Needle stick injuries (NSIs) are among the commonest occupational hazards in healthcare, occurring during injections, blood sampling, suturing and sharps disposal. The World Health Organization estimates that about 3 million healthcare workers sustain percutaneous exposure to blood-borne pathogens each year, including roughly 2 million to HBV, 900,000 to HCV and 170,000 to HIV [1]. Reported prevalence among healthcare workers ranges from 20% to 80% worldwide [2], and from 30% to 73% in Pakistan, where under-reporting is common [3]. Per-exposure transmission risk is about 6–30% for HBV, 1.8% for HCV and 0.3% for HIV [4–6]. Only HBV is vaccine-preventable, so timely wound care, risk assessment and PEP are central to protecting exposed individuals. HIV PEP is a 28-day antiretroviral course that should be started as soon as possible after exposure [9,10], and can reduce HIV transmission by about 80%. Students are particularly vulnerable because of limited procedural experience, fatigue and variable supervision [7,8]. Studies in several countries report incorrect understanding of PEP timing and duration, poor awareness of reporting pathways and unsafe practices such as needle recapping [11,12]. Local data on PEP-specific KAP across medical and allied health programs are limited. We therefore assessed knowledge, attitudes and practices regarding PEP after NSIs among clinical-year students at Baqai Medical University.

Design and setting. This descriptive cross-sectional study was conducted at Baqai Medical University, Karachi, from August 2025 to January 2026, after approval from the Institutional Review and Ethics Board. Participants and sampling. Clinical-year (3rd–5th year) students of MBBS, BDS, BSN, DPT and MLT programs who gave voluntary informed consent were eligible. Pre-clinical students, students with a prior NSI, and those who declined or returned incomplete questionnaires were excluded. Stratified random sampling with proportional selection by program was used. The sample size of 267 was calculated in OpenEpi v3.0.1 at 95% confidence and 5% margin of error. Instrument. A validated, anonymous, self-administered questionnaire (printed and online) collected demographics and assessed knowledge (6 items on transmission, PEP timing and duration, wound washing, needle recapping and HBV vaccination; score 0–6), attitudes (5 five-point Likert items on seriousness of NSIs, reporting and training; score 0–5) and practices (3 items on glove use, sharps disposal and recapping; score 0–3). Analysis. Data were analysed in IBM SPSS Statistics v26. Descriptive statistics are reported as frequencies, percentages and mean ± SD. Kolmogorov–Smirnov and Shapiro–Wilk tests showed non-normal distributions for all scores (p < 0.001), so the Mann–Whitney U test (gender) and Kruskal–Wallis test (program, year of study) were used. A p-value < 0.05 was considered significant.

53.6%), and 3rd-year students were the largest year group (41.9%) (Table 1). Table 1. Demographic characteristics of participants (N = 267) Variable n % Gender Male 130 48.7 Female 137 51.3 Academic program MBBS 143 53.6 BDS 65 24.3 DPT 34 12.7 BSN 21 7.9 MLT 4 1.5 Year of study 3rd year 112 41.9 4th year 92 34.5 5th year 63 23.6 The mean knowledge score was 2.98 ± 2.06 (about 50% of the maximum), the mean attitude score 3.39 ± 1.73 (about 68%) and the mean practice score 2.58 ± 0.73 (about 86%) (Table 2). MBBS students had the highest mean knowledge score (3.31), and DPT students the lowest (2.32). Practice scores varied little between programs. MLT results (n = 4) should be interpreted cautiously. Table 2. Mean KAP scores overall and by academic program Domain (range) Overall (mean ± SD) MBBS BDS BSN DPT MLT Knowledge (0–6) 2.98 ± 2.06 3.31 2.60 2.90 2.32 3.25 Attitude (0–5) 3.39 ± 1.73 3.62 3.12 3.48 3.20 4.00 Practice (0–3) 2.58 ± 0.73 2.62 2.48 2.53 2.62 2.75 Female students had significantly higher knowledge scores than males (mean rank 143.63 vs 123.85; p = 0.034), while attitude (p = 0.184) and practice (p = 0.967) scores were similar. Across programs, knowledge differed at the borderline of significance (χ² = 9.484, p = 0.050); attitude (p = 0.109) and practice (p = 0.369) did not differ (Table 3). Attitude scores differed significantly by year of study (p = 0.025): 5th-year students had more positive attitudes than 3rd-year (p = 0.008) and 4th-year (p = 0.039) students. Table 3. Comparison of KAP scores by gender (Mann–Whitney U) and academic program (Kruskal–Wallis) Domain Male mean rank Female mean rank p (gender) χ² (program) p (program) Knowledge 123.85 143.63 0.034* 9.484 0.050 Attitude 140.21 128.11 0.184 7.553 0.109 Practice 134.16 133.85 0.967 4.280 0.369 *Statistically significant (p < 0.05).

Students in this study had moderate knowledge, favourable attitudes and suboptimal practices regarding NSIs and PEP. Knowledge deficits centred on PEP initiation timing, treatment duration and reporting procedures. This is consistent with reports of high NSI exposure and inadequate preparedness among healthcare workers in Pakistan (45% sharps injury in the preceding year) [13], India (about 73% occupational exposure) [14] and Ethiopia (pooled prevalence 28.8% over 12 months) [15]. Attitudes were generally positive, yet some students were reluctant to report exposures, plausibly from fear, embarrassment or uncertainty about institutional support. Previous studies show the same attitude–behaviour gap: 47% of medical students in one study [16] and 53% in another [17] did not formally report their injuries. Practice findings mirror a Pakistani study in which only 29.7% of injured medical students reported the incident [18] and a Saudi study in which 74.1% of nursing students recapped needles and 77.4% did not report NSIs [19]. Favourable attitudes alone therefore do not guarantee safe behaviour. Female students scored higher on knowledge, and knowledge varied marginally by program, with MBBS students highest, possibly reflecting differences in curricular exposure to infection control. Attitude scores rose with advancing year of study, suggesting that clinical experience may shape occupational safety awareness. These explanations are speculative given the cross-sectional design. Strengths and limitations. Strengths include sampling across five programs, a validated tool and appropriate non-parametric analysis. Limitations include a single-institution setting, which limits generalisability; the cross-sectional design, which precludes causal inference; self-reported data subject to recall and social-desirability bias; the very small MLT subgroup (n = 4); and the short practice scale (3 items), which limits sensitivity. Recommendations. Regular workshops on NSIs and PEP; hands-on training in sharps handling and post-exposure management within clinical curricula; clear, supportive institutional reporting systems; confirmed HBV vaccination before clinical rotations; and multicentre studies across Pakistan

Medical and allied health students at Baqai Medical University showed moderate knowledge, positive attitudes and inadequate practices regarding PEP after needle stick injuries, with specific gaps in PEP timing, duration and reporting. Strengthened infection-control education, practical training and institutional support during undergraduate training may reduce NSI risk and improve appropriate use of PEP.

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