Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management.

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Dentists are considered to be at high risk of occupational exposure, especially needlestick injuries. This study aimed to investigate the prevalence of exposure-injuries (EI) and the factors influencing post exposure management in an academic setting in the Eastern Province of Saudi Arabia. Materials and methods This retrospective study extracted information related to exposure injuries reported by dental care providers and staff working in an academic institution between 2016 and 2022. The chi-square test was used to measure the association between the study variables, and the statistical significance (p value) was set at < 0.05. Data were analyzed using the Statistical Package for Social Sciences (SPSS Software Version 23). Results A total of 100 EI were reported over a period of six years. These injuries mainly occurred during afternoon sessions (55%), were significantly more common in females (62.2%, p=0.013) and students (55.6%, p=0.002), and were mainly caused by needlesticks (71.9 %, p= 0.016). Immediate post exposure management and serological tests were performed by 85% and 86.6%, respectively, and were implemented significantly more frequently if the incidence occurred in the morning clinical session (p=0.035). Post exposure management was reported by females more than males (p=0.0130). Conclusion incidence of exposure injuries was high and more common among females and students. Post exposure management was influenced by factors such as sex, cause of injury, and time of occurrence. There is an urgent need for continuous training in the handling of sharps and the implementation of engineering controls. 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F1000Research 2025, 14 :762 ( https://doi.org/10.12688/f1000research.167094.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] Balgis Gaffar https://orcid.org/0000-0001-7593-1887 1 , Sarah Alqahtani 2 , Fatimah Alsafer 2 , [...] Walaa Almallahi 2 , Kawthar Abu Aziz 2 , Zahra Almashhad 2 , Soban Khan https://orcid.org/0000-0002-8573-3080 3 , Eman Bakhurji https://orcid.org/0000-0002-4540-9315 1 Balgis Gaffar https://orcid.org/0000-0001-7593-1887 1 , Sarah Alqahtani 2 , [...] Fatimah Alsafer 2 , Walaa Almallahi 2 , Kawthar Abu Aziz 2 , Zahra Almashhad 2 , Soban Khan https://orcid.org/0000-0002-8573-3080 3 , Eman Bakhurji https://orcid.org/0000-0002-4540-9315 1 PUBLISHED 04 Aug 2025 Author details Author details 1 Department of Preventive Dental Sciences - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia 2 College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia 3 Department of Dental Education - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia Balgis Gaffar Roles: Conceptualization, Formal Analysis, Investigation, Supervision, Writing – Review & Editing Sarah Alqahtani Roles: Investigation, Methodology, Writing – Original Draft Preparation Fatimah Alsafer Roles: Investigation, Methodology, Writing – Original Draft Preparation Walaa Almallahi Roles: Investigation, Methodology, Writing – Original Draft Preparation Kawthar Abu Aziz Roles: Investigation, Methodology, Writing – Original Draft Preparation Zahra Almashhad Roles: Investigation, Methodology, Writing – Original Draft Preparation Soban Khan Roles: Formal Analysis, Methodology, Validation, Writing – Review & Editing Eman Bakhurji Roles: Project Administration, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Public Health and Environmental Health collection. Abstract Aim Exposure injuries pose significant health risks to health care providers. Dentists are considered to be at high risk of occupational exposure, especially needlestick injuries. This study aimed to investigate the prevalence of exposure-injuries (EI) and the factors influencing post exposure management in an academic setting in the Eastern Province of Saudi Arabia. Materials and methods This retrospective study extracted information related to exposure injuries reported by dental care providers and staff working in an academic institution between 2016 and 2022. The chi-square test was used to measure the association between the study variables, and the statistical significance (p value) was set at < 0.05. Data were analyzed using the Statistical Package for Social Sciences (SPSS Software Version 23). Results A total of 100 EI were reported over a period of six years. These injuries mainly occurred during afternoon sessions (55%), were significantly more common in females (62.2%, p=0.013) and students (55.6%, p=0.002), and were mainly caused by needlesticks (71.9 %, p= 0.016). Immediate post exposure management and serological tests were performed by 85% and 86.6%, respectively, and were implemented significantly more frequently if the incidence occurred in the morning clinical session (p=0.035). Post exposure management was reported by females more than males (p=0.0130). Conclusion incidence of exposure injuries was high and more common among females and students. Post exposure management was influenced by factors such as sex, cause of injury, and time of occurrence. There is an urgent need for continuous training in the handling of sharps and the implementation of engineering controls. READ ALL READ LESS Keywords Needle stick injuries; exposure injuries; post exposure management; occupational injuries; dental students Corresponding Author(s) Balgis Gaffar ( [email protected] ) Close Corresponding author: Balgis Gaffar Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Gaffar B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Gaffar B, Alqahtani S, Alsafer F et al. Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :762 ( https://doi.org/10.12688/f1000research.167094.1 ) First published: 04 Aug 2025, 14 :762 ( https://doi.org/10.12688/f1000research.167094.1 ) Latest published: 12 May 2026, 14 :762 ( https://doi.org/10.12688/f1000research.167094.2 )  There is a newer version of this article available. Suppress this message for one day. Introduction Dental practitioners are considered to be at high risk for occupational exposure, especially needle stick injuries. 1 The Centers for Disease Control and Prevention (CDC) defined occupational exposure as: “Exposures that occur through needlesticks or cuts from other sharp instruments contaminated with an infected patient’s blood (including blood-contaminated saliva) or through contact of the eye, nose, mouth, or skin with a patient’s blood.” 2 Needlestick injuries (NSIs) are considered one of the most serious health concerns in general and in dental practice, specifically due to their dangerous health consequences and frequently recorded incidents. 3 NSIs are accidental skin penetrating wounds caused by sharp instruments in a medical setting. 3 They are defined as “an accidental skin penetrating wound caused by hollow-bore needles such as hypodermic needles, blood-collection needles, Intravenous (IV) catheter stylets, and needles used to connect parts of IV delivery system, scalpels, and broken glass.” 3 Exposure to NSI could result in several consequences that jeopardize general practitioners’ health. 4 Approximately 3 out of 35 million HCWs worldwide are exposed to NSIs every year and are prone to blood-borne pathogens. 4 Although NSI are associated with 20 different transmitted pathogens, blood-borne infections such as hepatitis C virus (HCV), hepatitis B virus (HBV), and human immunodeficiency virus (HIV) are the most prevalent diseases in the dental field. 4 In addition to infectious diseases, hidden consequences that negatively affect general practitioners are usually not mentioned. 5 Economic burden and psychological issues, such as stress and anxiety, and in extreme cases, can lead to disability and mortality. 5 Mishaps, lack of experience, stress, and obligation overburden are considered causes of high exposure to NSI. 6 Needlestick injuries usually occur when practitioners open, use, or discard instruments. 6 In dentistry, approximately three in ten dental assistants experienced at least one NSI (29.8%) in private dental clinics, and the reported injuries were significantly associated with a lack of infection control knowledge, non-compliance with vaccination protocols, and working in dental clinics that had no infection control unit. 5 Previous studies identified certain limitations in the investigation of NSIs, such as limitation of the resources, recall bias caused by self-reporting of NSIs, and lack of awareness about the importance of reporting, which resulted in underreporting of the incidents. 5 , 7 Furthermore, owing to the underreporting of incidents, it is difficult to estimate the actual occurrence of NSI incidents. 8 A study conducted in 2018 showed that many factors contribute to underreporting issues, such as lack of knowledge about the importance of reporting incidents and the fear of getting blamed. 