Investigation and Analysis of the NIS Protection Level and Influencing Factors of Clinical Nurses: a Large Population Sample Survey Based on China Economic Belt

Background: Needle stick injuries are a leading cause of occupational exposure in clinical nurse practice, with previous studies establishing that their incidence is typically lower in developed countries and affected by the local economic level. In China, significant differences in economic development levels exist between different regions. Based on the division of the economic region, this study investigated and analyzed differences in the incidence of needle stick injuries and the influencing factors among clinical nurses in different economic regions.

Methods:

The survey considered the level of economic development and regional characteristics. It included at least 5 tertiary hospitals from each provincial administrative unit, encompassing general hospitals, specialized hospitals, maternal and child health care hospitals, etc. Inclusion criteria for nurses: in-service and on-the-job clinical nurses working in tertiary hospitals holding valid nurse qualification certificates who voluntarily cooperated with the investigators. Exclusion criteria: nursing students, nursing managers, individuals taking maternity leave due to pregnancy or childbirth, refusal to participate in the survey, questionnaire completion time not meeting the minimum requirement, reverse entry selections, and incomplete responses. All study subjects were informed of the survey details in advance and signed the informed consent form before accessing the survey page.

Questionnaire This survey included a custom-made questionnaire entitled "Survey on the status of needle prick injuries in clinical nurses". It was designed by the researcher in collaboration with the experts of the clinical IV therapy team of the First Affiliated Hospital of Chongqing Medical University based on the "NSI protection expert consensus in 2018" [23] and was completed through four rounds of discussion and revisions. The expert group consisted of 13 members (including one statistical expert) distributed across five cities, seven general hospitals, and one medical college (statistical expert), among which 10 held senior titles and three held deputy senior titles. The questionnaire was reviewed by via four rounds of expert consultations from seven hospitals. Considering the influence of regional cultural differences in written expression, 268 pilot questionnaires were initially conducted in Chongqing (Western region), Guangdong (Southern region), and Hebei (Northern region) to further refine language and content. Finally, the questionnaire comprised three sections: 1. demographic characteristics of nurses, including region, hospital name, department name, age, years of experience, nursing role, nurse title, educational level, etc.; 2. Knowledge, belief, and behavior of nurses regarding NSI protection; 3. Hospital management, training, and assessment of the implementation of "NSI protection". The Kronbuck coefficient of the knowledge, belief, and behavior questionnaire was 0.789.

Based on the population data of each provincial administrative unit in 2021 [24], a stratified sampling method was employed based on a ratio of 1/100,000 population for each unit. The online questionnaire survey was distributed through an online survey software (Questionnaire Star) combined with an online sampling method. China Nursing Association is the only national nursing association organization for Nurses in China, with the Hospital Infection Management Committee of the Chinese Nursing Society being a subdivision of the organization. Its members are distributed in 28 provincial administrative units across the country, with over 800 members and 130 nursing department directors. This survey was officially published by the Hospital Infection Management Committee of the Chinese Nursing Society. Following approval of the survey notification information and questionnaire by the committee, the committee informed the liaison officers of the national hospital infection management committee to inform the head nurses of the hospital through the official WeChat working group, who in turn shared the questionnaire in the WeChat working groups of the department nurses. The notice asked the head nurse to emphasize the principle of voluntariness to the investigation object when sharing the questionnaire.