|Year : 2020 | Volume
| Issue : 2 | Page : 47-55
Prevalence of needlestick injuries among health-care workers in iranian hospitals: An updated systematic review and meta-analysis
Yousef Alimohamadi1, Maryam Taghdir2, Mojtaba Sepandi2, Leila Kalhor3, Fahimeh Abedini3
1 Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
2 Health Research Center, Life Style Institute; Department of Epidemiology and Biostatistics, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
3 Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran
|Date of Submission||05-Oct-2019|
|Date of Acceptance||26-Apr-2020|
|Date of Web Publication||30-May-2020|
Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Background: Needlestick and sharp injuries have been identified as the most dangerous factor among health-care workers. The Centers for Disease Control and Prevention estimates that 385,000 health-care workers experience needlestick each year. Methods: The aim of this study was to determine the prevalence of needlestick injuries (NSIs) in Iranian health-care workers. In this review and meta-analysis, the local and international databases such as Scopus, Medline, PubMed, ScienceDirect, Web of Science, Google Scholar, Scientific Information Database (SID), and Magiran were searched using keywords including “prevalence” OR “needle” OR “needle stick” OR “Sharp injury” OR “Iranian personnel's” OR “Iranian health care workers” OR “Iranian hospitals” OR “Iran.” The original researches that determined the prevalence of NSIs among Iranian health-care workers and published from January 2005 to June 2019 were included in the current study. The pooled prevalence of NSIs was determined using a random-effects model with a 95% confidence interval. All analyses were performed using STATA version 11 (Stata Corporation, College Station, TX, USA). P < 0.05 was considered as a significant level. Results: The overall prevalence of NSIs among Iranian health-care personnel was about 50.8 (46.3–55.2). Furthermore, this prevalence in educational, noneducational, both noneducational and educational, and military centers was about 51.1 (46.5–57.7), 40.4.1 (34.2–46.6), 61.0 (32.1–89.9), and 41.5 (23.0–60.0), respectively. The prevalence of NSIs among the nurses was 51.1 (45.4–56.8), which was more than other groups. Conclusions: The prevalence of NSIs in Iranian hospitals was high. Since most of the injuries are caused by nurses, more intervention programs should be designed for nurses in these wards.
Keywords: Iranian hospitals, needlestick injury, prevalence
|How to cite this article:|
Alimohamadi Y, Taghdir M, Sepandi M, Kalhor L, Abedini F. Prevalence of needlestick injuries among health-care workers in iranian hospitals: An updated systematic review and meta-analysis. Arch Trauma Res 2020;9:47-55
|How to cite this URL:|
Alimohamadi Y, Taghdir M, Sepandi M, Kalhor L, Abedini F. Prevalence of needlestick injuries among health-care workers in iranian hospitals: An updated systematic review and meta-analysis. Arch Trauma Res [serial online] 2020 [cited 2020 Jul 3];9:47-55. Available from: http://www.archtrauma.com/text.asp?2020/9/2/47/285482
| Introduction|| |
A needlestick injury (NSI) is the penetration of the skin by a hypodermic needle or another sharp object, which has been in contact with blood, tissue, or other body fluids. These injuries caused by needles and sharp objects including medical devices that may have already been contaminated with infectious agents., A NSI often occurs during activities such as blood transfusions, sampling, needle removal, collection of excreted materials, re-insertion of syringes, blood and body excretions, and secretions. NSIs are considered as an occupational hazard for health-care workers. The Centers for Disease Control and Prevention estimates that 385,000 health-care workers in America annually experience NSI. Many countries, including Iran, try to prevent NSI, but despite safety precautions, NSIs still occur and inflict significant economic costs. Several factors such as work-related stress, lack of skills, lack of caution, organizational factors, staff shortages, and fatigue are all contributing factors. Cho et al., in an extensive review study, identified three main factors in NSIs that include engineering factors (e.g., design of devices and tools), organizational factors (such as reporting policies), and behavioral factors (such as needle reinsertion and disposal issues). In addition to cost and concern, the NSI transmits blood-borne infections such as hepatitis B, hepatitis C, and HIV. Furthermore, more than 90% of infections caused by NSI among health-care workers occur in low-income countries., The World Health Organization estimates that NSI is responsible for 40% of hepatitis B and C and 2.5% of HIV worldwide. NSIs can cause diseases such as brucellosis, diphtheria, gonorrhea, and so on. In addition to the risk of illness and death, it also causes psychological trauma and long-term disabilities, fear, stress, and anxiety. Although it is important to report needlestick cases, in Iran, 59% of the NSI cases among health-care workers are not reported. Due to the importance of NSI prevention among health-care workers, a pooled estimation of NSI prevalence is greatly warranted for planning effective preventive interventions among health-care workers. In spite of the presence of poled estimation of NSIs in published studies with different qualities in last years, it needs to update previous information and consider new dimensions in the estimation of pooled measures. Thus, the present systematic review and meta-analysis aimed to update previous information in this issue and to estimate a pooled prevalence of NSIs among Iranian health-care workers.
