1. Introduction
Healthcare workers (HCWs) are continuously exposed to biological risk injuries. Transmissible infectious diseases through occupational exposure can be attributed to three modes of transmission: contact, droplet, and airborne [
1]. Glove breaking (68%), needlestick injuries (36.2%), cautery burns (7%), passing through sharp objects (7.2%), conjunctival contact (3.4%), face contact (7.5%), and blade cuts (3%) are the most common accidents resulting in biological agent exposure [
2]. Needlestick injuries (NSI) and other accidents caused by sharp objects to healthcare personnel are regrettably quite common in hospitals, particularly during surgical operations. A recent systematic literature review on the global prevalence of percutaneous injuries among healthcare workers estimated that the one-year prevalence of sharp and puncture injuries was 36.4% (95% CI: 32.9–40.0). Surgeons had the greatest one-year prevalence (72.6%; 95% CI: 58.0–87.2) of any occupational category. The estimates for medical doctors (excluding surgeons), nurses (including midwives) and laboratory staff (including laboratory technicians) were 44.5% (95% CI: 37.5–51.5), 40.9% (95% CI: 35.2–46.7) and 32.4% (95% CI: 20.9–49.3), respectively. Healthcare professionals working in hospitals also had higher percutaneous injuries (41.8%) than those working in non-hospital environments (7.5%). Significant geographical differences were also noted in the review; they ranged from 7.7% (95% CI: 3.1–12.4) in South America to 43.2% (95% CI: 38.3–48.0) in Asia. The estimates for Europe and Africa were similar, coming in at 31.8% (95% CI: 25.0–38.5) and 34.5% (95% CI: 29.9–39.1), respectively [
3].
NSI constitute most percutaneous injuries, with approximately one in three healthcare workers at risk of injury each year. This high prevalence has significant implications for the mental health of exposed healthcare workers and the risk of contracting bloodborne infections. Occupational exposure to blood and other bodily fluids among healthcare professionals has been related to psychological issues such as depression, anxiety, post-traumatic stress disorder (PTSD), and occupational burnout [
4,
5]. Numerous blood-borne infectious illnesses, particularly viruses like hepatitis B (HBV), hepatitis C (HCV), and the human immunodeficiency virus (HIV), can be spread by these mishaps. Sharps injuries occur during use or during disassembly and disposal of sharps, even when preventive measures, such as providing PPE or training personnel, have been taken. According to estimates from the US Occupational Health and Safety Administration (OSHA), 5.6 million HCWs may be exposed to various blood-borne diseases at work as a result of NSIs [
6]. According to estimates from the World Health Organisation, in 2000, 39% of HCV infections, 37% HBV infections, and 4.4% HIV infections among HCWs worldwide that were caused by these three pathogens and were related to contaminated needle or sharp injuries [
7]. Many variables, including overuse of needles, recapping of needles, unnecessary use of sharp devices, absence of devices with safety measures, absence of PPE and containers for disposing of sharps, lack of engineering control (e.g., safety features on needles), staff shortage, inadequate knowledge of hazards and training, improper disposal of sharps, and unexpected patient reactions, are linked to an increased risk of NSIs [
8]. Moreover, needlestick and sharp injuries incur a significant financial cost to the healthcare system. This cost may be associated with managing affected healthcare workers or paying compensation claims [
9], the cost of tying up staff to investigate the injury, expense of laboratory testing, the cost of postexposure prophylaxis and treatment for exposed and infected workers, expenses of temporarily or permanently replacing staff. Additionally, the costs of needlestick and sharp injuries to the hospital system are substantial. This cost may be related to treating impacted HCWs or paying compensation claims [
9], devoting staff time to look into the injury, paying for laboratory testing, covering exposed and infected workers’ postexposure prophylaxis and treatment costs, hiring new employees either temporarily or permanently, and so forth [
10]. According to the findings of this systematic study, one HCWs out five have experienced an NSI. Papadopoli et al. showed that most nursing students do not report their injuries and that NSI is common among them [
11]. According to a cross-sectional study, hospital staff members who had not received training about needlestick and sharps injuries were much more likely to underreport injuries, even though it is crucial to report these injuries in order to prevent and treat blood-borne infections early on [
12].