8 Reporting of NSI is fundamental for prevention and treatment as it allows the assessment of the necessity for post-exposure prophylaxis, enables early diagnosis of infectious diseases, and reduces the stress of the exposed staff. 9 The Occupational Safety and Health Administration (OSHA) stated that dental care providers should adhere to certain protocols for handling NSI. 10 Injured dental practitioners are anticipated to perform immediate post-exposure evaluation and management, inform the supervisor, and proceed with writing the report. 10 As HIV, hepatitis B, and hepatitis C are some of the risks associated with NSI, immediate prophylaxis is mandatory. 10 Medical attention should be paid within hours of the incident. 10 If the source is suspected of any blood disease, hepatitis B and C, and HIV blood tests are required. 10 Post-management, B vaccines and HBIG are used as prophylactic treatments. 10 The report should be finalized by practitioners and supervisors. 10 According to the Centers for Disease Control (CDC), follow-up depends on the risk assessment of the patient starting at six weeks, three months, and six months. 11 The awareness and knowledge regarding preventive measures for NSI are deficient, which results in life-threatening blood-borne infections due to unsafe injection practices and lack of standard precautions. 12 Therefore, this study aimed to investigate the prevalence and associated risk factors of NSI in the Eastern Province of Saudi Arabia. Materials and methods Study design and setting This retrospective study was conducted at the dental hospital of Imam Abdulrahman bin Faisal University (IAU) in Eastern Province, Saudi Arabia, from March to July 2023. Study participants Incident reports of IAU dental students, faculty, assistants, interns, patients, and housekeepers who were exposed to injuries from February 2016 to December 2022 were retrieved from the Quality Department/College of Dentistry IAU. Data collection tool and procedure We used a data extraction sheet prepared using Microsoft Excel. The sheet included information about 1) demographics (age, sex, designation), 2) time of incidence, 3) the person exposed, 4) department, 5) cause of incident, 6) explanation of the incident, 7) immediate post-exposure management, 8) any treatment or first aid required, 9) any follow-up treatment required, 10) why this incident happened, 11) serological test post-exposure, 12) and when the serological testing. The independent variables of the study were demographics (age, sex, occupation), time of incidence, the person exposed, department, cause of faulty equipment, type of equipment and material, cause/defective material, explanation of the incident, immediate post-exposure management, any treatment or first aid required, any follow-up treatment required, why this incident occurred, serological test post-exposure, and when the serological test was undertaken. The dependent variable (study outcome) was the occurrence of exposure injuries. Ethical considerations This retrospective study utilized anonymized patient data extracted from dental records for research purposes. Ethical approval was obtained from Deanship of Scientific Research, Imam Abdulrahman Bin Faisal University (IRB-2023-02-143). Since the study involved only unidentified secondary data without patient interaction, the requirement for individual informed consent was waived. All data were handled in strict compliance with data protection laws and institutional confidentiality policies. Patient privacy and data security were upheld throughout the study, with access restricted to authorized researchers. The study team that collected the information was blinded and had no access to the names, personal information, or identifiers of the reports. To ensure the confidentiality of the records, the data extraction process was monitored by an officer from the quality department and was performed during working hours in a specified hour, and no records were taken or moved out of the designated area. Statistical analysis Data were anonymously coded and entered for statistical analysis using the Statistical Package for Social Sciences (SPSS Software Version 23). All available 100 records were included in the study, without any exclusion. Each variable was presented using basic statistics in the form of frequencies, percentages, means, and standard deviations. The chi-square test was used to measure the association between the study variables, and the statistical significance (P value) was set at ≤0.05. Results The prevalence of NSI in this study was 100, with a peak of 28 incidences in 2021 ( Figure 1 ), and more injuries were reported during November (15 reports) ( Figure 2 ). Table 1 presents the descriptive analysis of the collected data. NSI were more common among females (n = 61, 62.2%). The results also showed that over 8% of the incidents occurred during the afternoon clinical sessions, with NSI being more prevalent among students (55.6%), followed by Interns (29.3%). The most frequently reported sharp injury was the needle (71.9%). An explanation of the incidence was provided for most cases (68.4%). Immediate post exposure management and first aid were provided in 85.7% of reported cases. Serological tests were performed in 86.6% of the cases, of which 62.5% underwent the test performed on the same day as the incidence. The most common reason for injury was engaging in an unsafe working procedure (63.2%) ( Table 1 ). Figure 1. Number of reported exposure injuries per year. Figure 2. Month-wise number of reported exposure injuries. Table 1. Descriptive statistics (N = 100). Frequency (%) Gender Male 37 (37.8) Female 61 (62.2) Time of incidence AM 43 (44.3) PM 54 (55.7) Position Student 55 (55.6) Faculty 3 (3.0) Assistant 11 (11.1) Intern 29 (29.3) Housekeeper 1 (1.0) Source of Injury Needle 46 (71.9) Endodontic Instrument 7 (10.9) Surgical Instrument 11 (17.2) Faulty instrument Yes 25 (25.8) No 72 (74.2) Defective material Yes 3 (3.1) No 93 (96.9) Explanation of incidence Yes 67 (68.4) No 31 (31.6) Immediate post-exposure management Yes 84 (85.7) No 14 (14.3) First aid provided Yes 86 (87.8) No 12 (12.2) Follow-up treatment Yes 84 (88.4) No 11 (11.6) Reason of incidence Unsafe working condition 14 (14.7) Unsafe procedure 60 (63.2) Defective equipment 3 (3.2) Other 18 (18.9) Serology test performed Yes 84 (86.6) No 13 (13.4) When the test performed Same day 50 (62.5) A day after 21 (26.3) After more than a day 9 (11.3) Of the 46 incidences caused by needlestick, only 65.2% of the cases had explained the incidence. If the source of injury was an endodontic instrument, the explanation was provided in 71.4% of a total of 7 reported injuries. Remarkably, the cause or explanation of the incidence was completely provided for all exposures that occurred by the surgical instrument ( Table 2 ). While, if the injury occurred from a needle, the explanation was provided significantly fewer times than for other sources of injury (p = 0.016). Table 2. Factors influencing post-exposure management. Variables Categories Post-exposure management P value Gender Yes N (%) No N (%) Male 26 (74.3) 9 (25.7) 0.013 * Female 57 (93.4) 4 (6.6) Dentalcare provider Student 25 (45.5) 30 (54.5) 0.002 * Faculty 0 ⁑ 3 (100) Assistant 0 ⁑ 11 (100) Intern 12 (41.4) 17 (58.6) Time of incidence AM 40 (95.2) 2 (4.8) 0.035 * PM 43 (79.6) 11 (20.4) First Aid provided Yes 84 (97.7%) 2 (2.3%) 0.000 * No 0 ⁑ 12 (100) Reason of incidence Unsafe working condition 12 (85.7%) 2 (14.3%) 0.241 Unsafe procedure 54 (90%) 6 (10%) Defective equipment 3 (100) 0 ⁑ Other 13 (72.2%) 5 (27.8%) Type of sharp instruments Needle 30 out of 46 (65.2) 0.016 * Endodontic instrument 5 out of 7 (71.4) Surgical instrument 11 (100) * Statistically significant at a level of 0.05. ⁑ No responses in this category. Compared to other sharps, needlestick were significantly associated with a higher incidence of exposure injuries (p = 0.016). In the current study, immediate post-exposure management was significantly higher if the incidence happened in the morning clinical session than in the afternoon clinical session (p = 0.035) ( Table 2 ). With regards to providing first aid after injury, it was found that a significantly high proportion received first aid 97.7% immediately after the injury, while only 2.3% did not receive immediate first aid after the injury (p = 0.000). In addition, a significantly higher proportion of females (93.4%) proceeded with the serology test than males (74.3%) (p = 0.0130). Similarly, irrespective of the position of the person who got injured, females had a significantly higher incidence of injuries (p = 0.002) ( Table 2 ). Table 3 shows that none of the demographic factors were associated with exposure injuries. Table 3. Factors associated with exposure injuries. Variables Categories Type of