| Methods|| |
This study reviewed data on the prevalence of NSIs in Iran during 2005–2019. In this review and meta-analysis, both local and international databases including Scopus, Medline, PubMed, ScienceDirect, Web of Science, Google Scholar, SID and Magiran were searched using related keywords. The search strategy for PubMed was as follows: “prevalence” OR “needle” OR “needle stick” OR “sharp injury” OR “Iranian personnel” OR “Iranian health care workers” OR “Iranian hospitals” OR “Iran.” Similar specification was used for the other databases. Furthermore, a manual search of reference lists in the selected articles was conducted. In case of the unavailability of full texts or missed information, we attempted to obtain the full text or information from authors by E-mail. The Persian sites were also searched using the equivalent of these terms. Further, the sources of studied articles were reviewed to get access to other articles.
Research papers conducted both in English and Persian on the prevalence of NSIs in Iran, between January 2005 and June 2019, were selected for the study. The inclusion criteria were as follows: cross-sectional studies, articles in Persian and English languages, and articles with an appropriate methodological quality (quality score more than 7). Qualitative studies, reviews, letters to editors, and studies conducted on housekeeping staff were excluded from the study. More details are shown in [Figure 1].
|Figure 1: The process of surveying, screening, and selecting the articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement|
Click here to view
Risk of bias and quality assessment
The relevant articles were selected and their full texts were extracted. Each article was evaluated independently by two researchers. After selecting the studies, the related variables in each study including the study type, sample size, prevalence of needlestick, demographic characteristics of participants, time, and place of a study were entered in the predesigned Microsoft Excel datasheet.
In addition, to assess the risk of bias and the quality of studies, a 12-item checklist was used. Using this checklist, the studies assessed different items including clarity in research question, selection of an appropriate approach for the research question, clarity in study context, role of the researcher, clarity in the sampling method, appropriateness of sampling method, clarity in methods of data collection, selection of an appropriate method of data collection, clarity in methods of data analysis, describing main characteristics of the understudy population, appropriateness of methods of data analysis, and reliability of findings. Items were reviewed for each study; one score was given for each item if the item met the criterion item. The minimum and the maximum scores by this checklist were 0 and 12, respectively.
The statistical heterogeneity was examined using the Chi-square test. P < 0.05 was considered as heterogeneity. Inconsistency between the studies was evaluated using the I2 statistic; the higher amount of I2 value indicates the real heterogeneity between studies. The range of this index is between 0% and 100%. Studies with an I2 statistic of >75% are referred to as high heterogeneity. We also estimated the between-study variance using the tau-squared (tau2) statistic. The Begg and Egger tests were conducted to assess the publication bias., The final meta-analysis was conducted to estimate the pooled prevalence using a random-effects model with a 95% confidence interval. We conducted subgroup analyses and meta-regression to assess factors related to the heterogeneity. All analyses were performed using the STATA version 11.0 software (Stata Corp, College Station, TX, USA). All statistical tests were two-tailed. For Begg and Egger tests, P < 0.1 was considered as statistically significant, but for other tests, P < 0.05 was considered as statistically significant.
| Results|| |
After risk of bias checking so, all of the 62 studies were checked using the mentioned checklist and none of the studies were excluded. Totally 4823 records were retrieved from January 2005 to June 2019 using the search strategy. In this study, 4573 of the records were removed because they were unrelated to the understudied issue. Furthermore, from a total of 4823 records, 92 duplicate records were excluded from the study. We also excluded 66 articles after screening their titles and abstracts. The full texts of the remaining 62 studies were screened, and 30 studies were excluded [Figure 1]. Finally, 62 full-text articles were included in this meta-analysis that the pooled prevalence of NSIs was estimated for them. The general characteristics of the studies are shown in [Table 1]. The total sample size was 19408 cases. In this study, 27 (43.5%) of the total studies had been performed on health-care workers and 24 (38.7%) and 11 (17.7%) of the studies had been conducted on nurses and students, respectively. The percentage of hepatitis B vaccination coverage in total personnel was 88.1% ± 11.8. All studies were performed on both men and women.
