Needlestick Injuries Strike More Than a Third of Sierra Leone’s Nurses and Midwives Each Year

Nearly four in ten nurses and midwives in Sierra Leone’s hospitals report being stuck by a needle or cut by a sharp instrument in the past year, according to a new cross-sectional study published in BMC Nursing. The survey, conducted across 26 purposively selected hospitals between 3 and 28 November 2025, offers one of the most detailed pictures yet of occupational sharps injuries in the West African nation, and it reveals not only a heavy injury burden but also a troubling chain of missed opportunities in post-exposure care.

The research team, led by Eric Nzirakaindi Ikoona of Sierra Leone’s National Public Health Agency, surveyed 1,091 of 1,194 eligible nurses and midwives, an unusually strong 91.4 percent response rate for a hospital-based occupational health study. Participants self-reported needlestick and other percutaneous sharps injuries, which occur when a contaminated needle, scalpel, or other sharp object breaches the skin and can transmit bloodborne pathogens such as HIV, hepatitis B virus, and hepatitis C virus. In total, 400 participants, or 36.7 percent, reported at least one such injury in the previous twelve months, with a hospital-cluster bootstrap 95 percent confidence interval of 34.2 to 39.2 percent. Over their working lifetimes, 632 participants, or 57.9 percent, reported a sharps injury.

The statistical approach deserves attention because it reflects the clustered nature of the data. Rather than treating every nurse as an independent observation, the researchers estimated prevalence intervals using a 20,000-replicate bootstrap that resampled entire hospitals, then fitted modified Poisson regression models with finite-sample-corrected hospital-cluster covariance and t-based inference anchored to 25 cluster degrees of freedom. They also calculated model-standardized prevalence differences to express associations in absolute terms, a choice that makes the practical stakes of each risk factor easier to grasp than relative ratios alone.

The single strongest predictor of injury was needle recapping, the practice of bending or replacing the cap on a used needle by hand before disposal, a habit global infection prevention guidance has long urged clinicians to abandon. Nurses and midwives who recapped had an adjusted prevalence ratio of 1.85 for past-year injury, meaning their injury prevalence was nearly double that of those who did not. Expressed as an absolute difference, recapping was associated with 24.4 additional percentage points of injury prevalence, with a confidence interval of 17.9 to 30.9 points. Because recapping brings fingers within millimeters of a contaminated needle tip, the finding underscores how a single modifiable behavior can dominate the injury landscape.

Workload and working conditions also left clear statistical fingerprints. Self-reported high patient load raised injury prevalence by a third (adjusted prevalence ratio 1.33), while the absence of a sharps disposal container within arm’s reach increased it by 23 percent. Staff who had worked at least five recent night shifts showed a 21 percent higher prevalence, and those in emergency, surgical, or operating theater settings were also at elevated risk. The absence of recent sharps-handling or infection prevention and control training was associated with a 28 percent higher injury prevalence. Notably, the routine unavailability of safety-engineered devices, such as needles with built-in protective shields, showed no clear association with injury rates in this dataset, a result the authors interpret cautiously.

That null finding on safety-engineered devices is one of the study’s more provocative results. Intuition suggests that retractable or shielded needles should reduce sticks, but the data showed an adjusted prevalence ratio of just 1.06 with a confidence interval crossing unity. The authors argue that before health systems in resource-constrained settings invest heavily in these devices, which can cost several times more than conventional sharps, properly designed prospective evaluations with cost analyses are needed to establish whether they deliver measurable protection in practice.

The post-exposure cascade revealed by the survey is where the findings become most sobering. Among the 400 injured participants, only 202, or 50.5 percent, reported their injury within 24 hours, the window that matters most for effective intervention. Just 232, or 58.0 percent, received any assessment for post-exposure prophylaxis, the course of antiretroviral and other medications that can prevent HIV from establishing infection after a high-risk exposure. Among the 192 participants for whom HIV post-exposure prophylaxis was clinically indicated, only 109, or 56.8 percent, actually initiated the medication regimen.

Even among those who did start prophylaxis, the care pathway frayed at every subsequent step. Of the 109 initiators, 84, or 77.1 percent, began treatment within the critical 24-hour window, 73, or 67.0 percent, completed the full 28-day course, and only 68, or 62.4 percent, had documented follow-up. Each attrition point represents a moment when a preventable HIV or hepatitis infection could have been averted but was not. The authors frame these gaps as evidence that reporting pathways must exist not just on paper but in forms that staff actually know how to use, and that round-the-clock exposure care services are essential in hospital settings where injuries occur at all hours.

The study’s design carries important caveats that the authors state plainly. As a cross-sectional survey with a non-probability sample of purposively selected hospitals, it cannot establish causal relationships between workplace factors and injuries, and its findings cannot be generalized as a precise national estimate for Sierra Leone. Self-reported injury data are also vulnerable to recall bias, and the hospital-cluster bootstrap, while methodologically sophisticated, cannot fully compensate for a sampling frame that was not random. District-level breakdowns presented in supplementary materials come with explicit warnings against ranking districts given unequal sample sizes and purposive selection.

Even with those limitations, the study delivers an actionable agenda. The authors call for accessible sharps disposal containers placed within arm’s reach at every point of care, no-recapping policies reinforced through training, reporting systems that clinicians trust and understand, hepatitis B vaccination for all clinical staff, and 24-hour post-exposure care services. In a country still rebuilding its health workforce after Ebola and other crises, protecting the nurses and midwives who form its backbone is not merely an occupational health issue but a matter of health system resilience. The message from the data is clear: the injuries are common, the prevention tools are known, and the gap lies in consistent implementation.

Subject of Research: Needlestick and sharps injury burden, reporting, and workplace risk factors among nurses and midwives in Sierra Leone

Article Title: Needlestick and other percutaneous sharps injuries among nurses and midwives across 26 hospitals in Sierra Leone: a cross-sectional study of burden, reporting, and associated workplace factors

Article References: Ikoona, E. N., Namulemo, L., Sinnah, M. M., Vandi, M. A., & Sahr, F. (2026). Needlestick and other percutaneous sharps injuries among nurses and midwives across 26 hospitals in Sierra Leone: a cross-sectional study of burden, reporting, and associated workplace factors. BMC Nursing. https://doi.org/10.1186/s12912-026-05303-6

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05303-6

Keywords: needlestick injury, sharps injuries, nurses, midwives, Sierra Leone, occupational health, post-exposure prophylaxis, infection prevention and control, hepatitis B, HIV, hospital safety, BMC Nursing