Regional differences and influencing factors of needlestick injury protection among clinical nurses in China: a national cross-sectional survey based on economic region.

Abstract

This study aimed to investigate regional differences in needlestick injury (NSI) protection among clinical nurses across China's economic regions and to explore the influencing factors including hospital management, training and assessment mechanisms. A national cross-sectional survey was conducted using a stratified sampling strategy combined with online questionnaire dissemination. Mediation analysis was applied to examine the indirect effects of economic regions on NSI protection. The survey was conducted across tertiary hospitals in 28 provincial-level administrative regions of China, covering the Eastern, Central and Western economic regions. A total of 15 274 valid questionnaires were collected from in-service clinical nurses working in tertiary hospitals who held valid nurse qualification certificates. No interventions were applied in this observational study. The primary outcome was the total score of nurses' knowledge, beliefs and practices (KBP) regarding NSI protection. Secondary outcomes included individual KBP dimension scores, NSI incidence in the past year and indicators of hospital management, training and assessment related to NSI prevention. Significant regional differences were observed in NSI-related management, assessment, training and nurses' KBP scores across different economic regions (all p<0.05). Nurses in the Central economic region demonstrated higher management quality, training, assessment and KBP scores than those in the Eastern and Western regions. In contrast, nurses in the Eastern region showed greater awareness and utilisation of needle-free infusion systems. Multivariable analyses indicated that economic region, hospital management, personnel training and assessment were independently associated with nurses' NSI protection ability. Compared with nurses in the Eastern and Western regions, nurses in the Central region demonstrated significantly better NSI-related beliefs, behaviours and overall protection scores. Mediation analysis further showed that management, assessment and training partially mediated the relationship between economic region and NSI protection, with mediation proportions ranging from 7.964% to 37.745% (all p<0.05). Strengthening hospital-level NSI management systems, standardised training and regular assessment programmes may improve nurses' NSI protection ability and help reduce regional disparities. These findings highlight the importance of institutional management strategies in enhancing occupational safety among clinical nurses. NCT06733779.