Table 1.

Summary of the included studies.

Serial number	Authors and year of publication	Study location	Research aim and objectives	Study design and time frame	Sample, recruitment method, participant details, characteristics, and response rate	Study outcome measures	Key results	Quality ranking
(1)	Ashfaq et al. (2011) [40]	Lahore Medical and Dental College, Lahore, Pakistan.	To assess the degree of awareness of NSIs among dental health professionals.	Cross-sectional study, questionnaire survey in 2010.	In total, 139 dental health professionals including dental students (n = 55), graduates (n = 63), and staff (n = 21) were sampled (sampling technique was not specified). Participants were of mixed gender: n = 76 males and n = 63 females. The response rate was 100%.	Prevalence and frequency of NSI exposures, mechanism of the injury, knowledge of precautionary measures to prevent NSIs, knowledge of first aid management of NSIs, and participant's HBV vaccination status.	In total, 45% (n = 63) of dental health professionals were exposed to NSIs. NSIs resulted from needle recapping (n = 33), needle exchange (n = 17), sharps disposal, (n = 12) and local anaesthetic administration (n = 9). A large number of participants were aware of precautionary measures (n = 132) and first aid management (n = 118). The HBV vaccine coverage was also high (n = 121).	Low
(2)	Baig et al. (2014) [41]	Maxillofacial Surgery Department, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan.	To estimate the risk of NSIs, their frequency, nature, and awareness level of prophylaxis among the students, house officers, and supporting staff of dentistry.	Descriptive cross-sectional study, questionnaire survey from April 2012 to April 2013.	In total, n = 613 individuals including maxillofacial surgeons (30%, n = 181), general dentists/supporting staff (3%, n = 21), house officers (18%, n = 107) and undergraduate students (49%, n = 298) were sampled (sampling technique was not stated). The sampled participants were of mixed gender comprising 48% (n = 289) males and 52% (n = 318) females. The response rate was 99%.	Prevalence, frequency, and predisposing factors of NSIs, awareness of PEP, and HBV vaccination coverage of dental-HCWs.	A high number of NSIs (n = 776) were experienced by 60% (n = 363) of the participants. Of those who experienced an NSI, 40% were students, 38% were dental surgeons, 12% were house officers, and 4% were supporting staff. 64% (n = 233) of dental-HCWs experienced one NSI, 18% (n = 64) experienced two NSIs, 12% (n = 42) experienced three NSIs, and 7% (n = 26) experienced more than three. NSIs resulted from needle recapping 33% (n = 87), surgical procedures 28% (n = 73), or drawing blood samples 26% (n = 69). The most common reasons behind NSIs among the participants were stress 43% (n = 112), work overload 38% (n = 99), carelessness 8% (n = 30), and unskilled instrument handling 5% (n = 17). Almost 70% reported NSIs as self-injuries. Overall, almost 76% of NSIs were unreported by dental-HCWs, due to lack of awareness of the reporting system. HBV vaccine coverage was 92%.	Low
(3)	Gichki et al. (2015) [42]	Dental section, Bolan Medical College, Sandeman Provincial Hospital, Quetta, Pakistan.	To assess the knowledge and awareness of NSIs among house officers and dental students.	Observational cross-sectional study, self-administered questionnaire survey. Study period not mentioned.	A total of 100 participants including house officers (29%) and dental students (71%) participated. The age range of the participants was 21–29 years; they were of mixed gender with 44% males and 56% females. The sample recruitment technique as well as the response rate was not mentioned.	Prevalence, frequency, and predisposing factors of NSIs. Knowledge and awareness of the transmission of BBV, availability of vaccines, importance of reporting NSIs, and initiating PEP. Participant's precautionary measures towards NSIs and vaccination status.	A total of 33% of participants experienced an NSI; 21% experienced one NSI and 12% experienced more than one. Good knowledge of the following aspects was reported: NSIs (97%); risk of transmission of BBVs (98%); transmission of pathogens (71%); availability of HBV vaccine (83%); preventing NSIs through needle recapping (69%) and engineering control devices (84%); reporting NSIs (99%); needle recapping technique (61%); and different stages of PEP (60–91%). Knowledge of the risk of HIV transmission through NSIs was the weakest area (13%) and 20% admitted their NSI was due to negligence. 73% of the respondents wore gloves while practicing, 67% avoided the practice of needle recapping. 88% were vaccinated against HBV.	Low