In order to gather and offer helpful information for creating a successful preventative program, the current study looks into and highlights injury episodes at the University of Campania “L.Vanvitelli” in students (as equiparate working personnel) who have suffered accidental cuts, needlestick injuries, or mucous membrane contact at work. Therefore, the primary objective of this study is to analyze the incidence, characteristics, and risk factors associated with biological risk injuries—particularly needlestick and sharps injuries—among healthcare students and residents in our Institution over a ten-year period (2014–2023). The findings aim to provide evidence-based data to support the development of targeted preventive strategies tailored to this vulnerable population.
2. Materials and Methods
2.1. Study Design and Population
This study is a retrospective observational cohort study conducted on a group of first-year students enrolled in healthcare-related degree programs at the Vanvitelli University, including Nursing, Dental Hygiene, Pediatric Nursing, Radiological Technology, and Obstetrics, medical residents, and the third year of the degree course in Medicine and Surgery. These students are mandatorily subjected to health surveillance as required by Italian occupational health regulations. This study was performed from 2014 to 2023 at the University of Campania “L.Vanvitelli”, with the purpose of estimate the frequency and characteristics of biological risk injuries in healthcare students subjected to health surveillance, to provide useful information for the creation of an effective prevention and safety program. Italian legislation classifies healthcare students (medical and nursing students) and medical residents as HCWs, since they perform clinical activities in university hospitals. Consequently, universities are mandated to verify health and immunological protection against biological agents of both healthcare workers and students as established by Legislative Decree No. 81 of 9 April 2008, Article 279. Based on the Risk Assessment Document, from 2014 to 2023, we conducted a health surveillance program targeting third-year medical students, first-year healthcare professional students (nursing, dental hygiene, pediatric nursing, radiological technology and obstetrics) and first-year medical residents. Third-year medical students were included because clinical activities and associated biological risk exposure begin at this stage of their curriculum, whereas other healthcare professional students start clinical internships in their first academic year. The study design was submitted to an ethics committee for approval and the study protocol was ratified by the Institutional Ethical Committee (Prot. 0018421/i/22).
2.2. Data Collection
Data collection was carried out during the Health Survellaince, which consisted of a medical examination specifically focused on occupational biological risk exposure. Regarding biohazard, a blood sampling was also conducted to analyze immunological protection against hepatitis virus. During the preventive medical examination, it was asked to all the participants in this study a written and informed consent and to fill a pre-coded questionnaire indicating age, sex, degree program, vaccination state for HBV by the occupational physician. Biological injuries occurring during practical healthcare activities in various degree programs were monitored and certified by the Emergency Ward. The Emergency Ward’s role was to certify each injury event and initiate the post-exposure protocol according to the University’s Injury Protocol drafted by the occupational physician. In each case of injury, data were collected about the type of injury, date of the injury, university course, duration of training safety at work, performed activities during NSI e DPI used, body area, body fluids and tissues involved, post-exposure action taken after NSI and eventual prophylaxis for HIV or HCV. The monitoring protocol for exposure included serological testing for HBV, HCV, and HIV at baseline (time 0), and at 3, 6, and 12 months after the event to detect possible new infections. Clinical follow-up was conducted by occupational medicine specialists in accordance with national guidelines. A preliminary descriptive analysis of our population was carried out, considering age, gender and affiliation, and of the students who suffered biological risk injuries during the years of training internship, correlated to the socio-demographic characteristics, the work history (department; year of enrollment; time elapsed since the injury) of the sample under study.
In our study population, all students were required to undergo specific training on occupational risk prevention prior to starting clinical activities, which included e-learning modules and in-person sessions on biological hazards, use of personal protective equipment (PPE), and protocols for injury management. This training program was mandated by the university’s occupational health service, and adherence was verified by the occupational physician during the health surveillance visits. Participants must have completed the training course before accessing training placements in hospital departments.
2.3. Statistical Analysis
We developed a database for data collection, with exclusive access by three authorized investigators, authors of this paper. Prior to statistical processing, data quality control was conducted through logistical and formal sampling checks, which included data entry and verification by two different researchers. Statistical analysis of the data was performed using ‘R’ software (version 4.2.0). Sample data has been described using ‘means’ and ‘standard deviations’ (SD) for continuous variables, and absolute and percentage frequencies for qualitative variables. The injured subject has been described similarly and compared to the total of subjects undergoing occupational medicine examination for health surveillance to identify which characteristics are associated with injuries. The ‘Student t-test’ was used for continuous variables, while the ‘Chi-square’ test was applied for qualitative variables. Missing data were handled through complete case analysis. Records with missing values for key variables included in the regression models were excluded from the multivariable analysis. The percentage of missing data was below 5% for all variables. The incidence of the event was calculated as the number of new cases observed during the study period divided by the population at risk, expressed per 1000 individuals. To estimate the uncertainty associated with this incidence rate, a 95% confidence interval (CI) was calculated using the Poisson distribution. Incidence was calculated separately for each year of visit for subjects with a first visit date between 2014 and 2020, as a minimum observation period of up to 5 years was possible only for this subset. This approach allowed the assessment of temporal trends over time, although it is acknowledged that most university courses last less than 5 years (e.g., 3 years for nursing and midwifery). Subjects with visits after 2020 were excluded due to insufficient follow-up time.