The lowest and the highest estimated prevalence rates of NSIs in studies were 17.2 and 89.3%, respectively. The overall prevalence of NSIs among Iranian health personnel was about 50.8 (46.3–55.2) (I2 = 97.8%) [Figure 2]. The prevalence rates of NSIs in educational, noneducational, both noneducational and educational, and military centers were about 51.1 (46.5–57.7), 40.4.1 (34.2–46.6), 61.0 (32.1–89.9), and 41.5 (23.0–60.0), respectively [Table 2]. The prevalence of NSIs among the nurses was 51.1 (45.4–56.8), which was more than other groups. Furthermore, the prevalence of NSIs among the night shift workers with a rate of 72.7 (64.2–81.2) was more than other groups. Moreover, sharp object and hand were the main cause of NSIs and the major organ involved in NSIs among Iranian health-care personnel [Table 2]. In terms of heterogeneity, the results of meta-regression showed that working shift had a significant effect on heterogeneity between the studies (P: 0.01), but other variables such as “year,” “sample size,” “target personnel,” “damaged organ,” “type of hospital,” and “injury agent” had no significant effect on heterogeneity between the studies (P > 0.05) [Table 3].
|Figure 2: Prevalence of needlestick injuries in health-care workers of Iranian hospitals|
Click here to view
|Table 2: The prevalence of needlestick injuries according to different variables among Iranian health-care workers|
Click here to view
|Table 3: The results of univariate meta-regression in detecting the factors affecting heterogeneity|
Click here to view
The effect of “year” of study and “sample size” on determined prevalence is shown in [Figure 3]. According to these figures, the prevalence of NSIs was decreased by increasing the sample size. In addition, by increasing the year of the study, the prevalence of NSIs has been almost constant.
|Figure 3: The effect of “year” and “sample size” of the studies on determined prevalence rates in Iran|
Click here to view
| Discussion|| |
Several studies have been recently conducted on the prevalence of NSIs, which have reported different results. This study showed the overall prevalence of NSI in Iranian health-care workers in Iran, which was 50.8% (46.3–55.2). This amount was higher than the prevalence of NSIs in Qatar (20.9%) and Pakistan (94%). According to another study, the prevalence of NSIs among Iranian health-care workers was about 42%. The differences between the two studies may be due to different inclusion periods for the studies or different sample sizes.
The results of the present study showed that the prevalence of NSIs in educational hospitals was more than that in noneducational and military hospitals. This may be due to more patient referrals and overcrowding as well as staff fatigue in educational hospitals. Furthermore, this increased prevalence may be due to novice medical students with low training skills working in educational hospitals. Furthermore, the results indicated that the prevalence of NSIs in nurses was more than in other health-care workers. Similar to our findings, the systematic reviews conducted by Khraisat et al., Martins et al., and Voide et al. showed that the prevalence of NSIs in nurses was higher than in other health-care workers in hospitals (64% vs. 44%). Furthermore, in a study carried out by Yoshikawa et al., NSIs occurred in nurses three times more than in other health-care workers. One explanation could be the fact that nurses are exposed to the injections more and are responsible for venipunctures, intravenous fluid administration, and other procedures that require the use of needles. Furthermore, they engage with direct contact with patients, high workload, and more exposure to sharp objects, inadequate staffing, and long working hours. Despite the findings of the present study, some studies such as Khatony et al. and Lakbala et al. showed that the prevalence of NSIs in operating room staff was more than nurses. Reviewing literature shows that the incident of NSIs is associated with three main factors: engineering (the form of devices), organizational (injury-reporting policies), and behavioral (recapping needles and disposing of them) factors. According to the results, the cause of most injuries was reported to be behavioral factors such as recapping the needle., Further, our findings indicated that the prevalence of NSIs was more among the night shift workers than in other groups. Reasons for this include high fatigue, drowsiness, stress, and lack of staff during the night shift. The results of the present study are consistent with the results of some similar studies conducted by Salmanzadeh et al. and Aghabeigi et al.