instrument P value Needle Endodontic instrument Surgical instrument Gender Male 10 (71.4%) 3 (21.4%) 1 (7.1%) 0.285 Female 36 (73.5%) 4 (8.2%) 9 (18.4%) Person Exposed Student 25 (71.4%) 4 (11.4%) 6 (17.1%) 0.598 Faculty 2 (100%) 0 0 Assistant 6 (66.7%) 2 (22.2%) 1 (11.1%) Intern 13 (76.5%) 1 (5.9%) 3 (17.6%) Housekeeping 0 0 1 (100%) Reason of incidence Unsafe working condition 10 (76.9%) 1 (7.7%) 2 (15.4%) 0.862 Unsafe procedure 31 (72.1%) 5 (11.6%) 7 (16.3%) Defective equipment 1 (50%) 0 1 (50%) Other 3 (75%) 0 1 (25%) Time of incidence Morning 23 (69.7%) 4 (12.1%) 6 (18.2%) 0.918 Afternoon 23 (74.2%) 3 (9.7%) 5 (16.1%) Faculty Instrument Yes 2 (66.7%) 0 1 (33.3%) 0.615 No 44 (73.3%) 7 (11.7%) 9 (15.0%) Defective material Yes 1 (50%) 0 1 (50%) 0.486 No 44 (72.1%) 7 (11.1%) 10 (16.4%) Equipment/material type Needle 28 (68.3%) 5 (12.2%) 8 (19.5%) 0.477 Bur 5 (83.3%) 0 1 (16.7%) Scalpel 3 (75%) 1 (25%) 0 Probe 3 (25%) 1 (25%) 0 Syringe 2 (100%) 0 0 Scaler 3 (100%) 0 0 Other 2 (50%) 0 2 (50%) * Statistically significant at a level of 0.05. Discussion The dearth of literature on the prevalence of exposure injuries among dental care providers in Saudi Arabia and worldwide highlights the need to address this critical research topic. This study evaluated the prevalence of exposure injuries among faculty members and dental students in an academic institution. The current investigation showed that the prevalence of exposure injuries was highest among students, females, and during afternoon sessions. The most common sources were needles. This is the first study to report the prevalence of exposure injuries in an academic institution, given the seriousness of the consequences. The findings of the current study can guide decision and policy makers in prioritizing training and awareness regarding post exposure management. In the present study, needles were found to be the cause in two-thirds of the reported exposure injuries, followed by surgical instruments and endodontic files, similar to what was reported in Pakistan, 8 Jeddah, 5 Jezan, 14 and Najran. 3 These findings highlight the risk of exposure injuries associated with the instruments used in dental procedures, from administering local anesthesia to root canal treatment and ending with dental surgeries. There are many critical steps that increase the risk of exposure when using needles, for example, during injection of local anesthesia (LA), recapping, irrigation, suturing, fine-needle aspiration biopsy, or disposal of the needle. Compared with other uses of needles, needle pricks from dental anesthetic needles account for the highest proportion of needle exposure. 15 These injuries occur more specifically during cheek retraction when the LA is injected. 15 This incident can be prevented if the operator uses a modified retraction technique that involves retracting the cheeks using an examination mirror. 15 Other preventive measures can be taken during needle capping, such as the one-handed scooping technique, using a disposable syringe, and using a safe (retractable) syringe. 16 Moreover, we found that students followed by interns had more exposure injuries than did other dental care providers or employees. This observation is in agreement with a previous study in Riyadh, Saudi Arabia, which reported a significantly higher incidence of injuries among undergraduate students and interns. 6 In another study, more than one-fifth of the interns sustained at least one NSI during clinical training. 13 Students were the most affected dental care providers. 19 On the other hand, Andrade et al. stated that incidences of sharp injuries increase with the age of the worker. 20 Additionally, Cheng et al. found that experienced clinicians reported more exposure injuries. 21 A study conducted in 2021 showed that dental students in their undergraduate education in Saudi Arabia experience higher levels of anxiety, stress, and depression. 17 This could be one of the reasons for the observed higher frequency among students. 17 Coping and management strategies are recommended, and programs can be developed to improve students’ quality of life and mental health. 17 Besides equipment-related factors, there are some demographic-related risk factors associated with an increased risk of NSI, which include gender, position, education, and age of the operator. 7 Almost two-thirds of the reported incidents were among females, supporting previous studies. 5 , 6 , 13 , 14 , 19 , 22 It is unclear whether females experienced a greater number of NSI exposures or whether they were more inclined to report NSI. 13 Another reason that might explain the observed gender differences may be related to females being more anxious and stressed than males during clinical practice. 17 This fact is believed to be true because females are more concerned about their health and the importance of post-exposure protocols. A higher incidence of exposure injuries occurred during afternoon clinical sessions, in line with a recent study by Huang et al., which indicated that the majority of NSI exposures occurred between 1:00-3:00 PM. 13 This might be related to healthcare providers working in a hurry to finish their procedures at the end of the day with more fatigue and less energy. This observation agrees with that of Fernandes et al. 19 who found that the NSI was higher in the afternoon. In addition to psychological factors, experience and hand skills are contributing factors to increasing the chances of NSI. 13 The lapse of concentration and fatigue can be minimized if healthcare providers are working with well-trained chairside assistants because inadequate training can increase the risk of having NSI with the dentist and the assistant, which is called peer-inflicted NSI. 13 Reporting of exposure injuries is one of the mandatory guidelines that must be implemented to ensure accurate risk assessment and minimize exposure to bloodborne pathogens. 18 In the current study, the peak of reported injuries was in 2021 post the COVID-19 period where reinforcing the infection control protocols after quarantine might have led the practitioner to be more committed to guidelines and report any injuries. In the same context, the majority of the cases were in the last quarter of the year, similar to what was reported by Huang et al. 13 As the end of the year, students are prone to a variety of stresses associated with their studies; they are required to complete cases, specific requirements, performance evaluations, and clinical examinations. As future dentists who will provide dental care for the general population, dental students must be trained to effectively prevent occupational exposure. 23 , 24 This highlights the importance of documenting the frequency and circumstances of exposure injuries in identifying unsafe working circumstances and having an accurate risk assessment to minimize the NSI and hence the transmission of blood-borne pathogens. Implementing standard universal precautions in dental institutions is the best strategy for preventing occupational exposure. 23 , 24 A closer look at those injuries occurring in IAU academic institution shows that the overall rate of compliance with immediate post-exposure management was much higher than in other studies in Taiwan and Sweden. 23 Possible explanations for the high rate include 1 hospital policy that encouraged reporting, 2 the role of the hospital’s infection prevention team, and 3 increased awareness over the years of the risks of infection transmission by needlestick injury. It is also important to mention that our protocol of post-exposure management includes first aid such as washing the injury site with water or using antiseptics to clean the wound, seeking guidance from doctors or the relevant department of the institution, and reporting followed by performing the required serological tests. The main reason for incompliance with post exposure management was time. 23 When analyzing the time elapsed between the time of injury and further medical assessment by performing serological tests, it was found that in most cases, the ideally recommended time was respected. Nevertheless, the prevalence of individuals who delayed seeking postexposure care remains high. This condition is worrying because post exposure management becomes ineffective as time elapses. 19 Trends in the frequency and profile of NSI exposure should be carefully monitored and evaluated, which allows the identification of hazardous practices and diminishes the risk of future exposure. 1 Reporting NSI is one of the mandatory guidelines that must be performed to ensure accurate risk assessment and minimize exposure to bloodborne pathogens. 25 – 27 Poor reporting contributes to an unclear picture of the incidence of needlestick injuries and hampers effective preventive measures. 