Students were followed longitudinally throughout the duration of their academic training, with person-years of observation calculated accordingly for each professional category and training year. The Cochran–Armitage test for trend was used to evaluate changes in the incidence rates across the years. This enabled the calculation of incidence by year of training. A flowchart (
Figure 1) was created to describe the participant pathway, from the initial population of 14,908 students and residents undergoing occupational health surveillance between 2014 and 2023, to the final inclusion in the analysis of those with a first visit between 2014 and 2020, which allowed for a minimum 5-year follow-up period. A total of 2518 participants with a first visit after 31 December 2020, were excluded due to insufficient follow-up data. The extent of missing data for the analyzed variables was assessed and found to be below 1%. These were handled using listwise deletion in multivariate analyses.
Based on the available data for all subjects, a logistic regression model was estimated to evaluate which factors influence the occurrence of injuries. This model helped identify significant associations between the variables and injuries, allowing for a more comprehensive understanding of the factors contributing to injury risk.
Multicollinearity among independent variables was assessed using the Variance Inflation Factor (VIF). Variables with VIF > 5 were considered indicative of collinearity and evaluated for potential exclusion or adjustment.
The goodness-of-fit of the logistic regression model was evaluated using the Hosmer–Lemeshow test. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was verified through calibration plots.
3. Results
A total of 14,908 participants had occupational medicine examinations between January 2014 and December 2023, taking into account that Health Surveillance serves an average of 1500 students and medical residents annually. During the observation period, 141 of these subjects, who are basically student workers, suffered an injury. Female subjects were approximately two-thirds of the participants, while the mean age of the population was 25.2 years (SD 5.5 years). Half of the study participants were attending degree courses in health professions (including nursing, pediatric nursing, obstetrics, dental hygiene, radiological technologies). Additionally, 24.8% were residents, categorized into the surgical area (4.1%), medical area (11.4%), and service area (9.3%) divided between the surgical area (4.1%), medical area (11.4%) and others (9.3%). Students in the degree program for medicine and surgery accounted for 24.3% of the total population.
Table 1 reports the characteristics of the study population along with the distribution of biological risk injuries experienced during the reference period.
In terms of injuries, 95 subjects experienced NSI, making this the most common type of injury (67.4%). Other injuries included wounds from sharp objects (12.8%), blood splashes in the conjunctiva (6.4%), blood splashes on non-intact skin (1.4%), and splashes of biological fluids (ascitic fluid) in the conjunctiva or on intact skin or mucosa (4.3%). The incidence of injuries was notably highest among residents (56%), followed by healthcare professions students (41.8%), and only 2% among medical students. Within the medical resident population, surgical residents experienced injuries significantly more often (24.8%) compared to medical residents and service residents.
As shown in
Table 1, injured workers were mostly women.
Table 2 instead showed an average age at the time of the injury of approximately 26 years. The incidence of biological risk injuries was more frequent after the first year of training, and approximately two-thirds of the injured population had a protective antibody titer against HBV (>10 IU/mL, according to Zanetti AR et al. 2005) [
13]. The occurrence of biological risk injuries was more frequent during the early years of the course of study (74.5%). In particular, the variable “Year of course at the injury” indicates the year of study in which the student was enrolled at the time the injury occurred.
The overall incidence of the event was found to be 11.07 per 1000 individuals, calculated on the subgroup of 12,390 participants with complete follow-up, rather than the full initial cohort of 14,908. The 95% CI for the overall incidence rate was 4.54 to 17.60 per 1000 individuals. For the analysis, only subjects with a first visit date between 2014 and 2020 were included. Subjects with visits in more recent years were excluded, as it was not possible to assess a 5-year observation period from the time of the event.
Figure 1 shows the number of participants at each stage of the study and the reasons for exclusion. Out of 14,908 participants, 141 sustained biological risk injuries. Missing data were minimal and did not impact the final analysis.