Other findings of the present study showed that the sharp object and hand was the main cause of NSIs and the most damaged organ in NSIs among Iranian health-care personnel; these results are in line with the results of other studies conducted by Nejadrahim R, et al., Seraji et al., Rahnavard et al., Khatony et al., Pili et al., Aghabeigi et al., Abdifar et al., Lakbala et al., and Kebede et al. Considering the effective factors and performing subgroup analysis, selection of an extended time interval for published articles, a large sample size, and a high number of selected studies were the strengths of the current study. Some limitations of the present study included inadequate information of some articles, irregular regional distribution of studies from around the country, small sample size, and unknown sampling method of some studies. Reporting an accurate estimate of this problem in Iran and comparing it with other countries through meta-analysis is highly recommended. We also suggest further studies to be conducted to investigate and compare the prevalence of NSIs in dentists, nursing and medical students, and housekeeping staff with other health-care workers.
| Conclusion|| |
The results of the present study showed a high frequency of NSIs. Lack of compliance with standards in using the equipment, wearing protective devices, and disposing of sharp objects may increase the risk of NSIs. NSIs and injuries due to sharp objects can be reduced by taking such measures as supplying standard and safe equipment, holding training courses regarding safety issues in the work environment, providing enough staffing, and cutting down working hours.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Gheshlagh RG, Aslani M, Shabani F, Dalvand S, Parizad N. Prevalence of needlestick and sharps injuries in the healthcare workers of Iranian hospitals: An updated meta-analysis. Environ Health Prevent Med 2018;23:44.
Ghasemzadeh I, Kazerooni M, Davoodian P, Hamedi Y, Sadeghi P. Sharp injuries among medical students. Glob J Health Sci 2015;7:320-5.
Adib-Hajbaghery M, Lotfi MS. Behavior of healthcare workers after injuries from sharp instruments. Trauma Mon 2013;18:75-80.
Kebede G, Molla M, Sharma HR. Needle stick and sharps injuries among health care workers in Gondar city, Ethiopia. Saf Sci 2012;50:1093-7.
Mehregan N, Adineh M, Saberipour B, Ghorbani P, Hemmatipour A. The prevalence of sharp object injuries among the operating room staff. Orig Article 2018;5:25-31.
Khatony A, Abdi A, Jafari F, Vafaei K. Prevalence and reporting of needle stick injuries: A survey of surgery team members in Kermanshah University of medical sciences in 2012. Glob J Health Sci 2015;8:245-51.
Cho E, Lee H, Choi M, Park SH, Yoo IY, Aiken LH. Factors associated with needlestick and sharp injuries among hospital nurses: A cross-sectional questionnaire survey. Int J Nurs Stud 2013;50:1025-32.
Jahangiri M, Rostamabadi A, Hoboubi N, Tadayon N, Soleimani A. Needle stick injuries and their related safety measures among nurses in a university hospital, Shiraz, Iran. Saf Health Work 2016;7:72-7.
Tabatabaei SM, Pour FB, Avval JO, Osmani S, Mokhtari S, Bekheyr MA. Occupational exposure to blood and other body fluids among healthcare workers in three teaching Hospitals, Southeast Iran. International Journal of Infection 2016;3:1-6.
Baghcheghi N, Koohestani HR, Rezaei K, Seraji A, Abedi AR. Prevalence needlestick/sharps injuries among nursing student and related factor. Iran Occup Health J 2011;7:6.
Higgin J, Thompson S, Deeks J, Altman D. Measuring inconsistency in meta-analysis. BMJ 2003;327:557-60.
Julian P, Higgins S. Handbook for Systematic Reviews of Interventions. Cochrane Training. Version 9. 2019.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088-101.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-34.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-88.
Nejadrahim R, Gharahughi N, Sistanizade M. Needlestick injuries in the health care workers of Urmia educational Hospitals. J Nurs Midwifery Urmia Univ Med Sci 2005;3.
