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

Needlestick and other percutaneous sharps injuries expose nurses and midwives to bloodborne pathogens. Evidence across Sierra Leonean hospitals remains limited. We assessed injury burden, post-exposure response, and associated workplace factors. We conducted a hospital-based cross-sectional survey of nurses and midwives in 26 purposively selected hospitals from 3 to 28 November 2025. Participants self-reported needlestick and other percutaneous sharps injuries and workplace exposures. We estimated major prevalence intervals with a 20,000-replicate hospital-cluster bootstrap and fitted modified Poisson models with finite-sample-corrected hospital-cluster covariance and t-based inference using 25 cluster degrees of freedom. We calculated model-standardized prevalence differences to express absolute associations. Of 1,194 eligible participants, 1,091 completed the survey (91.4%). Past-year injury was reported by 400 participants (36.7%, hospital-cluster bootstrap 95% confidence interval [CI] 34.2%–39.2%), and lifetime injury by 632 (57.9%, 95% CI 55.3%–60.7%). Among 400 injured participants, 202 reported the injury within 24 h (50.5%) and 232 received post-exposure prophylaxis (PEP) assessment (58.0%). Among 192 participants for whom HIV PEP was indicated, 109 (56.8%) initiated PEP. Among the 109 initiators, 84 (77.1%) started within 24 h, 73 (67.0%) completed the 28-day course, and 68 (62.4%) had documented follow-up. Injury prevalence was higher with recapping (adjusted prevalence ratio [aPR] 1.85, 95% CI 1.57–2.18), self-reported high patient load (aPR 1.33, 95% CI 1.10–1.61), and no recent sharps or infection prevention training (aPR 1.28, 95% CI 1.10–1.48). Prevalence was also higher with no sharps container within arm’s reach (aPR 1.23, 95% CI 1.06–1.41), at least five recent night shifts (aPR 1.21, 95% CI 1.03–1.42), and emergency, surgical, or theater work. Recapping showed an adjusted prevalence difference of 24.4% points (95% CI 17.9–30.9). Routine unavailability of safety-engineered devices showed no clear association (aPR 1.06, 95% CI 0.90–1.24). Self-reported needlestick and other percutaneous sharps injuries were common among nurses and midwives in participating hospitals. Reporting and follow-up were incomplete. The findings support accessible sharps disposal, no-recapping systems, reporting pathways that staff know how to use, hepatitis B vaccination, and 24-hour exposure care. Safety-engineered devices warrant costed prospective evaluation before wider adoption. The cross-sectional, non-probability design limits causal and national inference. Not applicable.