The incidence per 1000 individuals for each year of visit was as follows:
In 2014, the incidence was 9.80 per 1000 individuals (95% CI: 4.54–15.06).
In 2015, the incidence was 10.12 per 1000 individuals (95% CI: 6.89–13.35).
In 2017, the incidence was 10.18 per 1000 individuals (95% CI: 6.65–13.71).
In 2018, the incidence was 13.13 per 1000 individuals (95% CI: 8.11–18.15).
In 2019, the incidence was 15.61 per 1000 individuals (95% CI: 9.22–22.00).
In 2020, the incidence was 11.36 per 1000 individuals (95% CI: 2.82–19.90).
The Cochran–Armitage test for trend did not show significant results, with a p-value of 0.1765, indicating that there was no statistically significant trend in incidence over the study period.
The results of the multivariate logistic regression analysis confirmed the findings from the univariate analysis, showing that students in nursing courses and residents had a significantly higher frequency of injuries compared to students in the medical course. Specifically, the odds ratio for nursing students was 8.673 (95% CI: 3.196–35.634), while for residents in specializations the odds ratio was 50.726 (95% CI: 17.789–214.279). These findings highlight a substantially increased risk of biological risk injuries for both nursing students and medical residents compared to students in the medical course (
Table 3). However, given the relatively small sample size in some subgroups, the wide confidence intervals indicate that these estimates should be interpreted with caution, despite being adjusted for potential confounders in the multivariate model.
4. Discussion
This study evaluated, over a broad time span of nearly a decade of observation, the injury characteristics of a particular work population, that of students in their first work experience, capturing critical issues aimed at understanding whether health and safety protection for these young workers is sufficiently effective. Healthcare professionals are at serious risk for biological hazard injuries because they are exposed to biological agents that can spread by parenteral and/or mucocutaneous routes. The risk of injury is closely linked to the type and extent of clinical activities performed, which vary considerably among different categories of students enrolled in healthcare programs. For example, medical residents and surgical trainees are more frequently involved in invasive procedures compared to first-year nursing or radiology students, who may have more limited clinical exposure. This difference in training intensity and clinical responsibility contributes to varying risk profiles among student categories. In this context, the lower injury rate observed among medical students in our study is consistent with their limited involvement in high-risk procedures during the early stages of training, and should therefore be interpreted as a consequence of reduced exposure rather than an indication of improved safety practices. Few studies focus on injuries among medical residents and medical students, despite the fact that there is a wealth of research on the prevalence of biological injuries among healthcare professionals generally [
14,
15,
16,
17]. In a recent systematic review and meta-analysis, according to Chen et al. analysis of sharps injury rates among nursing students, between 6% and 51% of people worldwide have had a sharps injury [
18]. In their study of sharps injuries among Nepali healthcare students, Bhattarai et al. discovered that 42.8% had been hurt at least once while enrolled in the program, 10% were dentistry students, while 20% were medical students, and 70% were nursing students [
19]. In a Canadian study, the distribution of sharps injuries among healthcare students was comparable, according to McCarthy and Britton who reported that 27% of incidents included nursing students, 57% involved medical students, and 82% involved dentistry students [
20]. Midwifery students are often included in studies of nursing students, with a rate of sharps injuries reported around 35.5% [
21,
22], including medical students, the range varies from 11% [
23] to 95% [
24], while among dental students it varies from 13% [
25] to 43.1% [
26]. However, the extent, causes, and reporting of sharps injuries among health care students are little understood [
16,
17], which is why this study was carried out on this group population. Our findings indicate that while there were no significant differences between the population of injured and non-injured individuals based on age or gender, there was a statistically significant value for afferents, indicating that the incidence of injuries was greater among trainees and nurses. Importantly, the Cochran–Armitage test for trend did not reveal significant changes over the study period, suggesting that the risk of biological injuries has remained relatively stable and underscoring the need for targeted preventive measures. Comparing our results with studies on nursing students, our injury frequency of 0.95% is lower than the Italian data from previous studies that varies from 18.8% [
27], 13.2% [
28] and 14.8% according to with one of the most recent studies on the topic [
11].