25 Therefore, healthcare providers, including students and interns, should be encouraged to report incidences anonymously and increase their awareness that such reporting will not affect their grades or performance. This study has certain limitations that need to be addressed. First, retrospective studies may have imposed a risk of recall bias. In addition, many confounding factors may be present but were not collected. The data were also extracted from one site, and future studies should include multiple institutions to allow better analysis of risk factors in comparison to different policies and post exposure protocols. Lastly, the retrospective nature of the study allows only the establishment of an association, but cannot determine causation. Conclusion The incidence of exposure injuries in the current study was high and mainly caused by needles. Females and students reported more exposure injuries, with these injuries occurring more frequently during the afternoon sessions. Post exposure management is influenced by sex, cause of injury, and time of occurrence. There is a need for continuous safety training, especially among students. Data availability The datasets analyzed during this study were derived from anonymized patient dental records, provided under strict confidentiality agreements with Imam Abdulrhman University Dental Hospital (IAU-DH). Due to ethical restrictions and institutional data protection policies, raw or processed data cannot be made publicly available to preserve patient privacy. Requests for limited, de-identified data may be considered on a case-by-case basis, subject to approval by the institutional ethics committee and compliance with applicable regulations. Researchers interested in collaborative access may contact IAU-DH for further inquiries. Acknowledgments The authors would like to thank the quality unit team and the medical director at the College of Dentistry, Imam Abdulrahman bin Faisal University for facilitating this study. References 1. 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PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 04 Aug 2025 ADD YOUR COMMENT Comment Author details Author details 1 Department of Preventive Dental Sciences - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia 2 College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia 3 Department of Dental Education - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia Balgis Gaffar Roles: Conceptualization, Formal Analysis, Investigation, Supervision, Writing – Review & Editing Sarah Alqahtani Roles: Investigation, Methodology, Writing – Original Draft Preparation Fatimah Alsafer Roles: Investigation, Methodology, Writing – Original Draft Preparation Walaa Almallahi Roles: Investigation, Methodology, Writing – Original Draft Preparation Kawthar Abu Aziz Roles: Investigation, Methodology, Writing – Original Draft Preparation Zahra Almashhad Roles: Investigation, Methodology, Writing – Original Draft Preparation Soban Khan Roles: Formal Analysis, Methodology, Validation, Writing – Review & Editing Eman Bakhurji Roles: Project Administration, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 12 May 2026, 14:762 https://doi.org/10.12688/f1000research.167094.2 version 1 Published: 04 Aug 2025, 14:762 https://doi.org/10.12688/f1000research.167094.1 Copyright © 2025 Gaffar B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Gaffar B, Alqahtani S, Alsafer F et al. Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :762 ( https://doi.org/10.12688/f1000research.167094.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 04 Aug 2025 Views 0 Cite How to cite this report: Prasetio DB. Reviewer Report For: Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :762 ( https://doi.org/10.5256/f1000research.184174.r444556 ) The direct URL for this report is: https://f1000research.com/articles/14-762/v1#referee-response-444556 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 06 Feb 2026 Diki Bima Prasetio , Universitas Gadjah Mada, Yogyakarta, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184174.r444556 This article addresses a frequently discussed topic, and the author has clearly outlined the overall research flow. The article's strength lies in its transparent retrospective methodology, which details the data collection period and comprehensive research period, the ethical approval ... Continue reading READ ALL This article addresses a frequently discussed topic, and the author has clearly outlined the overall research flow. The article's strength lies in its transparent retrospective methodology, which details the data collection period and comprehensive research period, the ethical approval received, and a complete list of independent variables. However, there are indeed several weaknesses that have not been explained in this paper, so from my perspective as a reviewer, the author needs to improve them to enrich and perfect the reader's understanding of this paper: 1. In the abstract, please state the population and sample size used in this study in the methods section. Correct the order of keywords to alphabetize. 2. In the introduction, the abbreviation "HCWs" appears unfamiliar to lay readers because it is not explained in the paper. 3. In the methods section, regarding data collection, the inclusion and exclusion criteria used for this data are not explained. In the study participants section, explain the total population and the final sample size. If any were discarded, why? Additionally, in the data collection section, explain the categories of the dependent variable, namely exposure injuries, which will be used in the results. 4. In the results section, the researcher explains that N = 100, but not all variables have 100 data points, creating inconsistencies. The researcher should explain transparently by adding explanatory notes to the table explaining why the data is missing. 5. In the limitations section, please clarify the limitations the researcher experienced during the data collection process, not just the possibilities. 6. There are references in numbers 3, 9, 12, 18, 20, 21, 22, 24, 26, and 27 that are used that are more than 10 years old. These references should be replaced with more recent ones if possible. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Occupational health and safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Prasetio DB. Reviewer Report For: Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :762 ( https://doi.org/10.5256/f1000research.184174.r444556 ) The direct URL for this report is: https://f1000research.com/articles/14-762/v1#referee-response-444556 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 12 May 2026 Balgis Gaffar , Department of Preventive Dental Sciences - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia 12 May 2026 Author Response We thank the Reviewer for their constructive and practical suggestions, which helped improve clarity, transparency, and reporting completeness. 1. Abstract: Population, Sample Size, and Keywords Reviewer comment: Include population ... Continue reading We thank the Reviewer for their constructive and practical suggestions, which helped improve clarity, transparency, and reporting completeness. 1. Abstract: Population, Sample Size, and Keywords Reviewer comment: Include population and sample size; alphabetize keywords. Response: The Abstract Methods section clearly states the study population and sample size (N = 100 reported incidents). Keywords have been alphabetized. 2. Abbreviation “HCWs” Reviewer comment: HCWs is not defined. Response: The abbreviation “healthcare workers (HCWs)” is now defined at first mention in the Introduction. 3. Inclusion/Exclusion Criteria and Sample Clarification Reviewer comment: Clarify inclusion/exclusion criteria, total population, and dependent variable categories. Response: The Methods section has been revised to clearly state that: All reported exposure injury records between 2016–2022 were included No records were excluded The final sample consisted of 100 incident reports Additionally, exposure injuries are now described as categories of reported incidents (e.g., needle, surgical instrument), not as outcome variables. 4. Missing Data in Tables Reviewer comment: Some variables do not sum to N = 100. Response: We appreciate this observation. Explanatory footnotes have been added to the relevant tables clarifying that: Some variables were not documented in all incident reports Percentages are calculated based on available data per variable, not the total sample 5. Limitations During Data Collection Reviewer comment: Clarify actual limitations encountered, not hypothetical ones. Response: The Limitations section now clearly describes: Missing or incomplete documentation in some reports Lack of denominator data (total staff/students) Inability to verify underreporting Constraints inherent to retrospective institutional records 6. Outdated References Reviewer comment: Several references are older than 10 years. Response: Wherever possible, older references have been replaced with more recent literature. Other old references were retained as they allow for comparisons of exposure injuries over time and when no recent references within the context of the country were available. We thank the Reviewer for their constructive and practical suggestions, which helped improve clarity, transparency, and reporting completeness. 