Occupational exposure risk perception and its multilevel influencing factors among nurses in central sterile supply departments: a cross-sectional study based on the social ecological model

Objective Occupational exposure remains a critical issue in occupational safety management within healthcare institutions. Nurses working in central sterile supply departments (CSSDs) face a relatively high risk of occupational exposure due to the unique characteristics of their working environment. However, the multilevel mechanisms influencing occupational exposure risk perception among this population have not been systematically investigated. This study aimed to explore the level of occupational exposure risk perception and its multilevel influencing factors among CSSD nurses. Methods A cross-sectional study design was employed. From June 2025 to January 2026, study preparation and site coordination were conducted. Following ethics approval in January 2026, an online questionnaire survey was administered among 580 CSSD nurses from 28 tertiary hospitals. Guided by the Social Ecological Model, variables were collected across individual, interpersonal, organizational, community, and policy levels. Stepwise multiple linear regression analysis was performed to identify factors associated with occupational exposure risk perception. Results The overall level of occupational exposure risk perception among CSSD nurses was moderate, tending to be above the midpoint of the scale. Multivariate analysis showed that self-efficacy, social support, participation in occupational exposure training, regular emergency drills, and supervisory protection were positively associated with occupational exposure risk perception, whereas occupational burnout was negatively associated with risk perception (all p 0.05). Conclusion Occupational exposure risk perception among CSSD nurses was associated with individual psychological resources and organizational support factors. Based on these findings, multilevel strategies may be considered and should be evaluated in future longitudinal or interventional studies, including strengthening psychological resource support, occupational safety training, and organizational safety culture, to inform capacity building in occupational protection and infection prevention and control.