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Training programme to prevent occupational exposure: China


Clinical bottom line

A randomised study of an intensive training programme for student nurses at the beginning of clinical practice increased knowledge, improved behaviour, and halved the rate of needlestick injuries.


H Wang et al. A training programme for prevention of occupational exposure to bloodborne pathogens: impact on knowledge, behaviour and incidence of needle stick injuries among student nurses in Changsha, people's Republic of China. Journal of Advanced Nursing 2003 41: 187-194.


Two of three classes of student nurses who had completed three years of academic work and three months of clinical practice were randomised to receive standard education or an educational intervention. The standard intervention was brief instruction on vaccination against hepatitis B. The educational intervention included a 60 minute lecture and 20 minute video with teaching aids and printing material covering a wide range of issues. It emphasised the prevention of needlestick injuries.

A self-administered questionnaire on universal precautions and professional behaviour was used at the start, and after four months. It measured knowledge (maximum score 10) and behaviour (maximum score 84).

Adherence to universal precautions was documented using an observational checklist looking at handwashing, wearing gloves and handling needles.

Needlestick injuries were collected using forms available in the clinical areas where students worked.


There were 56 student nurses in the education group and 50 in the control. Their average age was 19 years (range 16 to 21 years). Most had been or were being vaccinated against hepatitis B, while 21% were not vaccinated. The response rate for return of questionnaires was 86%.


Knowledge and behaviour scores were quite high at baseline in both groups. At four months the results were significantly higher in the education group (Figures 1 and 2).

Figure 1: Knowledge scores at baseline and at four months

Figure 2: Behaviour scores at baseline and at four months


Direct observations were carried out on a subset of 38 student nurses for 30 minutes four months after the intervention. While none of the results reached statistical significance at the 5% level, the pattern was one of improved and safer behaviour in those nurses given the intervention (Table 1).

Table 1: Observed behaviour

Education (%)
Control (%)
Wash hands before procedures
Wash hands after procedures
Wearing gloves
Recapping needles
Bending needle
Disposing into sharps container


There were 50 needlestick injuries over four months, a rate of 1.4 per student nurse per year. Three-quarters involved hollow bore needles. There were significantly fewer needlestick injuries among nurses who received the educational intervention (Figure 3).

Figure 3: Percent with needlestick injuries over four months


This is an interesting and useful randomised study. It demonstrates that a structured training programme to prevent needlestick injuries can deliver big benefits in student nurses.