1. Abstract: Population, Sample Size, and Keywords Reviewer comment: Include population and sample size; alphabetize keywords. Response: The Abstract Methods section clearly states the study population and sample size (N = 100 reported incidents). Keywords have been alphabetized. 2. Abbreviation “HCWs” Reviewer comment: HCWs is not defined. Response: The abbreviation “healthcare workers (HCWs)” is now defined at first mention in the Introduction. 3. Inclusion/Exclusion Criteria and Sample Clarification Reviewer comment: Clarify inclusion/exclusion criteria, total population, and dependent variable categories. Response: The Methods section has been revised to clearly state that: All reported exposure injury records between 2016–2022 were included No records were excluded The final sample consisted of 100 incident reports Additionally, exposure injuries are now described as categories of reported incidents (e.g., needle, surgical instrument), not as outcome variables. 4. Missing Data in Tables Reviewer comment: Some variables do not sum to N = 100. Response: We appreciate this observation. Explanatory footnotes have been added to the relevant tables clarifying that: Some variables were not documented in all incident reports Percentages are calculated based on available data per variable, not the total sample 5. Limitations During Data Collection Reviewer comment: Clarify actual limitations encountered, not hypothetical ones. Response: The Limitations section now clearly describes: Missing or incomplete documentation in some reports Lack of denominator data (total staff/students) Inability to verify underreporting Constraints inherent to retrospective institutional records 6. Outdated References Reviewer comment: Several references are older than 10 years. Response: Wherever possible, older references have been replaced with more recent literature. Other old references were retained as they allow for comparisons of exposure injuries over time and when no recent references within the context of the country were available. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 12 May 2026 Balgis Gaffar , Department of Preventive Dental Sciences - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia 12 May 2026 Author Response We thank the Reviewer for their constructive and practical suggestions, which helped improve clarity, transparency, and reporting completeness. 1. Abstract: Population, Sample Size, and Keywords Reviewer comment: Include population ... Continue reading We thank the Reviewer for their constructive and practical suggestions, which helped improve clarity, transparency, and reporting completeness. 1. Abstract: Population, Sample Size, and Keywords Reviewer comment: Include population and sample size; alphabetize keywords. Response: The Abstract Methods section clearly states the study population and sample size (N = 100 reported incidents). Keywords have been alphabetized. 2. Abbreviation “HCWs” Reviewer comment: HCWs is not defined. Response: The abbreviation “healthcare workers (HCWs)” is now defined at first mention in the Introduction. 3. Inclusion/Exclusion Criteria and Sample Clarification Reviewer comment: Clarify inclusion/exclusion criteria, total population, and dependent variable categories. Response: The Methods section has been revised to clearly state that: All reported exposure injury records between 2016–2022 were included No records were excluded The final sample consisted of 100 incident reports Additionally, exposure injuries are now described as categories of reported incidents (e.g., needle, surgical instrument), not as outcome variables. 4. Missing Data in Tables Reviewer comment: Some variables do not sum to N = 100. Response: We appreciate this observation. Explanatory footnotes have been added to the relevant tables clarifying that: Some variables were not documented in all incident reports Percentages are calculated based on available data per variable, not the total sample 5. Limitations During Data Collection Reviewer comment: Clarify actual limitations encountered, not hypothetical ones. Response: The Limitations section now clearly describes: Missing or incomplete documentation in some reports Lack of denominator data (total staff/students) Inability to verify underreporting Constraints inherent to retrospective institutional records 6. Outdated References Reviewer comment: Several references are older than 10 years. Response: Wherever possible, older references have been replaced with more recent literature. Other old references were retained as they allow for comparisons of exposure injuries over time and when no recent references within the context of the country were available. We thank the Reviewer for their constructive and practical suggestions, which helped improve clarity, transparency, and reporting completeness. 1. Abstract: Population, Sample Size, and Keywords Reviewer comment: Include population and sample size; alphabetize keywords. Response: The Abstract Methods section clearly states the study population and sample size (N = 100 reported incidents). Keywords have been alphabetized. 2. Abbreviation “HCWs” Reviewer comment: HCWs is not defined. Response: The abbreviation “healthcare workers (HCWs)” is now defined at first mention in the Introduction. 3. Inclusion/Exclusion Criteria and Sample Clarification Reviewer comment: Clarify inclusion/exclusion criteria, total population, and dependent variable categories. Response: The Methods section has been revised to clearly state that: All reported exposure injury records between 2016–2022 were included No records were excluded The final sample consisted of 100 incident reports Additionally, exposure injuries are now described as categories of reported incidents (e.g., needle, surgical instrument), not as outcome variables. 4. Missing Data in Tables Reviewer comment: Some variables do not sum to N = 100. Response: We appreciate this observation. Explanatory footnotes have been added to the relevant tables clarifying that: Some variables were not documented in all incident reports Percentages are calculated based on available data per variable, not the total sample 5. Limitations During Data Collection Reviewer comment: Clarify actual limitations encountered, not hypothetical ones. Response: The Limitations section now clearly describes: Missing or incomplete documentation in some reports Lack of denominator data (total staff/students) Inability to verify underreporting Constraints inherent to retrospective institutional records 6. Outdated References Reviewer comment: Several references are older than 10 years. Response: Wherever possible, older references have been replaced with more recent literature. Other old references were retained as they allow for comparisons of exposure injuries over time and when no recent references within the context of the country were available. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Moussa SA. Reviewer Report For: Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :762 ( https://doi.org/10.5256/f1000research.184174.r444552 ) The direct URL for this report is: https://f1000research.com/articles/14-762/v1#referee-response-444552 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 24 Jan 2026 Shady Ahmed Moussa , PHCC, Doha, Qatar Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.184174.r444552 This manuscript addresses an important occupational health issue in dentistry, exposure injuries and post-exposure management within an academic dental institution in Saudi Arabia. The topic is relevant to infection control, dental education, and occupational safety. While the study provides useful ... Continue reading READ ALL This manuscript addresses an important occupational health issue in dentistry, exposure injuries and post-exposure management within an academic dental institution in Saudi Arabia. The topic is relevant to infection control, dental education, and occupational safety. While the study provides useful descriptive data, several methodological, analytical, and interpretive limitations reduce the strength of its conclusions. Strengths 1. Relevant and Understudied Topic Exposure injuries among dental care providers, particularly students, are clinically significant yet underreported, especially in Middle Eastern academic settings. The manuscript helps fill a regional data gap, adding local evidence to the global literature. 