Healthcare workers (HCWs) confront a varied range of occupational hazards daily, with needle-stick injuries (NSIs) being few and far between in their frequency but enormous in their consequences. NSIs tend to happen when a needle or sharp object accidentally penetrates the skin, most often while giving injections, drawing blood, or disposing of sharps. With tertiary care hospitals dealing with an enormous influx of patients amid resource constraints in places like Jammu and Kashmir, NSIs become more worrisome. Besides causing immediate trauma to the person affected and his or her body part, they also expose the persons concerned to blood-borne pathogens such as Human immunodeficiency virus (HIV), Hepatitis B virus (HBV) and Hepatitis C virus (HCV). World Health Organization and Prüss-Üstün et al. estimated that NSIs account for approximately 16,000 HCV infections, 66,000 HBV infections, and 1,000 HIV infections globally each year in HCWs (1,2). In India, studies done in similar settings report the prevalence of NSIs as ranging from 30% to 60%, and as a usual practice, most of the cases are not even reported due to workload pressure and lack of awareness (3,4,10,12). The factors contributing to the problem in Kashmir's healthcare scenario include overcrowding in emergency departments, poor training in safe disposal techniques and variable supply of PPE. Nurses and medical students who are typically responsible for patient care suffer the most from these risks. Past research in tertiary hospitals of Srinagar and North India has shown that recapping needles has traditionally been counted among the greatest causes of NSIs, despite being discouraged by universal precautions (4,5). In addition, there is low vaccination coverage for HBV hence, many HCWs remain vulnerable after being exposed (11,12). All these are being aggravated by underreporting, blocking timely post-exposure prophylaxis (PEP) and institutional interventions. The study looks into NSIs in the Government Medical College Hospital Anantnag, a leading tertiary care hospital offering services to the rural and urban populations of South Kashmir. By analysing the data of incidents spanning from July 2023 to July 2025, the research aims to highlight the demographic trends, common causes, and gaps in prevention. The study objectives were to determine the prevalence of NSIs among healthcare workers, the associated risk factors, compliance with reporting and prophylaxis.

This constitutes a retrospective, descriptive study conducted at Government Medical College Hospital, Anantnag, a tertiary care centre located in Jammu and Kashmir, India. Data was analysed for the period from July 2023 to July 2025 for reported cases of NSIs among HCWs involved in active patient care. Since anonymous secondary data was used, the need for obtaining individual written consent was waived, and this is in conformity with the Declaration of Helsinki guidelines concerning human subjects protection. The study population included healthcare workers who had NSI during the stipulated period. Non-percutaneous injuries, such as splashes, or incomplete data were excluded from the study. Data was retrieved from the NSI registry maintained by the Department of Microbiology in the hospital, which follows a standardized proforma. The proforma was maintained based on variables, including subject's identification number, age, sex, job category (doctor/nurse/student), department (ward, emergency, OT, ICU), date of injury, cause (recapping, manipulating sharp, transferring of fluid), type of device (syringe needle, IV cannula, etc.), whether reported (yes/no), whether PEP given (yes/no), HBV vaccination status (complete/partial/none), and knowledge level (good/average/poor-based on self-declared awareness of universal precautions). A convenience sample of all the 25 available cases was used as this comprised the entire dataset for the period. There being no formal sample size calculations on account of the retrospective nature and limited number of incident reports, the data were entered into a CSV file and analyzed using Python 3.9 with libraries such as pandas (data manipulation), seaborn (visualizations), and scipy (statistical tests). Frequencies, percentages, means, and standard deviations were presented in descriptive statistics. Cross-tabulations were used, especially in examining distributions by job category and department. Chi-square tests were considered to investigate relationships such as reporting status versus job category and injury cause versus department. A p-value <0.05 was set as a limit for statistical significance. Graphs, mainly bar charts presenting frequency and percentage distributions, and tables were generated for clear depiction of findings.

