Prevalence and control strategies of blood-borne occupational exposures among healthcare workers in Shaoxing Second Hospital from 2020 to 2025

Abstract

Objective

To analyze the characteristics and risk factors of blood-borne occupational exposures among healthcare workers at Shaoxing Second Hospital from 2020 to 2025 and to inform targeted prevention and control strategies.

Methods

A retrospective analysis was performed on 252 blood-borne occupational exposure events reported from January 2020 to December 2025. Occupational distribution, occurrence patterns, exposure routes, high-risk operations, pathogens, and postexposure prophylaxis data were statistically analyzed.

Results

The annual standardized incidence of blood-borne occupational exposures increased year by year. Nurses and staff with <5 years of service were the highest-risk groups. Sharp instrument injuries accounted for 92.46% of exposures. Hepatitis B virus was the dominant known pathogen (25.78%), whereas the hepatitis B virus postexposure prophylaxis rate was only 21.21%.

Conclusions

These findings indicate that healthcare workers at this hospital exhibit distinct high-risk features for blood-borne occupational exposures. To mitigate occupational exposure risks, a systematic and precise prevention program, hierarchical management of high-risk groups, and regular hepatitis B virus immune monitoring are recommended.

Introduction

Blood-borne occupational exposures (BBOEs) refer to occupational incidents sustained by healthcare workers (HCWs) during clinical diagnosis and treatment, nursing, laboratory operations, waste disposal, and other work procedures, in which the skin or mucous membranes are contaminated with blood-borne pathogens or punctured by contaminated sharp instruments such as needles and glass slides. ¹ Such exposures are associated with a high risk of infection with blood-borne pathogens and constitute a major occupational hazard for HCWs. ² Data indicate that HCWs in China experience an average of 7.5 BBOEs per person per year. ³ These incidents not only trigger negative psychological emotions, such as anxiety and fear, among HCWs but also increase the financial burden on governments and hospitals, with related expenditures covering blood testing, postexposure treatment, outpatient follow-up, and absence from work for recuperation. ⁴ Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are the most common blood-borne pathogens in occupational exposures. ⁵ Globally, needlestick injuries are estimated to account for 66,000, 16,000, and 1000 cases of HBV, HCV, and HIV infections, respectively. ⁶

The occurrence of BBOEs is influenced by multiple factors. Poor physical and mental health of HCWs, inadequate implementation of personal protective measures, insufficient professional operational experience, lack of education and training related to occupational exposure prevention, failure to strictly adhere to safe operating procedures, and insufficient awareness of exposure risks are all important factors contributing to such exposures.^7,8 Therefore, understanding the current status of occupational exposure to blood-borne diseases, exploring the high-risk factors influencing it, and formulating practical and reliable prevention and control measures can provide a basis for HCWs to implement hierarchical occupational exposure management, thereby effectively reducing the harm caused by occupational exposure. ⁹ In this study, a retrospective analysis of high-risk groups, high-incidence periods, high-incidence locations, high-risk operations, and blood-borne pathogen exposure status among BBOEs at Shaoxing Second Hospital over the past 5 years was conducted to develop targeted prevention and control strategies and maximize the occupational health of HCWs.

Participants and methods

Participants

A retrospective selection was conducted to identify all HCWs who reported BBOEs at Shaoxing Second Hospital from 1 January 2020 to 31 December2025 as research participants. These research participants included nurses, doctors, medical technicians, interns, advanced trainees, and field staff. Among them, interns and advanced trainees included postgraduate students, advanced training personnel, and standardized training personnel majoring in nursing, medicine, and medical technology. Field staff included cleaners, medical waste collectors, and nursing assistants. This study was approved by the Ethics Committee of Shaoxing Second Hospital.

Methods

Relevant data on BBOEs during the study period were screened and summarized from the occupational exposure reporting system embedded in the Xinglin Hospital Infection Detection System, a national electronic hospital infection monitoring system. The analysis included general demographic information of HCWs, job positions, length of service, time and location of exposure, exposure methods, exposure sites, exposure process, exposure source information, test results for infectious disease indicators, postexposure prophylactic medication status, and follow-up records.

The occupational exposure reporting system of this hospital has established network management with the Department of Hospital Infection Control, all inpatient wards, outpatient and medical technology departments, the clinical laboratory, and the pathogen detection laboratory. Concurrently, a comprehensive process for reporting, handling, and follow-up of occupational exposure along with relevant management systems has been established. All BBOE incidents require mandatory real-time electronic reporting, with the Department of Hospital Infection Control exclusively responsible for continuous monitoring and full-process follow-up to ensure the standardized and timely implementation of intervention measures, resulting in a low under-reporting rate. The hospital provides annual occupational exposure prevention training for all HCWs and mandates preservice training on this topic for all new staff and trainees. In addition, regular cross-validation between BBOE reports recorded in the Xinglin Hospital Infection Detection System and hospital-wide adverse event logs is performed to systematically identify potential reporting gaps, thereby ensuring the completeness and accuracy of the epidemiological data.