2. Use of Institutional Incident-Report Data Reliance on official quality department records avoids recall bias commonly seen in self-reported surveys. Inclusion of multiple staff categories (students, interns, faculty, assistants, housekeepers) improves institutional representativeness. 3. Ethical Rigor Ethical approval is clearly documented, with strong attention to data confidentiality and anonymization. The waiver of informed consent is appropriate for retrospective, de-identified data. 4. Practical Variables Collected The study captures clinically relevant variables, including: · Time of injury · Type of instrument · Immediate post-exposure management · Serological testing and timing · These variables are directly relevant to policy and training interventions. 5. Clear Descriptive Presentation Tables and figures clearly summarize frequencies and distributions. The Results section is logically structured and easy to follow. Weak Points / Limitations 1. Major Conceptual Limitation: “Prevalence” Is Misused The study reports 100 incidents but does not define a denominator (total number of students/staff or person-years). Therefore, true prevalence or incidence rates cannot be calculated. The manuscript should be framed as a descriptive analysis of reported exposure incidents, not a prevalence study. 2. Outcome Variable Is Poorly Defined The manuscript states that the “dependent variable” is occurrence of exposure injuries, yet all included records already represent exposure injuries. This creates a logical inconsistency: there is no non-exposed comparison group. Consequently, several chi-square analyses are methodologically inappropriate. 3. Statistical Analysis Is Limited and Sometimes Misapplied Exclusive reliance on bivariate chi-square tests limits interpretability. No multivariable analysis was performed to control for confounding (e.g., gender vs. role vs. session timing). Small cell sizes (including zero counts) violate assumptions of chi-square testing in some tables. 4. Interpretation Overreaches the Data Statements such as “incidence was high” are not supported without institutional or national benchmarks. Gender differences are discussed as potential biological or psychological phenomena, yet reporting behavior bias is not adequately addressed. The manuscript occasionally implies causal relationships, which is inappropriate for a retrospective descriptive study. 5. Limited Generalizability Data were collected from a single academic institution. Institutional protocols, reporting culture, and supervision intensity may differ substantially from other settings. Findings should be interpreted as context-specific, but this is not emphasized enough. 6. Incomplete Exploration of Underreporting While underreporting is acknowledged in the Introduction and Discussion, the study design cannot assess the magnitude of underreporting. This weakens conclusions related to frequency and risk patterns. 7. Discussion Is Overly Long and Repetitive The Discussion section heavily reiterates previously published findings without sufficiently distinguishing what is novel in this study. Some cited literature is used descriptively rather than analytically. Summary Assessment Strengths Relevant topic Ethical and well-documented data source Useful descriptive insights into post-exposure practices Weaknesses Misuse of epidemiological terminology Methodological and statistical limitations Overinterpretation of descriptive data Limited external validity Final Recommendation (Reviewer Perspective) Moderate revision required The manuscript would benefit significantly from: Reframing the study as descriptive incident analysis Clarifying statistical limitations Toning down causal and prevalence claims Strengthening methodological transparency Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Moussa SA. Reviewer Report For: Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :762 ( https://doi.org/10.5256/f1000research.184174.r444552 ) The direct URL for this report is: https://f1000research.com/articles/14-762/v1#referee-response-444552 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 12 May 2026 Balgis Gaffar , Department of Preventive Dental Sciences - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia 12 May 2026 Author Response We thank the Reviewer for their thorough and insightful critique, which helped us improve the conceptual framing, statistical transparency, and interpretive balance of the manuscript. We agree with the reviewer ... Continue reading We thank the Reviewer for their thorough and insightful critique, which helped us improve the conceptual framing, statistical transparency, and interpretive balance of the manuscript. We agree with the reviewer that the original framing overstated epidemiological inferences. The manuscript has now been reframed as a descriptive retrospective analysis of reported exposure incidents, rather than a prevalence or incidence study. We appreciate the reviewer’s recognition of the study’s relevance, ethical rigor, use of institutional records, and practical implications for infection control and dental education. Weak Points / Limitations 1. Misuse of the term “Prevalence” Reviewer comment: True prevalence or incidence cannot be calculated without a denominator. Response: We fully agree. All references to “prevalence” and “incidence” have been removed or replaced with “number of reported exposure incidents” or “frequency of reported injuries.” The title, abstract, results, discussion, and conclusion have been revised accordingly. The study is now clearly presented as a descriptive analysis of reported exposure injuries, not a prevalence study. 2. Poorly Defined Outcome Variable Reviewer comment: All records represent exposure injuries; therefore, a dependent variable is conceptually inappropriate. Response: We agree and have revised the Methods section accordingly. The term “dependent variable” has been removed. The manuscript now clarifies that all included cases represent reported exposure incidents, and analyses are limited to patterns within these incidents (e.g., timing, role, post-exposure management), not predictors of injury occurrence. 3. Statistical Analysis Limitations Reviewer comment: Chi-square tests are sometimes inappropriate due to small cell sizes and lack of a comparison group. Response: We acknowledge this limitation. The Statistical Analysis section now explicitly states that analyses are exploratory and descriptive. We have: Clarified that chi-square tests were used only to examine associations among reported incidents. Added cautionary language regarding small cell sizes and zero counts. Avoided implying inferential or causal conclusions No multivariable analysis was attempted, and this limitation is now clearly acknowledged. 4. Overinterpretation of Results Reviewer comment: Statements such as “incidence was high” and causal interpretations are unsupported. Response: We agree. All language suggesting “high incidence,” causality, or biological explanations has been removed or toned down. Gender-related findings are now discussed primarily in terms of potential reporting behavior and institutional context, not biological susceptibility. Comparisons to external benchmarks are explicitly avoided. 5. Limited Generalizability Reviewer comment: Findings are institution-specific and should be framed as such. Response: This point has been strengthened in both the Discussion and Limitations sections, emphasizing that results reflect the reporting culture, protocols, and supervision structure of a single academic dental institution and should not be generalized beyond similar contexts. 6. Underreporting Reviewer comment: The study cannot quantify underreporting. Response: We agree and have clarified that while underreporting is discussed as a known issue in the literature, this study cannot assess its magnitude. Conclusions related to frequency and risk patterns have been revised to reflect this limitation. 7. Length and Repetition of Discussion Reviewer comment: The Discussion is overly long and repetitive. Response: We tried to summarize the discussion section and removed any redundant literature but we needed to emphasis what is novel about this institutional dataset and how findings inform post-exposure management practices rather than reiterating known risks We thank the Reviewer for their thorough and insightful critique, which helped us improve the conceptual framing, statistical transparency, and interpretive balance of the manuscript. We agree with the reviewer that the original framing overstated epidemiological inferences. The manuscript has now been reframed as a descriptive retrospective analysis of reported exposure incidents, rather than a prevalence or incidence study. We appreciate the reviewer’s recognition of the study’s relevance, ethical rigor, use of institutional records, and practical implications for infection control and dental education. Weak Points / Limitations 1. Misuse of the term “Prevalence” Reviewer comment: True prevalence or incidence cannot be calculated without a denominator. Response: We fully agree. All references to “prevalence” and “incidence” have been removed or replaced with “number of reported exposure incidents” or “frequency of reported injuries.” The title, abstract, results, discussion, and conclusion have been revised accordingly. The study is now clearly presented as a descriptive analysis of reported exposure injuries, not a prevalence study. 