(4)	Ikram et al. (2015) [38]	8 different institutes of Karachi, Pakistan.	To assess the frequency of NSIs and knowledge, attitude, and practice of dental workers towards NSI prevention.	Descriptive cross-sectional study, questionnaire survey from July 2014 to March 2015.	A sample of 800 participants, comprising undergraduates (23%), house officers (42%), faculty (25%), and general dental practitioners (10%), were included. Sampling technique was not stated. The response rate was 100%.	Prevalence of NSIs and the knowledge, attitude, and practices related to NSIs.	In total, 73.1% of participants gave a history of NSI during their dental practice. 92.8% had received HBV vaccine and 73% believed in the effectiveness of the vaccination, whereas only 38.5% believed in the effectiveness of gloves in reducing the occurrence of NSIs. Needle recapping was practiced by 51% of the participants, but 38.3% suggested that it should be avoided, whereas 34.4% and 27.4% suggested careful needle approximation and use of sharps containers, respectively. 70.1% were aware of PEP after an NSI and 82.3% agreed that they were provided with instructions about the risk of infections in their training, but 54.4% suggested the need for training and education, and 40.5% suggested revising protocols in outpatient departments OPDs.	Low
(5)	Jan et al. (2014) [26]	Independent private dental clinics in Hyderabad and Karachi, Pakistan.	To determine the frequency of NSIs among dental-HCWs including dental technicians.	Cross-sectional study, self-administered questionnaire survey during April 2013.	A total of 254 dental-HCWs including qualified dentists (n = 166) and dental technicians (n = 88) were selected, with no mention of the sampling strategy. The participants were of mixed gender: males (n = 209) and females (n = 45); from different age groups: 25–35 years old (n = 50), 36–45 years old (n = 73) and over 45 years old (n = 131). The response rate was 92.3%.	Prevalence and frequency of NSIs during the previous year. Reporting rates of NSIs and reasons for underreporting. Also, the knowledge and attitude towards universal precautions.	53% (135) of the 254 participants (qualified dentists and dental technicians) had experienced at least one NSI in the preceding 12 months. Among dentists, 54% experienced at least one NSI; 35% experienced two; and 11% experienced more than two NSIs. Among dental technicians, 51% experienced at least one NSI; 28% experience two; and 21% more than two. Infiltration anaesthesia was the most common procedure causing NSIs (44.4% among dentists and 42% among dental technicians). 59.6% of dentists did not report their NSI; the most common reason given was lack of belief in the reporting system (33.1%), whereas 92% of dental technicians did not report their NSI; the most common reason given was not knowing where to report or did not want to report (59.1%). Dentists (62.6%) had more knowledge about the safety guidelines than dental technicians (8%) and also had a better vaccination coverage (81.3%) than dental technicians (10.2%).	Low
(6)	Khan et al. (2009) [43]	Sardar Begam Dental College, Peshawar, Pakistan.	To evaluate the perception of cross infection in dental practice among dental surgeons and dental students	Descriptive cross-sectional study, survey questionnaire from December 2007 to March 2008.	Total 100 dental-HCWs including 43% dentists (consultants, demonstrators, and house officers) and 57% undergraduate students were sampled through convenience sampling technique. The demographic characteristics and response rate were not mentioned.	Prevalence of NSI, and knowledge and practice of infection control measures.	A total of 35% dental health professionals experienced an NSI during their dental career. The majority of them washed and covered it after allowing it to bleed (85%). Most of the participants also took the patient's medical history (79%) and screened the patient (65%). 65% of dental workers practiced safe disposal, whereas 84% practiced needle resheathing after administering injection, in which one-handed technique was the most common (49%).	Low