Seyyedeh RE, Mohammadnejad E, Hadizadeh R, Mozafari J, Ranjbaran S, Deljo R, et al
. Epidemiolojy of needle stick and sharp injuries among nurses in an Iranian teaching hospital. Arch Clin Infect Dis 2012;8:27-30.
Askarian M, Shaghaghian S, McLaws ML. Needlestick injuries among nurses of Fars province, Iran. Ann Epidemiol 2007;17:988-92.
Nazmieh H, Yarandi AN, Janmohammadi S, Hosseini F. Assessment of the injuries caused by sharp instruments in the health workers of university hospitals, in Yazd. Iran J Nurs 2005;18:49-59.
Lotfi R, Gholami A. Needle stick and sharps injuries and its risk factors among health center personnel (Astara; Iran, 2006). J Babol Univer Med Sci 2008;10:71-7.
Rakhshani F, Heidari M, Barati S. Prevalence of needlestick injuries among the healthcare professionals in Zahedan medical sciences university. Iran J Epidemiol 2009;4:87-91.
Gholami A, Salarilak SH, Alinia T, Rahim RA. Study of needle stick injuries among health care workers at teaching hospitals in Urmia, Iranian. J Epidemiol 2010;6:57-61.
Mohohammadnejad E, Dopolani FN. Risk factors of needle stick and sharp injuries among health care workers. J Nurs Midwifery Sci 2015;2:34-9. [Full text]
Mehrdad R, Meshki M, Pouryagub G. Effects of training course on occupational exposure to bloodborne pathogens: A controlled interventional study. Int J Prev Med 2013;4:1236-42.
Koohestani HR, Baghestani N, Rezaei K. Blood contaminated needle stick/sharp injuries and exposure to patients body fluids in medical emergency students. Iran J Crit Care Nurs 2010;3:57-62.
Ebrahimi MH, Khosravi A. Needlestick injuries among Nurses. J Res Health Sci 2007;7:56-62.
Heidari M, Shahbazi S. Prevalence of needle sticks exposure in operation room's staff of Borujen and Lordegan hospitals 2010-2011. J Sch Nurs Midwifery Allied Health 2010;5:32-7.
Moradi A, Mostafavi E, Moradi A. The prevalence and causes of needle stick injuries among the primary health care workers of Bahar city, Hamadan Province. Iran Occup Health J 2010;7:39-42.
Bijani B, Sotudehmanesh S, Mohammadi N. Epidemiological features of needle stick injuries among nursing staff. J Guilan Univ Med Sci 2011;20:61-8.
Seraji A, Koohestani H, Baghcheghi N, Rezaei K. Barriers to the reporting of needlestick/sharps injuries among nursing and midwifery students in Arak, Iran. Iran J Epidemiol 2011;7:58-64.
Shiva F, Sanaei A, Shamshiri A, Ghotbi F. Survey of needle stick injuries in peadiatric health personnel of 5 university hospital in Tehran. J Pak Med Assoc 2011;61:126-31.
Rahnavard F, Rezamasooleh SF, Kazemnejad E. Evaluation of the factors related to the reporting of injuries due to needle and sharp objects in nurses working in Guilan University of medical sciences, Rasht. Nurs Midwifery Jamenegar 2013;21:30-7.
Senjedak SM, Makiki F, Vagharseyyedin SA. Prevalence of needle stick injuries and some related issues among the nursing students. J Health Care 2012;15:30-8.
Shoghli A, Nasab NM, Ghorchian F, Masoumi H, Momtazi S. Study of the needle sticks injury (NSI) among the Zanjan educational hospitals staff. J Adv Med Biomed Res 2013;21:131-41.
Shahrabadi R, Seydshohadai M, Hosseini F. Sharp instruments injuries in intensive and general wards. Cardiovasc Nurs J 2012;1.
Pili JP, Nazanin I, Golbabei F. Factors associated with needle stick and sharp injuries among health care workers. Int J Occup Hyg 2013;5:191-7.
Askarian M, Malekmakan L, Memish ZA, Assadian O. Prevalence of needle stick injuries among dental, nursing and midwifery students in Shiraz, Iran. GMS Krankenhaushyg Interdiszip 2012;7:Doc05.