2. Poorly Defined Outcome Variable Reviewer comment: All records represent exposure injuries; therefore, a dependent variable is conceptually inappropriate. Response: We agree and have revised the Methods section accordingly. The term “dependent variable” has been removed. The manuscript now clarifies that all included cases represent reported exposure incidents, and analyses are limited to patterns within these incidents (e.g., timing, role, post-exposure management), not predictors of injury occurrence. 3. Statistical Analysis Limitations Reviewer comment: Chi-square tests are sometimes inappropriate due to small cell sizes and lack of a comparison group. Response: We acknowledge this limitation. The Statistical Analysis section now explicitly states that analyses are exploratory and descriptive. We have: Clarified that chi-square tests were used only to examine associations among reported incidents. Added cautionary language regarding small cell sizes and zero counts. Avoided implying inferential or causal conclusions No multivariable analysis was attempted, and this limitation is now clearly acknowledged. 4. Overinterpretation of Results Reviewer comment: Statements such as “incidence was high” and causal interpretations are unsupported. Response: We agree. All language suggesting “high incidence,” causality, or biological explanations has been removed or toned down. Gender-related findings are now discussed primarily in terms of potential reporting behavior and institutional context, not biological susceptibility. Comparisons to external benchmarks are explicitly avoided. 5. Limited Generalizability Reviewer comment: Findings are institution-specific and should be framed as such. Response: This point has been strengthened in both the Discussion and Limitations sections, emphasizing that results reflect the reporting culture, protocols, and supervision structure of a single academic dental institution and should not be generalized beyond similar contexts. 6. Underreporting Reviewer comment: The study cannot quantify underreporting. Response: We agree and have clarified that while underreporting is discussed as a known issue in the literature, this study cannot assess its magnitude. Conclusions related to frequency and risk patterns have been revised to reflect this limitation. 7. Length and Repetition of Discussion Reviewer comment: The Discussion is overly long and repetitive. Response: We tried to summarize the discussion section and removed any redundant literature but we needed to emphasis what is novel about this institutional dataset and how findings inform post-exposure management practices rather than reiterating known risks Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 12 May 2026 Balgis Gaffar , Department of Preventive Dental Sciences - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia 12 May 2026 Author Response We thank the Reviewer for their thorough and insightful critique, which helped us improve the conceptual framing, statistical transparency, and interpretive balance of the manuscript. We agree with the reviewer ... Continue reading We thank the Reviewer for their thorough and insightful critique, which helped us improve the conceptual framing, statistical transparency, and interpretive balance of the manuscript. We agree with the reviewer that the original framing overstated epidemiological inferences. The manuscript has now been reframed as a descriptive retrospective analysis of reported exposure incidents, rather than a prevalence or incidence study. We appreciate the reviewer’s recognition of the study’s relevance, ethical rigor, use of institutional records, and practical implications for infection control and dental education. Weak Points / Limitations 1. Misuse of the term “Prevalence” Reviewer comment: True prevalence or incidence cannot be calculated without a denominator. Response: We fully agree. All references to “prevalence” and “incidence” have been removed or replaced with “number of reported exposure incidents” or “frequency of reported injuries.” The title, abstract, results, discussion, and conclusion have been revised accordingly. The study is now clearly presented as a descriptive analysis of reported exposure injuries, not a prevalence study. 2. Poorly Defined Outcome Variable Reviewer comment: All records represent exposure injuries; therefore, a dependent variable is conceptually inappropriate. Response: We agree and have revised the Methods section accordingly. The term “dependent variable” has been removed. The manuscript now clarifies that all included cases represent reported exposure incidents, and analyses are limited to patterns within these incidents (e.g., timing, role, post-exposure management), not predictors of injury occurrence. 3. Statistical Analysis Limitations Reviewer comment: Chi-square tests are sometimes inappropriate due to small cell sizes and lack of a comparison group. Response: We acknowledge this limitation. The Statistical Analysis section now explicitly states that analyses are exploratory and descriptive. We have: Clarified that chi-square tests were used only to examine associations among reported incidents. Added cautionary language regarding small cell sizes and zero counts. Avoided implying inferential or causal conclusions No multivariable analysis was attempted, and this limitation is now clearly acknowledged. 4. Overinterpretation of Results Reviewer comment: Statements such as “incidence was high” and causal interpretations are unsupported. Response: We agree. All language suggesting “high incidence,” causality, or biological explanations has been removed or toned down. Gender-related findings are now discussed primarily in terms of potential reporting behavior and institutional context, not biological susceptibility. Comparisons to external benchmarks are explicitly avoided. 5. Limited Generalizability Reviewer comment: Findings are institution-specific and should be framed as such. Response: This point has been strengthened in both the Discussion and Limitations sections, emphasizing that results reflect the reporting culture, protocols, and supervision structure of a single academic dental institution and should not be generalized beyond similar contexts. 6. Underreporting Reviewer comment: The study cannot quantify underreporting. Response: We agree and have clarified that while underreporting is discussed as a known issue in the literature, this study cannot assess its magnitude. Conclusions related to frequency and risk patterns have been revised to reflect this limitation. 7. Length and Repetition of Discussion Reviewer comment: The Discussion is overly long and repetitive. Response: We tried to summarize the discussion section and removed any redundant literature but we needed to emphasis what is novel about this institutional dataset and how findings inform post-exposure management practices rather than reiterating known risks We thank the Reviewer for their thorough and insightful critique, which helped us improve the conceptual framing, statistical transparency, and interpretive balance of the manuscript. We agree with the reviewer that the original framing overstated epidemiological inferences. The manuscript has now been reframed as a descriptive retrospective analysis of reported exposure incidents, rather than a prevalence or incidence study. We appreciate the reviewer’s recognition of the study’s relevance, ethical rigor, use of institutional records, and practical implications for infection control and dental education. Weak Points / Limitations 1. Misuse of the term “Prevalence” Reviewer comment: True prevalence or incidence cannot be calculated without a denominator. Response: We fully agree. All references to “prevalence” and “incidence” have been removed or replaced with “number of reported exposure incidents” or “frequency of reported injuries.” The title, abstract, results, discussion, and conclusion have been revised accordingly. The study is now clearly presented as a descriptive analysis of reported exposure injuries, not a prevalence study. 