This cross-sectional study was conducted from December 2014 to March 2015 on 240 nurses employed in two hospitals of Kerman. Sampling was performed through simple random sampling. The study inclusion criteria consisted of having a bachelor’s degree and a minimum work experience of three months at the ward. A researcher-made questionnaire designed using the views of experts in relevant fields and the review of similar papers was used to collect the data [8,12]. The questionnaire was composed of three parts. The first part assessed participants’ demographic information, including age, gender, marital status, work experience, the average number of shifts per month and the average number of work hours per week. The second part examined three factors, including the physical causes of needle stick injuries among the nurses through the assessment of seven items (needle, scissors, scalpel, angiocatheter, syringe cartridge, suture needle and pin). The human factors responsible for needlestick injuries among nurses through the assessment of nine items (crowded wards, lack of interest, distraction, stiff unyielding boxes filled to capacity, carelessness, fear, fatigue, needles left unattended and using hand instead of tools) and the methods for preventing needlestick through the assessment of five items (training, caution, proper needle disposal, proper resting and other items). The questionnaire was distributed among ten infection experts for confirming its validity and among 15 nurses participating in the pilot study for determining the reliability of its content, which was confirmed by a Cronbach’s alpha of 0.75. The nurses submitted their informed consent for participating in the study. The study was approved by the Ethics Committee of Zabol University of Medical Sciences.

The data obtained were analysed in SPSS (Statistical Package for Social Sciences) version 20.0. Descriptive statistical indicators such as frequency distribution, frequency percentage, mean and standard deviation were used to describe the data. Depending on the nature of the variables examined, the chi-square test, Spearman’s correlation coefficient and the t-test were used to investigate the relationship between needlestick injuries and other variables. The level of significance for the data was set at p<0.05.

From the total of 240 questionnaires distributed, 200 were completed. The questionnaire’s response rate was 83.3%; 172 participants (86%) were female and 28 (14%) were male; 169(84.5%) were married and 31(15.5%) were single. Participants had a mean age and standard deviation of 31±6.7, an age range of 18 to 52, and a work experience of 9.3±3.7 years, 29.6±4.7 shifts per month and 48.6±6.7 work hours per week. The results of the study showed that, from the entire population studied, 72 participants (36%) had no history of needlestick injuries while the others reported having experienced instances of needlestick injuries during the past year; 78 nurses (39%) reported one instance of needlestick injury, 34 (17%) reported two to three instances, eight (4%) reported four to five instances and eight (4%) reported more than five instances of needle stick injury during the past year. The main physical cause of needlestick injuries was syringe needles (82) and scissors (33) [Table/Fig-1]. From the nurses’ perspective, crowded wards (74) and lack of interest (30) were the main causes of injuries, while fatigue, needles left unattended and the use of hands instead of instruments were less responsible for the incidence of needlestick injuries [Table/Fig-2]. As for the methods of preventing needlestick injuries among nurses, the majority of the nurses believed the most effective methods to include training (82) and precautionary measures (51); [Table/Fig-3]. The first steps taken after the incidence of a needlestick injury were to wash the hands with water and soap (n=150), reporting to the head nurse (n=21), washing the hands with Betadine (n=14) and vaccination (n=15), in respective order. As for the time during which needlestick injuries had occurred, 73 nurses (36.5%) reported it to be the morning shift, eight (4%) the evening shift and 119 (59.5%) the night shift. The results of Spearman’s correlation coefficient test showed no statistically significant relationships between the history of needlestick injuries and variables including work experience, age and the number of shifts per month (p-value>0.05). [Table/Fig-4]. The chi-square test also showed no significant relationships between the history of needlestick injuries and gender (p-value=0.63) [Table/Fig-5]. The results of the t-test showed no significant differences between the average hours worked per week in nurses who had a history of needlestick injuries and in those without such a history (p-value=0.51) [Table/Fig-6].

According to the results, the majority of participants were female, which is consistent with a study conducted by Hassani Shokouh et al., [13] but not with the study conducted by Joneidi Jafari in military hospitals [12], which may be due to the higher number of female nurses in public hospitals. The results also showed that more than 64% of nurses have had at least one needlestick injury during the past year, which is consistent with the results of a study conducted in Pakistan [8], but not with the study conducted by A. Azap et al., [14], who found a lower rate for these injuries; these different results can be due to the differences in the study populations examined and the higher prevalence of infection prevention programs in place in the hospitals surveyed in the present study. The results also showed syringe needle heads to be the most common physical cause of needlestick injuries, which is consistent with the results of studies conducted by Vahedi, Nazmieh, Joneidi Jafari and Derek R. Smith [10,11,12,15]. The reason for the greater contribution of this factor to the injuries is that syringe needle heads are the most commonly-used sharp objects among medical staff and that nurses have the greatest contact with needle heads. Crowded wards and rushed performances were the main human factors responsible for needlestick injuries, and studies conducted by Vahedi and Rakhshani also identified heavy workloads, rushed performance and the lack of precaution as the main factors contributing to needlestick injuries [6,10]. As for the time during which needlestick injuries had occurred, the results showed that the night shift (59.5%) exhibited the most frequent incidence of these injuries in the nurses, which is not consistent with the results obtained by Johnson and Connor and C. Voide, who reported the morning shift to exhibit the most frequent instances of the injury [16,17]. A possible reason for this disparity is the community and the environment that have been surveyed or the nurses’ fatigue and sleepiness toward the end of the night shifts. The majority of nurses participating in this study claimed training (52%) and not rushing (42%) to be the best effective methods for preventing needlestick injuries; however, in another study, Hatcher argues that using a dedicated container for the disposal of needles can prevent up to 60% of the cases of needlestick injury [18]. As for the early post-injury treatment measures, the results showed that nurses’ knowledge and practice is inadequate, as most of them had chosen only to wash their hands with soap and water as the primary measure and only a small number (n=21) had performed the four essential post-injury measures, i.e. bleeding, washing, dressing and reporting), which is consistent with the results obtained by Nazmieh [16]. This study has limitations, which must be addressed. This was a cross sectional study that reduced the ability of the study.

Due to the high prevalence of injuries caused by sharp objects in nurses, needlestick injuries are suggested to be recorded in special forms and their causes to be checked by the Infection Control Committee. Due to nurses’ inadequate knowledge about the principles of dealing with needlestick injuries, holding training programs on this issue seems essential. Since syringe needle heads and angiocatheters are the main causes of needlestick injuries, providing safe medical equipment should also be emphasized.