the country. Our findings indicate that the overall prevalence of NSIs in Pakistani nurses (48%) and nursing students (43%) is significantly higher than the global average (40.97%) and particularly higher than in developed countries (30.5%) [42]. This difference highlights the urgent need for targeted interventions in low-resource settings such as Pakistan. These figures position Pakistan among the countries with the highest risk of NSIs, with certain underdeveloped provinces reporting prevalence rates as high as 70.9%. A subgroup analysis of NSI prevalence based on WHO regions revealed that the highest prevalence was found in Southeast Asia (49.9%), while the lowest was observed in the United States (25.1%) [1, 2, 42]. The overall prevalence in developed and developing countries was 30.5% (95% CI: 27.3–33.8%) and 46.6% (95% CI: 33.7–59.5%), respectively [1].

A comparison of the findings of this study with global studies indicates that the prevalence of NSI in Pakistan is significantly higher than in many developed countries. For example, studies in Europe and North America have reported a prevalence ranging from 20 to 30%, which is likely due to better access to safety equipment, efficient reporting systems, and regular training [10]. According to the results of the Saia study, the annual estimated number of NSI is 384,000 in the United States, 100,000 in the United Kingdom, 700,000 in Germany, 29,719 in France, 28,200 in Italy, and 21,815 in Spain [43]. This disparity likely reflects differences in healthcare infrastructure, availability of safety-engineered devices, and the robustness of occupational safety policies. Developed countries have benefited from the institutionalization of NSI prevention programs, standardized post-exposure protocols, and ongoing safety training, all of which remain inconsistently applied in Pakistan.

In the study by Hosseinipalangi, the overall prevalence of needle stick injuries was reported as 43%, with the highest rate observed in Africa (51%) [42]. The World Health Organization (WHO) has also identified the African region as having the highest incidence of needle stick injuries [2]. Yazie reported that in Ethiopia, the 12-month and lifetime prevalence of needle stick injuries in primary studies ranged from 13.2 to 55.1% and from 18.6 to 63.6%, respectively. The overall prevalence of needle stick injuries among healthcare workers in Ethiopia was 28.8% (95% CI: 23.0-34.5) and 43.6% (95% CI: 35.3–52.0) [44].

The high level of heterogeneity (I² >95%) indicates significant differences between studies in terms of methodology, demographics, and environmental conditions. Subgroup analysis based on geographic region showed that the prevalence of NSIs among nurses in provinces other than Punjab and Sindh (70.9%) was significantly higher than in Punjab (43.4%) and Sindh (39.1%) (p = 0.04). This regional variation may stem from unequal distribution of healthcare resources, variations in clinical training quality, and inconsistent implementation of safety protocols. Rural and underdeveloped regions in Pakistan often lack essential infrastructure such as proper sharps disposal systems, adequate staffing, and personal protective equipment, placing nurses at heightened risk [14]. In the study by Mengistu et al. (2021), the prevalence of NSIs ranged from 19.9 to 54.0%, with an overall prevalence ranging from 35.7 to 100% over the past year and throughout the career, respectively [6] Factors such as gender, workload, recapping of needles, excessive use of injections, adherence to universal precautions, training, occupation, work experience, and the use of personal protective equipment were identified as factors associated with the prevalence of NSIs in developing countries [6, 45].

Similar studies in developing countries, such as Ethiopia (55.1%), Africa (51%), and India (66.7%), have also reported high prevalence rates of NSI [42, 44, 46]. This indicates that the issue is not limited to Pakistan and is likely due to systemic factors such as resource shortages, inadequate training, and weak reporting culture [14]. In contrast, developed countries, through the implementation of strict safety policies, the use of advanced equipment, and regular educational programs, have succeeded in reducing the prevalence of NSI to below 20% [47]. In the present study, no statistically significant difference was found between regions concerning nursing students (p = 0.235), which likely reflects common challenges across all educational institutions in Pakistan. Among nursing students, the prevalence of NSI was significantly higher (p = 0.006). This increasing trend may be attributed to expanded clinical responsibilities, earlier exposure to high-risk environments, and possibly improved awareness and reporting in recent years. However, the growth in reported cases may also reflect gaps in training and supervision, especially in overcrowded teaching hospitals. It also signals critical gaps in nursing curricula, which often focus more on theoretical knowledge than practical safety competencies. Furthermore, the limited emphasis on infection control and NSI prevention in undergraduate training, along with large clinical cohorts and insufficient faculty-to-student ratios, may exacerbate this vulnerability.