Considering the type of injuries, sharps and needlestick injuries showed more frequent involvement among nurses. On a global scale, our injury rate is comparable to that of Australia, where we discovered a rate of about 13.9% [
29], and nations like China, Turkey, and Taiwan, where the injury rate ranges from 26% to 61.9% [
30,
31,
32,
33,
34]. These differences can be attributed to several factors. First of all, it should be considered that during the SARS-CoV-2 pandemic, as training courses at university hospitals were suspended, with the exception of resident doctors, there was a drastic reduction in accident events among nursing and medicine and surgery students, who were forced to follow distance learning in the years 2020–2021. The sharp decline in injury rates observed in 2020–2021 is consistent with the suspension of in-person clinical training during the COVID-19 pandemic. This contextual factor should not be underestimated, as it indicates that the observed reduction does not reflect an intrinsic improvement in safety practices, but rather a temporary reduction in exposure opportunities. Once clinical activities resumed, the risk patterns are likely to return to pre-pandemic levels, further underscoring the importance of maintaining continuous and structured training programs despite external disruptions. The students of our university, therefore, cannot start their training before they have completed a specific training course on work-related risks, both in e-learning mode and with face-to-face lectures, demonstrating the fundamental importance of information and training of healthcare personnel for the safe performance of medical practices and activities required by work.
It should not be forgotten that there may be cases of failure to report biohazard incidents by injured personnel. In our setting, however, the reporting pathway is formally structured: the Emergency Ward certifies each injury and initiates the University’s post-exposure protocol, ensuring that injured students are referred to the Occupational Health Surveillance Service for follow-up. Nevertheless, underreporting remains possible, and additional efforts are needed to foster awareness and simplify reporting procedures. The literature data regarding biological injury rates during the pandemic period are rather discordant and do not cover students but only healthcare workers; therefore, our study represents one of the few to provide injury rates among students in the pandemic era. In a retrospective study conducted in Turkey among healthcare workers from December 2019 (pre-pandemic period) to December 2020 (pandemic period), 27.65% and 21.4% biological injuries were reported, respectively. Among healthcare workers exposed in 2019, 16.8% were doctors, 53.6% nurses and 47.4% trainees. The study reported a significant decrease in medical doctors’ exposure rates between the pre-pandemic and pandemic eras, by 3.6% and 1.19% in 2019 and 2020, respectively. Although it is noteworthy that the total number decreased while not being statistically significant, it has been shown that the strict regulations adopted during the pandemic period were not sufficient to completely prevent these events [
35]. In a study conducted in Italy of 97 participating hospitals in 2017 and 117 in 2021, it was found that the average number of annual incidents per hospital did not increase significantly; in 2017 an average of 26.1 sharps injuries per hospital per year were reported, while in 2021 the average will be 31.3. This research has shown that the COVID-19 epidemic has had an impact on several aspects: the percentage of nurses who have recently attended sharps safety courses has more than halved since the previous survey and many of these courses used distance learning as their preferred method. In addition, the perception of working in emergency conditions has almost doubled and new problems include stress and fatigue at work and difficulties in handling sharps due to full protective clothing. Furthermore, the average number of sharps injuries had increased by 23% compared to 2017, although this increase was not statistically significant and the study design did not allow for further evaluation [
36]. Other discordances in the international literature data are due to the possibility of access to unsafe injection practices, which is greater in developing countries, where there are often no laws mandating the use of safety devices and where the high cost of such devices is a significant barrier. Consequently, it is essential to consider these contextual factors when comparing biohazard injury data internationally [
37,
38].
This is one of the few studies evaluating the frequency of injuries in European medical students and trainees, particularly after the implementation of the EU Directive on the prevention of sharps injuries in the healthcare sector over a large 10-year period [
39,
40]. Our study showed that 56% of the medical trainees surveyed reported a biohazard injury during the reporting period and, as expected, a higher percentage among surgical trainees (24.8%). These results are in line with those of previous studies conducted in the United States, which revealed an injury frequency of between 14% [
37] and 83% [
14,
17,
41]. The analysis by occupational category revealed that surgeons have the highest prevalence of sharps injuries. Similarly, percutaneous injuries were more common among doctors (excluding surgeons), dentists and nurses than among laboratory staff and paramedics. This is not surprising given that the roles of these healthcare professionals involve a higher level of exposure to sharps than others. In contrast, when rates of sharps injuries were studied through observation or prospective surveillance, nurses were the occupational group most frequently at risk [
42,
43]. Nurses are also more likely to contract occupational infections than other professional groups (including surgeons), because they are used to performing procedures involving blood-filled needles and cannulae, with a higher risk of infection transmission [
43]. Indeed, our results show that the most frequent types of injuries were needle-sticks and stab wounds (80.1%), followed by blood splashing in the conjunctiva (6.4%), or on non-intact skin (1.4%), splashes of biological liquids (ascitic fluid) in the conjunctiva or on intact skin or mucous membranes (8.6%), while the occupational category that showed the highest percentage of injuries from cuts or needle-sticks was nursing students (55%), showing that the most commonly involved procedures are those related to the use of sharp and stinging objects and that nurses are more frequently exposed to this type of medical device than others.
