Occupational Exposure to Blood and Body Fluids and Its Association with Anxiety Among Final-Year Medical Students: A Single-Center Cross-Sectional Study

Authors

Keywords:

Personal Protective Equipment, medical students, occupational exposure, clinical training, curriculum, anxiety

Abstract

Background: Occupational exposure to blood and body fluids (BBFs) remains a significant risk for healthcare professionals, particularly those in training. These exposures not only pose a biological hazard but may also contribute to psychological distress. This study aimed to assess the prevalence of BBF exposure among final-year medical students and investigate its association with anxiety levels.

Methods: A cross-sectional study was conducted in January–February 2025 at Bursa Uludağ University Faculty of Medicine, Turkey. Of 271 final-year students, 203 participated (74.9%). Data were collected using a structured online questionnaire assessing sociodemographic characteristics, exposure history, and anxiety levels using the Generalized Anxiety Disorder-7 (GAD-7) scale. Predictors of anxiety severity were analyzed using negative binomial regression.

Results: Overall, 56.2% of students reported at least one BBF exposure, with 67.5% experiencing multiple incidents. Common exposures occurred during venipuncture (50%) and arterial puncture (33.3%), with emergency department rotations posing the highest risk (66.7%). Despite high glove usage (100%), gown usage was low (16.7%). The mean GAD-7 score was significantly higher among exposed students (7.21 vs. 5.39, p=0.016). Regression analysis revealed BBF exposure (IRR=1.34), high-risk departments (IRR=1.52), and factors like performance anxiety (IRR=1.85) significantly increased anxiety severity.

Conclusion: In this single-center study, occupational BBF exposure was highly prevalent among final-year medical students and was significantly associated with elevated anxiety levels, especially in high-pressure clinical settings. Despite existing safety training and orientations, the study's findings revealed persistent gaps in critical areas such as PPE compliance (low gown usage) and effective management of psychosocial stressors (hierarchical pressure).

Author Biography

Levent Özdemir, Prof. Dr., MD. Bursa Uludağ University, Faculty of Medicine, Public Health Department, Bursa/TURKEY

  • Prof. Dr, MD
  • Professor (Full) at Bursa Uludağ Üni̇versi̇tesi̇ Faculty of Medicine
  • Public Health Department

Bursa, Turkey

References

1. Azap A, Ergönül O, Memikoğlu KO, Yeşilkaya A, Altunsoy A, Bozkurt GY, et al. Occupational exposure to blood and body fluids among health care workers in Ankara, Turkey. Am J Infect Control. 2005;33(1):48-52.

2. Puro V, De Carli G, Cicalini S, Soldani F, Balslev U; European Occupational Post-Exposure Prophylaxis Study Group. European recommendations for the management of healthcare workers occupationally exposed to hepatitis B virus and hepatitis C virus. Euro Surveill. 2005;10:260-264.

3. Prüss-Ustün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med. 2005;48(6):482-490.

4. Osborn EH, Papadakis MA, Gerberding JL. Occupational exposures to body fluids among medical students: a seven-year longitudinal study. Ann Intern Med. 1999;130(1):45-51.

5. Triassi M, Pennino F. Infectious risk for healthcare workers: evaluation and prevention. Ann Ig. 2018;30(4 Suppl 1):48-51.

6. Zhang L, Ai Y, Liu J, Yue N, Xuan J, Bal V, et al. Economic burden of needle-stick injury among healthcare workers in China. Value Health. 2018;21:S86.

7. Erdem Y, Talas MS. Blunt and penetrating object injuries in housekeepers working in a Turkish university hospital. Am J Infect Control. 2006;34(4):208-214.

8. Gücük M, Karabey S, Yolsal N, Özden YI. İstanbul Tıp Fakültesi Genel Cerrahi Kliniği çalışanlarında kesici-delici alet yaralanmaları. Hastane Infeksiyonlari Dergisi. 2002;6(2):72-81.

9. Kişioğlu AN, Öztürk M, Uskun E, Kırbıyık S. Bir üniversite hastanesi sağlık personelinde kesici-delici yaralanma epidemiyolojisi ve korunmaya yönelik tutum ve davranışlar. Turkiye Klinikleri J Med Sci. 2002;22:390-396.

10. Moon CS, Hwang JH, Lee CS, Park KH, Kim ES. Exposure to blood and body fluid among medical students in Korea. Am J Infect Control. 2010;38(7):582-583.

11. Gaspar FW, Jolivet DN, Wizner K, Schott F, Dewa CS. Pre-existing and new-onset depression and anxiety among workers with injury or illness work leaves. J Occup Environ Med. 2020;62(10):e567-e572.