Xu also reported that the prevalence of NSIs among nursing students was 35% (95% CI: 28–43%), and 63% of them did not report their NSI injuries (95% CI: 51–74%). The highest prevalence among nursing students was found in studies conducted in Asia, with a rate of 39.7% (95% CI: 31.7–47.7%) [48]. In Chen’s study, the overall prevalence of NSIs among nursing interns was 38% in Asian countries, 9% in the United States, and 30% in European countries [4]. On the other hand, meta-regression showed a decreasing trend in the prevalence of NSIs among nurses (p = 0.079), which may be due to increased awareness, improved access to safe equipment, or the implementation of preventive policies in recent years. The results of the Hosseinipalangi study also indicated a decreasing trend in the prevalence of NSIs among nurses [42]. While the decreasing trend in NSIs among nurses is encouraging, the difference was not statistically significant and may not reflect actual risk reduction, especially in the absence of national policies or large-scale interventions. Continued monitoring and evaluation are essential to understand whether observed trends result from improved practices or data variability.

Addressing NSIs in Pakistan requires a multi-pronged approach. First, institutional policies mandating the use of safety-engineered devices (e.g., retractable needles) and secure sharps disposal containers must be enforced. Second, national-level guidelines on post-exposure prophylaxis and NSI management should be integrated into hospital accreditation standards. Third, the inclusion of NSI prevention modules in pre-service nursing education and in-service training is critical, with emphasis on practical simulations, reporting protocols, and psychosocial support post-injury. Additionally, a centralized surveillance and reporting system is needed to track NSI cases, identify trends, and inform targeted interventions. Pakistan’s federal and provincial health departments can benefit from the implementation of digital platforms that allow anonymous, streamlined NSI reporting. Engagement of nursing leadership and hospital management is also essential to foster a safety culture, where NSIs are viewed as preventable incidents rather than personal failings.

Given that the prevalence among nursing students is nearly as high as among experienced nurses, academic institutions should strengthen partnerships with teaching hospitals to ensure structured supervision during clinical rotations. Mentorship programs, peer learning, and regular debriefing sessions can improve students’ confidence in handling sharps safely.

Limitations

To the best of our knowledge, this is the first systematic review and meta-analysis that has examined and reported the prevalence of NSIs among nurses and nursing students in Pakistan, offering a comprehensive overview of the current situation. However, several limitations should be acknowledged.

First, there was notable methodological heterogeneity across the included studies. Differences in data collection methods, sampling strategies, and the operational definitions of NSIs may have introduced variability in the reported prevalence rates, limiting the comparability of the findings. Moreover, statistical heterogeneity was extremely high (I² >95%) in both nurses and nursing students, which reduces the precision of the pooled estimates. Although subgroup analyses by province were conducted, other potential sources of heterogeneity, such as hospital type or institutional safety practices, could not be fully explored due to insufficient data. Second, underreporting is a critical concern. Due to the weak culture of reporting occupational injuries in Pakistan, especially in public healthcare settings, the actual prevalence of NSIs is likely higher than what has been documented in the included studies. Third, geographic representation was limited. A majority of the studies originated from more populous or accessible regions, with little to no data available from provinces such as Baluchistan and Khyber Pakhtunkhwa. This uneven distribution of data may compromise the generalizability of the findings to the national level. Fourth, publication bias was detected in studies on nursing students, suggesting that smaller studies with non-significant results might have remained unpublished. Although we applied the Trim-and-Fill method to adjust for this bias, it still limits the robustness of the findings in this subgroup. Finally, several potentially important confounding variables, such as work shifts, workload, and institutional safety culture, were not consistently reported or analyzed across studies. These factors may influence NSI risk but could not be adequately assessed in this review. For future research, it is recommended to conduct longitudinal studies with standardized methodological designs, integrate both quantitative and qualitative approaches, and focus on evaluating the effectiveness of preventive interventions across diverse healthcare settings in Pakistan.

Conclusion

This comprehensive meta-analysis, based on a systematic review of 27 reports from 25 studies in Pakistan, provides a concerning picture of the prevalence of NSIs among nurses and nursing students in the country. To reduce the prevalence, immediate actions such as targeted training, provision of safe equipment, and improvement of reporting policies are essential. Ultimately, successful experiences from other countries have demonstrated that even in resource-limited settings, significant reductions in NSIs can be achieved through strategic planning, accurate prioritization, and the implementation of evidence-based interventions. This study, by offering a comprehensive overview of the current situation and a comparative analysis with other countries, provides the necessary scientific framework to guide such actions and emphasizes the urgent need for policymakers and healthcare managers in Pakistan to address this serious issue. The expected outcome of this research is to inform evidence-based policymaking, guide safety training programs, and support institutional efforts to reduce NSIs through improved reporting and preventive strategies in Pakistan’s healthcare system.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

RGG, SS, KA and HE conceptualized the study question. SS and HE designed the study protocol and performed the study screening, selection, data extraction and quality assessment, with RGG acting as third reviewer in case of discordance. RGG performed the statistical analysis and drafted the initial manuscript. All authors read and approved the final version of this manuscript.

Funding

None.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.