Statistical analysis

Excel 16 was used to sort the research-related data, and Statistical Package for the Social Sciences (SPSS) 26.0 was used for data analysis. Count data were expressed as the number of events, percentage (cumulative percentage), or rate. The χ² test was used to compare groups, and p values <0.05 were considered statistically significant.

The crude annual incidence rate of BBOEs was defined as the event-based incidence rate, calculated as the number of reported events divided by the total number of at-risk HCWs (including formal staff, interns, advanced trainees, standardized training personnel and field support staff, and sourced from the Human Resources Department of Shaoxing Second Hospital) for each year and expressed as a percentage. The annual standardized incidence rate was computed via direct standardization, using our hospital's 2020 HCW occupational composition serving as the standard population structure to eliminate confounding from annual fluctuations in HCW numbers and composition on incidence comparisons.

Results

Distribution of BBOEs among HCWs by occupation

During the 6-year study period from 2020 to 2025, a total of 252 BBOE events were reported at our hospital. The overall crude incidence rate of BBOEs showed an upward trend during the study period, with fluctuations observed in the intermediate years. The lowest annual incidence was recorded in 2020 (5.74%) and the highest in 2025 (11.61%). The difference in BBOE incidence across years was statistically significant (χ² = 11.98, p < 0.05).

As shown in Table 1, stratified by occupational category, 106 BBOE events occurred in nurses, accounting for 42.06% of the total exposed events; 49 events in interns and interns, accounting for 19.44%; 48 events in physicians, accounting for 19.05%; 32 events in field support staff, accounting for 12.70%; and 17 events in medical technicians, accounting for 6.75%. In terms of the overall incidence rate over the 6-year study period, nurses had the highest BBOE incidence (approximately 2.25%), followed by trainees and interns (approximately 1.83%), field personnel (approximately 1.81%), and physicians (approximately 1.48%), whereas medical technicians had the lowest incidence (approximately 1.40%).

Table 1.

Event-based incidence of BBOEs among HCWs in Shaoxing Second Hospital, 2020–2025.

Occupation	2020			2021			2022			2023			2024			2025
	Total personnel	Exposure cases	Incidence rate (%)	Total personnel	Exposure cases	Incidence rate (%)	Total personnel	Exposure cases	Incidence rate (%)	Total personnel	Exposure cases	Incidence rate (%)	Total personnel	Exposure cases	Incidence rate (%)	Total personnel	Exposure cases	Incidence rate (%)
Nurses	720	12	1.67	747	25	3.35	762	15	1.97	771	15	1.95	844	14	1.66	869	25	2.88
Physicians	489	7	1.43	507	3	0.59	517	10	1.93	541	4	0.74	588	9	1.53	603	15	2.49
Medical technicians	159	1	0.63	182	1	0.55	201	3	1.49	202	2	0.99	238	5	2.10	233	5	2.15
Trainees and interns	375	5	1.33	514	12	2.33	496	11	2.22	536	12	2.24	380	5	1.32	380	4	1.05
Field personnel	295	2	0.68	295	9	3.05	295	5	1.69	295	1	0.34	295	6	2.03	295	9	3.05
Total	2038	27	5.74	2245	50	9.87	2271	44	9.31	2345	34	6.25	2345	39	8.64	2380	58	11.61

BBOEs: blood-borne occupational exposures; HCWs: healthcare workers.

Distribution of BBOEs among HCWs by time of occurrence

As shown in Figure 1, the average monthly number of BBOEs among HCWs at our hospital during the study period was 21. The highest number of BBOE events occurred in August, totaling 30 and accounting for 11.91% of the total exposed events. December ranked second with 27 events (10.71% of the total), whereas the lowest number of events was observed in February and May, with 12 events each, accounting for 4.76% respectively.

Figure 1.

Monthly distribution of BBOEs among HCWs in Shaoxing Second Hospital, 2020–2025.

BBOEs: blood-borne occupational exposures; HCWs: healthcare workers.

