Beyond knowledge: practice behaviours and attitudes independently associated with needlestick injuries among nursing students - a cross-sectional study with logistic regression modelling

Needlestick injuries (NSIs) are common during nursing students’ clinical training. This study estimated 12-month NSI prevalence, described knowledge-practice-attitude (KAP) profiles, and examined factors independently associated with NSI occurrence. A cross-sectional study was conducted at the Faculty of Nursing, Cairo University, Egypt, from December 2023 to March 2024. A convenience sample of 455 s-year through internship students completed a structured online questionnaire. The knowledge, practice and attitude scales had Cronbach’s alpha values of 0.70, 0.84 and 0.77, respectively. Multivariable logistic regression modelled any NSI in the preceding 12 months versus none. Reporting followed STROBE. Overall, 193 participants (42.4%) reported at least one NSI. Satisfactory knowledge, satisfactory practice and positive attitudes were observed in 44.2%, 82.4% and 71.9%, respectively. Higher adjusted odds of NSI were associated with internship year (aOR 3.41, 95% CI 1.87–6.22), ICU/ED placement (aOR 2.78, 95% CI 1.65–4.68), no prior NSI education (aOR 2.14, 95% CI 1.18–3.88), unsatisfactory practice (aOR 1.95, 95% CI 1.07–3.57), and negative attitude (aOR 1.83, 95% CI 1.02–3.29) (all p < 0.05). Knowledge score was not independently associated with NSI occurrence (aOR 1.12, 95% CI 0.89–1.41; p = 0.340). NSIs were common in this cohort. Clinical training stage, placement, prior NSI education, practice and attitude were independently associated with NSI occurrence. The null knowledge association should not be interpreted as evidence that knowledge is unimportant, because KAP domains were operationalised differently and measured cross-sectionally. Prospective studies should evaluate integrated safety education and supervised competency assessment.