In our study, the data suggest a higher incidence of injuries in earlier years of training, particularly the first year; however, further studies are needed to confirm this trend across all programs. This result highlights the critical need for targeted occupational health and safety training at the very beginning of healthcare curricula. Early interventions could strengthen awareness of preventive measures, improve adherence to safe practices, and reduce the likelihood of underreporting, thus offering an effective strategy to protect students in the most vulnerable stage of their professional development. The association between the years of training and the occurrence of biological injuries has already been reported in several studies, which have shown that the probability of accidental exposure decreases significantly from the first to the subsequent year of training as clinical skills and field experience increase [
14,
28]. In an Italian study involving nursing students, it was shown that the risk of exposure is associated with the student’s year of study, with the probability of accidental exposure in students decreasing significantly with increasing clinical skills during the course of study. Furthermore, almost 50% of the incidents occurred while students were alone, demonstrating that the presence of a mentor during clinical training activities is essential [
28]. Other studies confirm this evidence, including one conducted in Turkey, which examined 473 nursing students and found a lower rate of dangerous biological injuries in the second year than in the third and fourth [
33]. In another study conducted in India, the highest frequency of injuries (57.60%) occurred during the first year of the course, confirming, once again, that the probability of sustaining a biological injury is inversely related to years of experience [
44]. In our population an under-reporting of injury cases emerged, demonstrating a lack of preparedness of students on preventive measures to be taken following an injury event. Reasons for under-reporting of biological injuries found in the literature include the perception of biological injuries as ‘minor’ or low risk, lack of awareness of the reporting procedure, lack of awareness of the risks associated with injuries, being too busy for a time-consuming procedure, etc. [
41,
44,
45,
46,
47]. All these possible cited reasons show that young trainees are not adequately prepared to deal with occupational biological risks, so it is necessary to implement occupational safety training aimed at exposure prevention and post-exposure prophylaxis. Concerning this topic, it should be mentioned that there is currently no literature data on how frequently injured trainees adopt post-exposure prophylactic protocols after reporting an injury. Further studies should concentrate on this topic in order to examine any obstacles to adherence following reporting. It is important to highlight that, in our sample, additional examinations of injured workers conducted at 0, 3, 6, and 12 months following the event did not reveal any instances of seroconversion for HBV, HCV, or HIV in our research sample, as indicated for the protocol of injured workers.
Since one of the primary goals of their training must be the application of appropriate and safe workplace practices and behaviour, it is imperative that attention and instructional materials are focused on these target groups [
12]. As a result of our study, it is necessary to take into account student assistance programs and training for preventing occupational hazards. Probably not enough is being done, even in Italy, regarding the reduction in the risk of sharps injuries in health care, given also the figure of events in the country to date, with an increasing trend despite all the efforts made [
48]. Occupational health and safety training for health professions students represents a unique opportunity to educate them to protect themselves against occupational biological risks. Furthermore, it is crucial that students learn the correct management of accidental injuries through the timely and effective activation of post-exposure prophylaxis procedures; doing more also means intervening with targeted trainings in the very early stages of entry into the profession.
Strength and Limitations
This research presents important and innovative data compared to the scientific literature in the field, as it is one of the few studies that provides injury rates among students in the pandemic era. The importance of this study is related to the fact that Italian law obliges any worker, even student interns, trainees, or others, to be subject to the same preventive measures as structured workers; the analysis that is done on a population that is still in training, but which is studied on a par with high-skilled workers. All first-year students enrolled in medical degree programs at L.Vanvitelli University are eligible for this study. Furthermore, the size of the population involved and the long observation period must be taken into account. However, the study has some limitations. The potential underestimating of injury events—which affects all types of healthcare professionals and varies greatly throughout the globe—should be taken into account in our study. In our case we were unable to ascertain a certain frequency of underestimation because we examined injury cases that had been reported to the emergency department and had therefore followed an official reporting pathway.
Another limitation concerns the reliance on emergency department–reported events as the sole data source. This approach may underestimate the true incidence of injuries, as minor or unperceived events might not lead to ED visits and therefore remain unrecorded. Furthermore, differences in reporting behavior between students and professional healthcare workers could have introduced an additional bias, potentially limiting the generalizability of our findings.