The dataset involved 25 NSI cases--with the mean age calculated at 29.4 (SD=5.6; range=26-45). Female gender predominated with 68%, which reflected the gender profiles of nursing staff at the hospital. Nurses represented 52% (n=13) of incidents, while students (medical and nursing) made up 48% (n=12). Wards had the highest caseload, with 48% (n=12), followed by emergency at 28% (n=7), operation theatres (OT’s) at 16% (n=4), and ICU recorded the lowest at 8% (n=2). Recapping caused 52% of injuries and involved mainly syringe needles at 76%. Other common causes were manipulation of other sharps 28% (n=7) and fluid transfers 20% (n=5). Reporting rates remained low, as only 28% (n=7) of cases were reported to the infection control team in a formal manner. On PEP administration, 20% (n=5) of recorded incidents were given the treatment, all of these cases after reporting. There was found to be a gap regarding HBV vaccine status: 16% (n=4) completed their three doses, 20% (n=5) had interrupted their schedule, and 64% (n=16) had never been vaccinated. The knowledge levels were: 52% (n=13) were average, 32% (n=8) were good, and 16% (n=4) were poor. Chi-square analysis showed no significant association between reporting status and job category (χ²=0.00, df=1, p=1.000), indicating similar underreporting among nurses and students. However, a significant association was found between injury cause and department (χ²=9.84, df=4, p=0.043), with recapping more common in wards (67% of ward cases) and manipulating sharps prevalent in emergency (57% of emergency cases). Table 1: Demographic and Incident Characteristics of NSI Cases (N=25) Characteristic Frequency (n) Percentage (%) Age Group 26-30 years 14 56 31-35 years 6 24 36-45 years 5 20 Gender Female 17 68 Male 8 32 Job Category Nurse 13 52 Student Doctors 12 0 48 0 Department Ward 12 48 Emergency 7 28 OT 4 16 ICU 2 8 Table 2: NSI Causes, Reporting, and Prophylaxis (N=25) Variable Frequency (n) Percentage (%) Cause Recapping 13 52 Manipulating Sharp 7 28 Transferring Fluid 5 20 Device Type Syringe Needle 19 76 IV Cannula 4 16 Others 2 8 Reported Yes 7 28 No 18 72 PEP Administered Yes 5 20 No 20 80 Figure 1: Distribution of NSI Causes by Department: Bar chart showing recapping highest in wards, manipulating sharps in emergency; generated via seaborn Figure 2: HBV Vaccination Status Among Affected HCWs: Pie chart illustrating 64% unvaccinated; generated via seaborn

Our research identifies a concerning phenomenon of needlestick injuries (NSIs) in a tertiary care centre in Anantnag, with nurses and students carrying much of the burden. The NSI prevalence of 52% for nurses, as reported in this study, was quite consistent with SKIMS, Srinagar data suggesting that nurses reported 61% of NSI (5). Re-capping (52%) was once again the most frequently reported activity preceding needlestick injuries, which has been similarly reported globally and throughout India; Bashir et al. in a Coimbatore study supports this notion linking NSIs to hurried procedures and inadequate training (3). In considering the aim of this study, it is necessary to again mention the significance of the association between cause and department (p=0.043). Procedures conducted on wards, like injections, would likely increase chances for errors due to re-capping while emergencies would generate chaos contributing to the mishandling of sharps. The differences observed between departments on the causes of NSI highlight the opportunity for targeted intervention in the different settings. A concerningly high underreporting rate, 72%, is comparable to studies in North India where a high proportion (around 75%) of needle-stick injuries (NSIs) were unreported due to workload and perceived low risk (10). Underreporting of NSIs can lead to delays in post-exposure prophylaxis (PEP) and may misrepresent institutional data, limiting policy change. Administration of PEP was extremely low at 20%, significantly under-utilizing the guidelines produced by the Centers for Disease Control and Prevention (19). However, it was likely, at least partially, attributable to lack of awareness or perceived stigma. Vaccination coverage for hepatitis B virus (HBV) was low at 16% fully vaccinated, compared to urban centres such as Delhi with rates around 50% (10,11). In rural and predominantly Kashmir-based areas, limited access to proper vaccines, as well as reminders for follow-up may have been barriers too. In terms of knowledge levels—quantified as mostly average—there were showing gaps in continued education, which is supported by Bashir et al. (3) where poor knowledge of NSI proceedings correlated to an increased risk for NSIs. Limitations of this study include a small sample size (n=25), reliance on reported cases, possibly underestimating the actual prevalence of NSIs, and retrospective design, likely creating recall bias in self-rated knowledge. Future studies could consider using prospective surveillance as well as qualitative interviews to understand the barriers to adequate reporting in greater depth. Nonetheless, the analysis highlights useful and manageably implementable take-aways for our local hospitals.