(7)	Malik et al. (2012) [39]	Oral surgery department, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi, Pakistan.	Assess knowledge, attitude, and practices relating to NSIs and risk factors among dental practitioners.	Cross-sectional study, survey questionnaire; study period not mentioned.	A total of 100 participants including undergraduates (62%), postgraduates (21%), graduates (13%), and staff (4%) participated, with no identified strategy for sampling. They were of mixed gender: 55% females and 45% males. The majority (85%) were 20–30 years and most (94%) had 1–5 years' experience. The response rate was 100%.	Knowledge, attitude, and practice regarding NSIs, including prevalence and reporting rates.	Of the total 100 participants, 30 experienced an NSI, of which 28 were reported. NSIs were highest among dental students, age group 20–30 years, and practitioners with 1–5 years' experience. The participants were aware of the universal precautions (74%), hepatitis B (98%), hepatitis C, and HIV/AIDS transmission (84%) via NSIs, whereas only 53% were aware of needle-less safety devices. Needle recapping was practiced by 88% and was reported as one of the common reasons for NSIs (88%), along with disposing of gloves (94%). A large number of the participants wore gloves when disposing needles (94%) and manipulating the sharps bin (92%).	Moderate
(8)	Mehboob et al. (2012) [44]	Two teaching hospitals: Khyber College of Dentistry Peshawar, Pakistan, and Ayub Medical College, Abbottabad, Pakistan.	To determine the prevalence and awareness of professional hazards including psychological, musculoskeletal, biological, and allergic problems among dentists.	Cross-sectional study, survey questionnaire-study period not mentioned.	A total of 113 dentists were sampled. The sampling strategy was not specified. The participants included dental graduates (50%) and postgraduate trainees (35%), and the rest were the members or fellows of the college of physicians and surgeons. The majority of the participants (61%) had work experience of less than 5 years. Out of 150, 37 questionnaires were not returned (75% response rate).	The prevalence and frequency of NSIs and the precautions used by dentists during dental treatment.	70% of the participants were exposed to NSIs; 54% experienced less than 5 NSIs; 9.7% experienced 5–10 NSIs; 6.2% had more than 10 NSIs. Only 8.8% of the participants used all precautions during treatment, whereas the majority (85.8%) used a combination of 2 precautions, usually including gloves and masks. 82.3% of participants were vaccinated against HBV.	Low
(9)	Shahzad et al. (2013) [17]	Liaquat Medical University Hospital, Hyderabad, Pakistan.	To identify the risks of NSIs, the participants who sustained them, the circumstances under which they occurred, and how the risk of NSI was minimised among the participants.	Descriptive cross-sectional study, survey questionnaire-from August 2011 to September 2012.	In total, 513 participants including dental students (n = 325), house officers (n = 80), and paradental staff (n = 108), were included in the study. The sampling strategy was not specified. They were of mixed gender: 58% females and 42% males. The response rate was not taken into consideration.	Frequency and reporting rates of NSIs. The type of technique which caused NSIs, the department-wide distribution of NSIs, the different reasons of NSIs, and vaccination status of the participants.	773 total injuries occurred among the participants; 52% were students; 21% were dentists in their first professional year; 10% were paradental staff. 15% of all injuries went unreported. The NSI prevalence was the highest in the oral surgery department (58%), followed by the operative department (18%), and was the lowest in prosthodontics, orthodontics, and periodontology departments (3% each). NSIs most frequently occurred during infiltration anaesthesia (55%), followed by block anaesthesia (44%). The most common reasons for an NSI were hurrying (42%), fatigue (20%), lack of skill (14%), and not wearing gloves (12%). HBV vaccination coverage was 68%.	Low