Needlestick and Sharp Injuries Among Health Care Workers in Saudi Hospitals: A Review

Background and Context

Needlestick and sharp injuries (NSSIs) constitute one of the most significant occupational hazards facing healthcare workers (HCWs) worldwide. These injuries—defined as accidental penetration of the skin by needles, scalpels, lancets, or other sharp instruments that have been in contact with blood, tissue, or other body fluids—carry the risk of transmitting more than 20 blood-borne pathogens, including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). The World Health Organization estimated that among 35 million HCWs globally, approximately three million sustain percutaneous exposures to blood-borne pathogens annually, with two million of these exposures involving HBV, 0.9 million involving HCV, and 170,000 involving HIV.

In Saudi Arabia, the healthcare system has undergone rapid expansion to serve a growing population of Saudi nationals and a large expatriate workforce. The system comprises primary, secondary, and tertiary facilities, staffed by a multinational healthcare workforce drawn from dozens of countries. This review examined the published evidence on the incidence, risk factors, and preventive strategies related to needlestick and sharp injuries among HCWs in Saudi Arabian hospitals, with the aim of identifying areas requiring strengthened intervention.

Scope of the Problem

The evidence reviewed demonstrated that NSSIs remain prevalent across Saudi Arabian healthcare settings. Studies from various regions reported widely varying incidence rates, reflecting differences in study methodology, hospital type, reporting systems, and the populations surveyed. In Dammam Medical Complex in the Eastern Province, a retrospective analysis of all reported NSSIs over a 26-month period (2016–2018) found an overall incidence of 8.4 per cent among all healthcare employees. A larger cross-sectional survey of 609 HCWs across nine general hospitals in the Jazan region reported an overall incidence rate of 24 per cent, with rates of 30 per cent in secondary hospitals and 14 per cent in tertiary hospitals. A long-running surveillance study at King Abdul Aziz Hospital in Makkah, covering 2005 to 2017, documented a mean incidence rate of 25.43 per 100 occupied beds.

Risk Factors and Patterns

Across the studies reviewed, nurses were consistently identified as the professional group most affected by NSSIs, typically accounting for more than 50 per cent of all reported injuries. This reflects the high frequency of procedures involving sharps that nurses perform, including injections, intravenous line management, and blood sampling. Physicians accounted for approximately 25 per cent of injuries, with surgical procedures and suturing being the primary activities leading to their injuries.

The activities most commonly associated with NSSIs included disposal of used syringes (accounting for nearly 59 per cent of injuries among nurses in one study), blood sample collection (approximately 23 per cent of cases), intravenous or arterial line insertion and manipulation (approximately 19 per cent), and surgical procedures and wound care (approximately 13 per cent). Injuries occurred most frequently during morning shifts, when clinical activity volume is highest, and most commonly in ward settings.

A critical finding across multiple studies was the high rate of incomplete hepatitis B vaccination among expatriate healthcare workers. In Saudi Arabia, a significant proportion of the healthcare workforce is composed of expatriate workers from countries including the Philippines, India, Pakistan, and various other nations. These workers sometimes arrive without complete vaccination histories, and the rapid turnover of certain categories of HCWs (particularly housekeeping staff) compounds the challenge of ensuring universal vaccination coverage. One study found that approximately a quarter of injured non-Saudi workers had not completed the three-dose hepatitis B vaccination series before their injury.

Underreporting and Surveillance Challenges

Underreporting of NSSIs was identified as a persistent problem across the studies reviewed. While formal reporting systems exist in most Saudi hospitals, many HCWs do not report their injuries, particularly minor or low-perceived-risk incidents. Barriers to reporting included a belief that reporting would not lead to meaningful follow-up, fear of consequences, lack of awareness of reporting procedures, and language barriers among expatriate workers. Improving reporting rates was identified as essential for accurate surveillance, effective post-exposure prophylaxis, and the design of evidence-based prevention programmes.

Prevention Strategies and Recommendations

The review identified several evidence-based strategies for reducing NSSIs in Saudi healthcare settings. Engineering controls, including the adoption of safety-engineered sharp devices with built-in injury prevention features such as retractable needles and needle-free intravenous systems, were highlighted as the most effective primary prevention measure. A Cochrane systematic review of ten randomised controlled trials found high-quality evidence that blunt suture needles significantly reduce surgical sharps injuries compared to conventional sharp needles.

Training and education were identified as the second critical component. The significantly lower NSSI rates in tertiary compared to secondary hospitals in the Jazan study were attributed primarily to the impact of better and more continuous training programmes at the tertiary level. Mandatory and regularly refreshed training on safe injection practices, sharps disposal protocols, and post-exposure prophylaxis procedures was recommended for all categories of HCWs. Language-appropriate training materials were particularly important for the multinational workforce. Ensuring complete hepatitis B vaccination before or immediately upon employment was also emphasised, particularly for expatriate workers.

Limitations

This review was limited by the heterogeneity of study designs, settings, and outcome measures across the included studies, which precluded formal meta-analysis. The reliance on self-reported data and hospital reporting systems in most studies means that the true incidence of NSSIs is likely higher than reported. Most studies were cross-sectional or retrospective, limiting the ability to identify causal risk factors or evaluate the temporal effectiveness of interventions. The geographic focus on Saudi Arabia limits direct generalisability to other healthcare contexts, though the findings are broadly consistent with global patterns.