Needlestick injuries (NSIs) continue to pose a significant occupational risk in Anantnag's tertiary care environment, with a high rate among nurses and students attributed to unwarranted activities and the departments. An added risk is the lack of reporting, PEP use, and immunization rates. Hospitals should ensure mandatory training for safe practices, develop a process for reporting, and conduct a universal HBV vaccination drive. These approaches could address NSIs and provide further protection for health care workers in resource-constrained areas like Kashmir.

1. World Health Organization. The world health report 2002: reducing risks, promoting healthy life. Geneva: WHO; 2002. 2. Prüss-Üstün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med. 2005;48(6):482–90. 3. Bashir H, Qadri SS. Needle stick injuries among health care workers in a tertiary care hospital in India. Int J Res Med Sci. 2019;7(4):1032–8. 4. Aziz S, Akhter A, Akhter K, et al. Prevalence of needle stick injury and its associated factors among nursing staff working at a tertiary care hospital of North India. Int J Res Med Sci. 2023;11(10):3755–62. 5. Jan F, Para MA, Ali Z, et al. Needle stick and sharp injuries and their related safety measures among health care workers at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, India. Int J Adv Res. 2020;8(2):125–41. 6. Kebede A, Gerensea H. Prevalence of needle stick injury and its associated factors among nurses working in public hospitals of Tigray region, Ethiopia. BMC Res Notes. 2018;11(1):413. 7. International Labour Organization. Joint ILO/WHO guidelines on health services and HIV/AIDS. Geneva: ILO; 2005. 8. Indian Council of Medical Research. Guidelines for management of occupational exposures to HIV and recommendations for post-exposure prophylaxis. New Delhi: ICMR; 2019. 9. Ministry of Health and Family Welfare, Government of India. National guidelines on prevention and management of needle stick injuries. New Delhi: MoHFW; 2020. 10. Sharma R, Rasania SK, Verma A, et al. Study of prevalence and response to needle stick injuries among health care workers in a tertiary care hospital in Delhi, India. Indian J Community Med. 2010;35(1):74–7. 11. Singhal V, Bora D, Singh S. Hepatitis B in health care workers: Indian scenario. J Lab Physicians. 2009;1(2):41–8. 12. Muralidhar S, Singh PK, Jain RK, et al. Needle stick injuries among health care workers in a tertiary care hospital of India. Indian J Med Res. 2010;131:405–10. 13. Askarian M, Shaghaghian S, McLaws ML. Needlestick injuries among nurses of Fars province, Iran. Ann Epidemiol. 2007;17(12):988–92. 14. Nsubuga FM, Jaakkola MS. Needle stick injuries among nurses in sub-Saharan Africa. Trop Med Int Health. 2005;10(8):773–81. 15. Jayanth ST, Kirupakaran H, Brahmadathan KN, et al. Needle stick injuries in a tertiary care hospital. Indian J Med Microbiol. 2009;27(1):44–7. 16. Kermode M, Jolley D, Langkham B, et al. Occupational exposure to blood and risk of blood-borne virus infection among health care workers in rural north Indian health care settings. Am J Infect Control. 2005;33(1):34–41. 17. Lakbala P, Sobhani G, Lakbala M, et al. Sharps injuries in the operating room. Environ Health Prev Med. 2014;19(5):348–53. 18. Mehta A, Rodrigues C, Singhal T, et al. Interventions to reduce needle stick injuries at a tertiary care centre. Indian J Med Microbiol. 2010;28(1):17–20. 19. Centers for Disease Control and Prevention. Updated U.S. Public Health Service guidelines for the management of occupational exposures to HBV, HCV, and HIV and recommendations for post-exposure prophylaxis. MMWR Recomm Rep. 2001;50(RR-11):1–52. 20. Centers for Disease Control and Prevention. Sharps safety program. Atlanta: CDC; 2019. 21. International Health Care Worker Safety Center. EPINet report for needlestick and sharp object injuries. Charlottesville: University of Virginia; 2018. 22. Panlilio AL, Orelien JG, Srivastava PU, et al. Estimate of the annual number of percutaneous injuries among hospital-based health care workers in the United States, 1997–1998. Infect Control Hosp Epidemiol. 2004;25(7):556–62.