12. Granger S, Turner N. Work injuries and mental health challenges: a meta-analysis of the bidirectional relationship. Pers Psychol. 2025;78(1):11-57.

13. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097.

14. Konkan R, Şenormanci Ö, Güçlü O, Aydın E, Sungur MZ. Yaygın anksiyete bozukluğu-7 (YAB-7) testi Türkçe uyarlaması, geçerlik ve güvenirliği. Noropsikiyatri Ars. 2013;50(1):53-58.

15. Souza-Borges FRF, Ribeiro LA, Oliveira LCM. Occupational exposures to body fluids and behaviors regarding their prevention and post-exposure among medical and nursing students at a Brazilian public university. Rev Inst Med Trop Sao Paulo. 2014;56(2):157-163.

16. Inga E, López G, Kamiya C. Accidentes biológicos en estudiantes de medicina de una universidad peruana: prevalencia, mecanismos y factores de riesgo. An Fac Med (Lima). 2011;71(1):37.

17. Lee CS, Hwang JH, Seon SY, Jung MH. Exposure to blood and body fluids for medical students during clerkship. Korean J Med. 2008;74(5):500-505.

18. Alpat S, Özgüneş I, Nemli S, Erben N. Tıp fakültesi öğrencilerinde kan ve vücut sıvılarıyla temasa bağlı mesleki infeksiyon riski. Flora. 2008;13(2):88-92.

19. Karstaedt AS, Pantanowitz L. Occupational exposure of interns to blood in an area of high HIV seroprevalence. S Afr Med J. 2001;91(1):57-61.

20. Karani H, Rangiah S, Ross AJ. Occupational exposure to blood-borne or body fluid pathogens among medical interns at Addington Hospital, Durban. S Afr Fam Pract. 2011;53(5):462-466.

21. Cadman H, editor. WHO guidelines on drawing blood: best practices in phlebotomy. Geneva: WHO Press; 2010.

22. Aigbodion SJ, Motara F, Laher AE. Occupational blood and body fluid exposures and human immunodeficiency virus post-exposure prophylaxis amongst intern doctors. S Afr J HIV Med. 2019;20(1):958.

23. Lopes TL, Pinheiro AF, Silva CG, Mocelin PC, Zanin GD. Utilização, opinião e conhecimento dos profissionais de saúde sobre equipamentos de proteção individual durante a pandemia de SARS-CoV-2: um estudo transversal. Res Soc Dev. 2021;10(12):e26101220016.

24. Pereira A, Ribeiro A, Miranda G, Silva P, Silva A, Soares J, et al. Caracterização dos acidentes de trabalho num hospital terciário português entre 2017 e 2022. Rev Port Saude Ocup. 2023;15.

25. Roberts LW. Working together to ensure greater safety in our work and training environments. Acad Med. 2023;98(7):755-756.

26. Abere G, Yenealem DG, Wami SD. Occupational exposure to blood and body fluids among health care workers in Gondar Town, Northwest Ethiopia: a cross-sectional study. J Environ Public Health. 2020;2020:3640247.

27. Datar UV, Kamat M, Khairnar M, Wadgave U, Desai KM. Needlestick and sharps injury in healthcare students: prevalence, knowledge, attitude and practice. J Family Med Prim Care. 2022;11(10):6327-6333.

28. Quek TTC, Tam WWS, Tran BX, Zhang M, Zhang Z, Ho CSH, et al. The global prevalence of anxiety among medical students: a meta-analysis. Int J Environ Res Public Health. 2019;16(15).

29. Baxter AJ, Scott KM, Vos T, Whiteford HA. Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med. 2013;43(5):897-910.

30. Zhao LP, Kolonel LN. Efficiency loss from categorizing quantitative exposures into qualitative exposures in case-control studies. Am J Epidemiol. 1992;136:464-474.

31. Yaneva-Deliverska M. European Union regulation on prevention of sharps injuries in hospital and healthcare sector. J IMAB. 2012;18(3):357-359.

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Published

2026-03-19

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Özdemir, L., Özyar, S. S., İsrafilzade, S., & Khorasani, B. (2026). Occupational Exposure to Blood and Body Fluids and Its Association with Anxiety Among Final-Year Medical Students: A Single-Center Cross-Sectional Study. International Journal of Medical Students. Retrieved from https://ijms.info/IJMS/article/view/3816

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Copyright (c) 2026 Levent Özdemir, Sena Sude Özyar, Sabrina İsrafilzade, Behrokh Khorasani

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