1. Introduction
eedlestick is one of the most common occupational hazards that threaten dental center staff [1, 2, 3]. The most common way of transmitting pathogens to dental personnel is through subcutaneous injuries [4]. These injuries can have significant health and psychological consequences [6, 5] and impose many costs on individuals and society [7]. Various studies have shown that almost all dental staff is exposed to the NS [9, 8]. The prevalence of NS injuries has been reported in the high educational center [10].
By determining the prevalence of NSI and understanding the factors influencing its occurrence, designing standard educational protocols to prevent NS, and providing the necessary psychological counseling, NS’s risks and psychological effects can be reduced. Therefore, the present study was conducted to investigate the occupational exposure to NSJ and psychosocial factors associated with it among students of Arak Dental School.
2. Materials and Methods 
The present cross-sectional-descriptive study was performed on dental students of Arak University of Medical Sciences in 2018. The instrument used in the study was the checklist and SCL-90 questionnaire.
The first part of the checklist was related to demographic information. The next part of the checklist was related to NS questions, including NS report, student awareness, and conditions of NS occurrence, post-NS tests, and hepatitis B vaccination. SCL 90 test was used to assess mental health [11, 12]. Four psychological factors of anxiety, fear, self-morbidity, and depression were examined [11].
The test has a 5-point scale of zero, quantitative, partial, high, and severe, with 0, 1, 2, 3, 4 scores, respectively [13, 14]. To evaluate the reliability, thirty students were randomly selected and completed a questionnaire. Cronbach’s alpha coefficient was determined [11]. The validity of the questionnaires was examined using reliable sources and the opinions of experienced professors [15].
Descriptive analysis was expressed for quantitative variables with mean and standard deviation and qualitative variables with frequency and percentage. Chi-square test, Fisher’s test, and independent t-test were used in inferential statistics.
3. Results
Of the 80 students in the study, 42 female and 38 male, 59 reported a history of NSJ. The frequency distribution of NSJ is related to student’s academic year and was significantly higher among sixth-year students and less among fifth-year students (P<0.05). The frequency distribution of NS was not significantly related to the gender of the students (P>0.05). Out of 59 students who became NS, 15 reported it. The rate was higher among students who had just entered the clinic, but this difference was not statistically significant (P>0.05). Among students, 41 were aware of the necessary care after NS. However, the level of knowledge was not significantly related to students’ academic year (P>0.05).
Among the various devices that cause NSI in the dental school, endo files had the highest percentage (44.36%) and frequency, and dental needles (27.81%) were in the next order. Also, among the various actions that may cause NS injuries, the highest percentage was reported during endodontic treatment (27.89%) and then while cleaning equipment for sterilization (20.40%). The laboratory tests and vaccines performed by them are shown in Table 1.


Regarding mental health, students had the highest score in the anxiety dimension (1.58±0.68) and the lowest score in the self-morbidity dimension (1.17±0.33). The mean scores in depression and fear were 1.35±0.48 and 1.28±0.39, respectively; 44 people had mild psychological symptoms, 11 people had moderate symptoms, and 2 had severe symptoms (Table 2).


4. Discussion and Conclusion
Infection control in educational centers is always of particular importance [16]. The high prevalence of NS in the present study indicates the need to prevent NS. The frequency of NS was significantly higher among sixth year students. Sixth-year students were present in most clinical wards, indicating the highest likelihood of NS. The frequency of NS was not significantly related to the sex of students. However, the highest incidence of NS was observed in women, which indicates that women are more sensitive to NS [17]. Regarding training effectiveness in dealing with NS, 46.3% of students considered this training ineffective. Among the various conditions that cause NS, the highest incidence was while using the tool, and recommended that students be more careful when using the equipment. The most common cause was endo files. In the Shah study, this was reported while cleaning equipment, which is not consistent with the present study [18]. 80% of the students were vaccinated against hepatitis B. In the study of Asgarian, 86.2% of the students were vaccinated against hepatitis B [8]. Because the safest way to protect against hepatitis B is to get vaccinated, students should have their antibody titers checked periodically [19]. SCL-90 test scores after NS were high, even higher than the scores of the same test in the study of Tabrizizadeh, Which shows that the occurrence of NS can play a significant role in the occurrence of psychological problems [14]. In the study of Mehrad, Anxiety was also reported to be associated with NS [5]. 
Due to the high prevalence of NS, there is a need to appropriate training courses and minimize the incidence of psychological damage by increasing awareness and well-organized educational planning.

Ethical Considerations
Compliance with ethical guidelines
The study was approved by the Arak University of Medical Sciences (Code: IR.ARAKMU.REC.1397.269).

Funding
The study was extracted from the PhD dissertation of the first author at the Student Research Committee, School of Dentistry, Arak University of Medical Sciences, Arak.

Authors' contributions
All authors met the standard writing criteria based on the recommendations of the International Committee of Medical Journal Publishers.

Conflicts of interest
The authors declared no conflict of interest.



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