Aghabeigi R, Haghighi S, Asadi M, Adarvishi S, Zadeh MH, Ghaderi M. Frequency and factors of injuries by sharp instruments and needle sticks in operation room's workers in Ahvaz hospitals in 2013. J Clin Nurs Midwifery 2015;4:1-11.
Abdifard E, Sepahvand E, Aghaei A, Hosseini S, Khachian A. Needle-stick, sharp injuries, and its related factors among nurses of Imam Reza hospital, Kermanshah, Iran. J Client Cent Nurs Care 2015;1:183-8.
Geravandi S, Alavi SM, Yari AR, Yousefi F, Hosseini SA, Kamaei S, et al
. Epidemiological aspects of needle stick injuries among health care workers in Razi hospital Ahvaz, Iran, in 2015. Arch Hyg Sci 2016;5:85-91.
Lakbala P, Sobhani G, Lakbala M, Inaloo KD, Mahmoodi H. Sharps injuries in the operating room. Environ Health Prev Med 2014;19:348-53.
Amini M, Behzadnia MJ, Saboori F, Bahadori M, Ravangard R. Needle-stick injuries among healthcare workers in a teaching hospital. Trauma Mon 2015;20:e18829.
Yarahmadi R, Dizaji RA, Hossieni AF, Farshad AA, Nsiahcwa B, Moridi P, et al
. The prevalence of needle sticks injuries among health care workers at a hospital in Tehran Iranian. J Health Saf Environ 2013;1:23-9.
Hashemi SH, Mamani M, Torabian S. Hepatitis B vaccination coverage and sharp injuries among healthcare workers in Hamadan, Iran. Avicenna J Clin Microbiol Infect 2014;1:19949.
Hajivandi A, Ramavandi B, Rezaeeshiri A, Ahmadi B. A survey on the sharp and cutting wastes injury in nurses of the Bushehr city hospitals in the year 1392. J Nurs Midwifery Urmia Univer Med Sci 2015;13:490-7.
Abareshi F, Hekmatshoar R, Zokaei M, Akrami R. Survey of occupational exposure to needle stick and its risk factors among healthcare workers in one of Sabzevar's hospital. Iran Occup Health J 2018;14:70-7.
Mahmoudi N, Sepandi M, Mohammadi AS, Masoumbeigi H. Epidemiological aspects of needle stick injuries among nurses in a military hospital. Iran J Health Saf Environ 2015;2:374-9.
Milani HS, Eznollah A, Abbasi S. Epidemiology of sharp injuries among medical and nursing students of Shahid Beheshti university of medical sciences. Adv Nurs Midwifery 2017;26:27-34.
Balouchi A, Shahdadi H, Ahmadidarrehsima S, Rafiemanesh H. The frequency, causes and prevention of needlestick injuries in nurses of Kerman: A cross-sectional study. J Clin Diagn Res 2015;9:Dc13-5.
Joukar F, Mansour-Ghanaei F, Asgharnezhad M. Needlestick injuries among healthcare workers: Why they do not report their incidence? Iran J Nurs Midwifery Res 2018;23:382-7.
Salmanzadeh SH, Rahimi Z, Goshtasbipour M, Meripoor M. The prevalence of needle-stick injuries among healthcare workers in Dasht-e-Azadegan, Southern West of Iran. Int J Pharm Res Allied Sci 2016;5:417-22.
Khoshnood Z, Nouhi E, Adel M. Prevalence of needle stick and sharp injuries among nursing and midwifery students. Asian J Nurs Educ Res 2015;5:5-311.
Ghasemi M, Khabazkhoob M, Hashemi H, Yekta A, Nabovati P. The incidence of needle stick and sharp injuries and their associations with visual function among hospital nurses. J Curr Ophthalmol 2017;29:214-20.
Nouhi E, Khoshnood Z, Mahdi SA. Needle stick and sharp object injuries among nursing and midwifery students of Kerman University of medical science, 2007. Nurs Res 2010;5:18-22.
Nejadghaderi SM, Safizadeh H, Khanjani N. The knowledge and practice of medical staff about needle injuries in Rafsanjan's Ali-ebne-Abitaleb Hospital, Iran. J Health Dev 2012;1:1-10.