Distribution of BBOEs among HCWs by length of service

The incidence rate of BBOEs among HCWs showed a negative correlation with length of service. The exposure rate was significantly higher among those with <5 years of work experience, reaching 30.56%; among them, new employees with <1 year of work experience had the highest exposure rate of all length of service groups, at 27.78%. Overall, with the increase in work experience, the incidence rate of occupational exposure among HCWs showed a gradual downward trend. The incidence rates of BBOEs in personnel with 5–10 years, 10–15 years, and >15 years of work experience were 17.06%, 11.11%, and 13.49%, respectively.

Distribution of BBOEs among HCWs by location of occurrence of exposure methods

As shown in Figure 2, in terms of the location of exposure occurrence, the ward was the high-incidence location for BBOEs, with a total of 127 events, accounting for 50.40% of the total events. The operating room ranked second (39 events, 15.48%), followed by the outpatient and emergency department ranked the third (29 events, 11.51%); the remaining occurrence locations included the pathology department, clinical laboratory, infusion room, disinfection and supply center, hemodialysis room, medical waste disposal center, and endoscopy center.

Figure 2.

Distribution of BBOEs by occurrence location and exposure method among HCWs in Shaoxing Second Hospital, 2020–2025.

BBOEs: blood-borne occupational exposures; HCWs: healthcare workers.

In terms of exposure methods, sharp instrument injuries were the most common type of exposure, with a total of 233 events, accounting for 92.46%; 18 events were splashed with blood-borne pathogens on the ocular mucosa, accounting for 7.14%; 1 case was contact of broken skin with contaminated body fluids, accounting for 0.40%.

Main associated operations of BBOEs among HCWs

As shown in Figure 3, the three types of operations with the highest correlation with the occurrence of BBOEs were as follows: (a) needle withdrawal/separation of needles and placing sharp instruments into sharps containers, with a total of 80 events, accounting for 31.75%; (b) sharp instrument injuries during surgical or oral operations, 43 events, accounting for 17.06%; and (c) sorting instruments or medical waste after operations, 41 events, accounting for 16.27%. Other high-risk operations also included invasive operations such as blood collection, injection, puncture, acupuncture, being stabbed by randomly placed sharp instruments, pathological sampling, splashing on eyes or mucous membranes, recapping needles with both hands, and contact of broken skin with body fluids.

Figure 3.

High-risk operational procedures associated with BBOEs among HCWs in Shaoxing Second Hospital, 2020–2025.

BBOEs: blood-borne occupational exposures; HCWs: healthcare workers.

Distribution of infectious pathogens and postexposure prophylactic medication status of BBOEs among HCWs

In this study, because some individuals were exposed to multiple pathogens, the total number of pathogen exposure events (256) was slightly higher than the total number of occupational exposure events (252). As summarized in Table 2, in terms of the types of blood-borne pathogens involved, the number of events with unknown exposure sources was the highest, reaching 89 events, accounting for 34.77%; exposure to HBV was the second, with 66 events, accounting for 25.78%; 49 events were negative for the four infectious disease indicators, accounting for 19.14%; 44 events involved Treponema pallidum, accounting for 17.19%; 5 events involved HCV, accounting for 1.95%; and 3 events involved HIV, accounting for 1.17%.

Table 2.

Distribution of blood-borne pathogens and postexposure prophylaxis status for occupational exposures among HCWs in Shaoxing Second Hospital, 2020–2025.

Pathogens	Number of exposure events	Constituent ratio (%)	Number of medication events	Postexposure prophylaxis rate (%)
Unknown exposure source	89	34.77	1	1.12
HBV	66	25.78	14	21.21
Four infectious disease indicators (−)	49	19.14	0	0
Treponema pallidum	44	17.19	5	11.3
HCV	5	1.95	0	0
HIV	3	1.17	2	66.67
Total	256	100.00	22	8.59

HBV: Hepatitis B virus; HCV: hepatitis C virus; HIV: human immunodeficiency virus.

Based on the baseline hepatitis B surface antibody (HBsAb) levels of the exposed individuals and the type of contacted pathogens, infection risk assessment, postexposure prophylactic medication, and follow-up were conducted. Among them, the proportion of prophylactic medication for HBV exposure was 21.21%. These findings suggest that some HCWs still had HBsAb titers <10 μg/L, which were below the effective immune level.

