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Epidemiol Health. 2018;40:e2018042. doi: 10.4178/epih.e2018042. Epub 2018 Aug 20.

Predicting needlestick and sharps injuries and determining preventive strategies using a Bayesian network approach in Tehran, Iran.

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Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.



Recent studies have shown that the rate of needlestick and sharps injuries (NSIs) is unacceptably high in Iranian hospitals. The aim of the present study was to use a systematic approach to predict and reduce these injuries.


This cross-sectional study was conducted in 5 hospitals in Tehran, Iran. Eleven variables thought to affect NSIs were categorized based on the Human Factors Analysis and Classification System (HFACS) framework and modeled using a Bayesian network. A self-administered validated questionnaire was used to collect the required data. In total, 343 cases were used to train the model and 50 cases were used to test the model. Model performance was assessed using various indices. Finally, using predictive reasoning, several intervention strategies for reducing NSIs were recommended.


The Bayesian network HFACS model was able to predict 86% of new cases correctly. The analyses showed that safety motivation and fatigue were the most important contributors to NSIs. Supervisors' attitude toward safety and working hours per week were the most important factors in the unsafe supervision category. Management commitment and staffing were the most important organizational-level factors affecting NSIs. Finally, promising intervention strategies for reducing NSIs were identified and discussed.


To reduce NSIs, both management commitment and sufficient staffing are necessary. Supervisors should encourage nurses to engage in safe behavior. Excessive working hours result in fatigue and increase the risk of NSIs.


Accident prevention; Bayes theorem; Iran; Needlestick injuries

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