Farsi D, Zare MA, Hassani SA, Abbasi S, Emaminaini A, Hafezimoghadam P, et al
. Prevalence of occupational exposure to blood and body secretions and its related effective factors among health care workers of three emergency departments in Tehran. J Res Med Sci 2012;17:656-61.
Nasiri E, Vahed M, Siamian H, Mortazavi Y, Jafari H. Needle sticks injury with contaminated blood in the special unit, staff. Middle East J Sci Res 2010;5:61-4.
Akbari H, Ghasemi F, Akbari H, Adibzadeh A. Predicting needlestick and sharps injuries and determining preventive strategies using a Bayesian network approach in Tehran, Iran. Epidemiol Health 2018;40:e2018042.
Moayed MS, Mahmoudi H, Ebadi A, Salary MM, Danial Z. Effect of education on stress of exposure to sharps among nurses in emergency and trauma care wards. Trauma Mon 2015;20:e17709.
Habibzadeh H, Zinalpoor S, Jafarizadeh H, Hossein M. A study on the risk factors of needle stick and contact with secretions from patients among the students of Urmia university of medical sciences. J Urmia Nurs Midwifery Fac 2016;14:496-503.
Azadi A, Anoosheh M. Needlestick injuries reporting among clinical nurses. Iran J Nurs 2007;20:7-14.
Jafari NA, Shasti M, Izadi M, Ranjbar R, Ghasemi M. Evaluation of frequency of exposure to medical sharp devices among nurses of a university hospital. J Mil Med 2008;10:119-28.
Hashemipour M, Sadeghi A. Needlestick injuries among medical and dental students at the university of Kerman. A questionnaire study. J Dent Tehran Univer Med Sci 2008;5:71-6.
Aghadoost D, Tabatabaei B, Hajijafari M, Ziloochi M. Occupational exposure to blood in the stuff of educational-medical centers of Kashan University of medical sciences in 2005. Faiz J 2007;10:59-64.
Hoboubi N, Asadi N, Ghanavati FK, Jabery O. The association between workload and needlestick injuries among the nurses in the hospitals affiliated with Ahvaz University of medical sciences. Shiraz E Med J 2019;20:e81460.
Yarmohammadi M. Investigating the serologic status and epidemiological aspects of health care workers' exposure to HBV and HCV viruses. Knowl Health 2011;5:37-42.
Abdi MH, Najafipour S, Hamidizadeh S, Jamali F, Pournourouz N: Survey of accidental injuries caused by sharp instruments among the jahrom university of medical sciences hospitals health care workers 2008. 2009;7:30-38.
Galougahi MHK: Evaluation of needle stick injuries among nurses of Khanevadeh Hospital in Tehran. Iranian journal of nursing and midwifery research 2010;15:172.
Syed FS, Bener A, Kabbi A, Latif AK, Samson S. The epidemiology of needle stick injuries among health care workers in a newly developed country. Saf Sci 2006;44:387-94.
Siddique K, Anil S, Fzza SH. Knowledge attitude and practices regarding needle stick injuries amongst healthcare providers. Pak J Surg 2008;24:242-8.
Khraisat F, Juni MH, Rahman AA, Md Said S. Needlestick and sharp injuries among healthcare workers in hospitals: A mini-systematic review. Int J Clin Med Res 2014;1:151-60.
Martins A, Coelho AC, Vieira M, Matos M, Pinto ML. Age and years in practice as factors associated with needlestick and sharps injuries among health care workers in a Portuguese hospital. Accid Anal Prev 2012;47:11-5.
Voide C, Darling KE, Kenfak-Foguena A, Erard V, Cavassini M, Lazor-Blanchet C. Underreporting of needlestick and sharps injuries among healthcare workers in a Swiss university hospital. Swiss Med Wkly 2012;142:w13523.
Yoshikawa T, Wada K, Lee JJ, Mitsuda T, Kidouchi K, Kurosu H, et al
. Incidence rate of needlestick and sharps injuries in 67 Japanese hospitals: A national surveillance study. PLoS One 2013;8:1-5.
Sayehmiri K, Mohammadi E, Mohammadi I, Sayehmiri F. Epidemiology of needle sticks and sharps injuries in healthcare workers in Iran: A systematic review and meta-analysis. Iran Occup Health J 2014;11:93-103.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]