Discussion

Globally, it is estimated that approximately 35 million cases of occupational sharps injuries occur annually among HCWs, whereas the reported incidence rates vary considerably across countries and healthcare facilities. ¹⁰ In developed countries, data from the US Centers for Disease Control and Prevention (CDC) indicate that 385,000 sharps injury cases occur each year among hospital staff. ¹¹ In less developed countries, the incidence rate of sharps injuries is approximately 90% higher than that in developed countries, which is mainly attributed to inadequate supplies of personal protective equipment, insufficient standardized training, and underdeveloped surveillance systems. ¹²

The annual standardized incidence rate of BBOEs in our hospital rose from 5.74% in 2020 to 11.61% in 2025, which is broadly consistent with previous domestic findings (21.2%). ¹³ This rate is slightly higher than the average reported for high-income countries but markedly below that for low- and middle-income regions.^14–16 Overall, our findings fall within the global epidemiological range and reflect the real-world status of BBOE prevention and control in a Chinese tertiary hospital.

The results of this study demonstrated significant differences in the risk of BBOEs among HCWs with different occupations, lengths of service, and times and locations at Shaoxing Second Hospital from 2020 to 2025. Sharp instrument injury was the primary exposure route, and HBV was the most important blood-borne pathogen. These findings are generally consistent with those of relevant studies at home and abroad.

Work experience is an important factor affecting the occurrence of BBOEs. ¹⁷ In this study, HCWs with <5 years of work experience, especially those with <1 year of service, had the highest incidence of exposure. In addition, the number of BBOE events was relatively high in August, which was strongly associated with the arrival of new interns and newly recruited staff onboarding during this period. Because of limited clinical experience, unfamiliarity with hospital workflows, and weak awareness of occupational protection, novice HCWs are not only prone to occupational exposure but are also more likely to experience psychological problems, including anxiety, stress, depression, and even posttraumatic stress disorder, following exposure.^4,18,19 Based on these findings, medical institutions should incorporate occupational exposure prevention into the regular curriculum for medical students and provide systematic preservice training on this topic for new employees, interns, and advanced trainees. In addition, targeted hierarchical management and seasonal intervention strategies should be implemented. For nurses and support staff with <5 years of service, enhanced preservice training and monthly refresher sessions should be conducted with a focus on standardized safe sharp instrument handling procedures, and quarterly safety audits specifically targeting this group should be performed. Furthermore, a dedicated occupational exposure prevention training program should be developed in July for incoming interns and newly recruited staff, with intensified on-site supervision during August and December, when exposure rates are highest.

Sharp instrument injuries accounted for 92.46% of all BBOEs in this study and represented the predominant exposure type. Significant differences were observed in the use of high-risk procedures among HCWs across occupations. For nurses, high-risk procedures mainly included needle withdrawal/needle separation and disposal of sharps into sharps containers as well as invasive procedures such as blood collection and injection. Among physicians, sharp instrument injuries mainly occurred during diagnostic and therapeutic procedures, including surgery, oral treatment, and dressing changes. For support staff, most exposures resulted from sorting medical waste and cleaning instruments.

In addition to insufficient operational experience, other important contributing factors to sharp instrument injuries included frequent rotation between departments and procedures, nonstandard operations, inadequate use of personal protective equipment, high psychological pressure, inattention, and working while fatigued.^20–22 For ocular and mucosal splash exposures, wearing face shields or goggles would significantly reduce the risk among HCWs.^23–25 Furthermore, poor teamwork, lack of a fixed neutral zone for sharps, manual passing of instruments, and hasty suturing were common triggers for intraoperative sharp instrument injuries during surgery.^26,27

To prevent sharp instrument injuries, first, HCWs’ occupational risk prevention awareness should be systematically enhanced through targeted lectures and regular standardized training programs.^28–30 Second, institutional regulations should be established and rigorously enforced to explicitly prohibit high-risk dangerous practices, including direct manual separation of contaminated needles, two-handed recapping of used needles, and manual passing of sharps between personnel.^31–34 In addition, because medical waste handling represents a high-risk scenario for sharps injuries, particular emphasis must be placed on the proper classification of medical waste, especially sharps, and to the standardization of medical waste disposal protocols.^35,36 Adequate personal protective equipment should be made universally available, together with ongoing training and regular supervision to ensure proper and consistent use. To mitigate needlestick injuries caused by fatigue and reduced vigilance, medical institutions should optimize staffing allocation and implement scientific scheduling to prevent fatigued work among HCWs, thereby reducing occupational exposure risk at the organizational level. ³⁷ In addition, the widespread adoption of safety-engineered sharp devices, such as retractable needles, shielded intravenous catheters, and blunt suture needles, should be promoted. These devices automatically cover or retract the sharp tip immediately after use, effectively reducing accidental needlestick injuries associated with needle recapping and improper sharps disposal. ³⁸ Finally, in accordance with the relevant World Health Organization (WHO) guidelines, hospitals should establish robust reporting mechanisms and standardized operating guidelines for BBOEs, covering emergency management, personal protective equipment, and serial follow-up testing, and organize mandatory training for all HCWs to ensure full and uniform implementation of these protocols. ³⁹

HBV was the most frequently encountered blood-borne pathogen among HCWs in this study and remains the predominant infectious agent in occupational exposure worldwide.^2,40 Existing literature has well documented that HCWs experience a 3- to 5-fold higher risk of HBV infection compared with the general population,^41,42 with percutaneous exposure through needlestick or sharp instrument injuries and mucosal exposure to blood splashes being the well-established primary transmission routes. ⁴³ Notably, the risk of HBV transmission from infected source patients to nonimmune HCWs following sharp instrument injuries has been estimated to range between 6% and 31%, highlighting the substantial infection risk posed by even a single percutaneous exposure event. ⁴⁴ On a global scale, among the estimated 35 million HCWs worldwide, approximately 3 million sustain occupational HBV exposure annually, which leads to approximately 66,000 incident HBV infections and 261 associated deaths each year. ⁴⁵

Hepatitis B postexposure prophylaxis (PEP) is defined as the medical intervention provided immediately following potential HBV exposure to prevent blood-borne pathogen transmission and is widely recognized as a critical strategy for mitigating postexposure infection risk. ⁴⁶ Although PEP provides timely secondary protection after exposure occurs, primary prevention through hepatitis B vaccination remains the fundamental cornerstone of reducing occupational HBV transmission among HCWs. Accordingly, the WHO strongly recommends universal HBV vaccination for all healthcare personnel. ⁴⁷ The vaccine is typically administered as a standard 3-dose regimen over an immunization period of at least 6 months. A postvaccination HBsAb titer ≥10 μg/L is considered the threshold for protective immunity and provides durable long-term protection against HBV infection. ⁴⁸

In this study, the HBV PEP rate was 21.21%, indicating that some HCWs still had HBsAb titers below the effective immune threshold, reflecting suboptimal HBV vaccination coverage and immune response rates in our hospital. Furthermore, some HCWs with subprotective HBsAb titers did not receive standardized PEP following confirmed HBV exposure. This finding highlights gaps in current postexposure management and underscores the urgent need for stricter multidimensional preventive measures.

To optimize HBV prevention strategies for healthcare personnel, medical institutions should implement a comprehensive, multilevel approach encompassing preexposure prophylaxis, routine health monitoring, and standardized postexposure management. ⁴⁹ Specifically, targeted health education should be reinforced, and annual HBsAb testing should be mandated for all HCWs. Free booster vaccination should be offered to individuals whose antibody titers fall below the protective threshold of 10 μg/L to maintain long-term protective immunity and reduce reliance on postexposure interventions.

For occupational HBV exposures, a standardized PEP protocol should be strictly implemented. A 24-h on-duty mechanism for occupational exposure management system should be established, PEP indications and operating procedures should be fully popularized, and the whole-process closed-loop management from event reporting, risk assessment, medication intervention, and follow-up should be realized to ensure that all eligible exposed individuals receive timely, standardized PEP. In addition, medical institutions should establish standardized occupational health archives incorporating annual physical examinations and improve the postexposure follow-up system to provide standardized case management, timely psychological support for exposed individuals, and effectively prevent delayed medical care resulting from HCWs’ fluke mentality.

Conclusions and limitations

This retrospective study analyzed the epidemiological characteristics of BBOEs among HCWs at Shaoxing Second Hospital from 2020 to 2025. We identified the high-risk populations (nurses, interns, advanced trainees, and staff with employment tenure <5 years), high-incidence periods (August and December), primary exposure location (wards), predominant exposure mode (sharp instrument injury), major high-risk operations (needle withdrawal/separation, surgical procedures, and medical waste sorting), and most prevalent pathogen (HBV). Notably, some HCWs had nonprotective HBV antibody titers, indicating a critical gap in primary occupational HBV prevention. These findings provide robust clinical data for formulating targeted BBOE prevention and control strategies at our hospital and highlight that effective BBOE management, as a core component of medical institution occupational health management, requires a systematic, multidimensional framework rather than isolated single-link interventions.

Despite these meaningful findings, this single-center retrospective study has inherent limitations, including under-reporting bias from passive surveillance and an insufficient sample size for multivariable risk factor analysis. Future large-scale, multicenter prospective studies using mixed-methods approaches are needed to comprehensively identify BBOE risk factors and optimize prevention strategies. Our hospital will use these results to implement targeted interventions, strengthen inter-institutional collaboration, and continuously improve occupational health protection for HCWs.