2. Poorly Defined Outcome Variable Reviewer comment: All records represent exposure injuries; therefore, a dependent variable is conceptually inappropriate. Response: We agree and have revised the Methods section accordingly. The term “dependent variable” has been removed. The manuscript now clarifies that all included cases represent reported exposure incidents, and analyses are limited to patterns within these incidents (e.g., timing, role, post-exposure management), not predictors of injury occurrence. 3. Statistical Analysis Limitations Reviewer comment: Chi-square tests are sometimes inappropriate due to small cell sizes and lack of a comparison group. Response: We acknowledge this limitation. The Statistical Analysis section now explicitly states that analyses are exploratory and descriptive. We have: Clarified that chi-square tests were used only to examine associations among reported incidents. Added cautionary language regarding small cell sizes and zero counts. Avoided implying inferential or causal conclusions No multivariable analysis was attempted, and this limitation is now clearly acknowledged. 4. Overinterpretation of Results Reviewer comment: Statements such as “incidence was high” and causal interpretations are unsupported. Response: We agree. All language suggesting “high incidence,” causality, or biological explanations has been removed or toned down. Gender-related findings are now discussed primarily in terms of potential reporting behavior and institutional context, not biological susceptibility. Comparisons to external benchmarks are explicitly avoided. 5. Limited Generalizability Reviewer comment: Findings are institution-specific and should be framed as such. Response: This point has been strengthened in both the Discussion and Limitations sections, emphasizing that results reflect the reporting culture, protocols, and supervision structure of a single academic dental institution and should not be generalized beyond similar contexts. 6. Underreporting Reviewer comment: The study cannot quantify underreporting. Response: We agree and have clarified that while underreporting is discussed as a known issue in the literature, this study cannot assess its magnitude. Conclusions related to frequency and risk patterns have been revised to reflect this limitation. 7. Length and Repetition of Discussion Reviewer comment: The Discussion is overly long and repetitive. Response: We tried to summarize the discussion section and removed any redundant literature but we needed to emphasis what is novel about this institutional dataset and how findings inform post-exposure management practices rather than reiterating known risks Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 04 Aug 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 12 May 26 Version 1 04 Aug 25 read read Shady Ahmed Moussa , PHCC, Doha, Qatar Diki Bima Prasetio , Universitas Gadjah Mada, Yogyakarta, Indonesia Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Prasetio D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 06 Feb 2026 | for Version 1 Diki Bima Prasetio , Universitas Gadjah Mada, Yogyakarta, Indonesia 0 Views copyright © 2026 Prasetio D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This article addresses a frequently discussed topic, and the author has clearly outlined the overall research flow. The article's strength lies in its transparent retrospective methodology, which details the data collection period and comprehensive research period, the ethical approval received, and a complete list of independent variables. However, there are indeed several weaknesses that have not been explained in this paper, so from my perspective as a reviewer, the author needs to improve them to enrich and perfect the reader's understanding of this paper: 1. In the abstract, please state the population and sample size used in this study in the methods section. Correct the order of keywords to alphabetize. 2. In the introduction, the abbreviation "HCWs" appears unfamiliar to lay readers because it is not explained in the paper. 3. In the methods section, regarding data collection, the inclusion and exclusion criteria used for this data are not explained. In the study participants section, explain the total population and the final sample size. If any were discarded, why? Additionally, in the data collection section, explain the categories of the dependent variable, namely exposure injuries, which will be used in the results. 4. In the results section, the researcher explains that N = 100, but not all variables have 100 data points, creating inconsistencies. The researcher should explain transparently by adding explanatory notes to the table explaining why the data is missing. 5. In the limitations section, please clarify the limitations the researcher experienced during the data collection process, not just the possibilities. 6. There are references in numbers 3, 9, 12, 18, 20, 21, 22, 24, 26, and 27 that are used that are more than 10 years old. These references should be replaced with more recent ones if possible. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Occupational health and safety I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 12 May 2026 Balgis Gaffar, Department of Preventive Dental Sciences - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia We thank the Reviewer for their constructive and practical suggestions, which helped improve clarity, transparency, and reporting completeness. 1. Abstract: Population, Sample Size, and Keywords Reviewer comment: Include population and sample size; alphabetize keywords. Response: The Abstract Methods section clearly states the study population and sample size (N = 100 reported incidents). Keywords have been alphabetized. 2. Abbreviation “HCWs” Reviewer comment: HCWs is not defined. Response: The abbreviation “healthcare workers (HCWs)” is now defined at first mention in the Introduction. 3. Inclusion/Exclusion Criteria and Sample Clarification Reviewer comment: Clarify inclusion/exclusion criteria, total population, and dependent variable categories. Response: The Methods section has been revised to clearly state that: All reported exposure injury records between 2016–2022 were included No records were excluded The final sample consisted of 100 incident reports Additionally, exposure injuries are now described as categories of reported incidents (e.g., needle, surgical instrument), not as outcome variables. 4. Missing Data in Tables Reviewer comment: Some variables do not sum to N = 100. Response: We appreciate this observation. Explanatory footnotes have been added to the relevant tables clarifying that: Some variables were not documented in all incident reports Percentages are calculated based on available data per variable, not the total sample 5. Limitations During Data Collection Reviewer comment: Clarify actual limitations encountered, not hypothetical ones. Response: The Limitations section now clearly describes: Missing or incomplete documentation in some reports Lack of denominator data (total staff/students) Inability to verify underreporting Constraints inherent to retrospective institutional records 6. Outdated References Reviewer comment: Several references are older than 10 years. Response: Wherever possible, older references have been replaced with more recent literature. Other old references were retained as they allow for comparisons of exposure injuries over time and when no recent references within the context of the country were available. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Prasetio DB. Peer Review Report For: Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :762 ( https://doi.org/10.5256/f1000research.184174.r444556) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/14-762/v1#referee-response-444556 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Moussa S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Jan 2026 | for Version 1 Shady Ahmed Moussa , PHCC, Doha, Qatar 0 Views copyright © 2026 Moussa S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript addresses an important occupational health issue in dentistry, exposure injuries and post-exposure management within an academic dental institution in Saudi Arabia. The topic is relevant to infection control, dental education, and occupational safety. While the study provides useful descriptive data, several methodological, analytical, and interpretive limitations reduce the strength of its conclusions. Strengths 1. Relevant and Understudied Topic Exposure injuries among dental care providers, particularly students, are clinically significant yet underreported, especially in Middle Eastern academic settings. The manuscript helps fill a regional data gap, adding local evidence to the global literature. 2. Use of Institutional Incident-Report Data Reliance on official quality department records avoids recall bias commonly seen in self-reported surveys. Inclusion of multiple staff categories (students, interns, faculty, assistants, housekeepers) improves institutional representativeness. 3. Ethical Rigor Ethical approval is clearly documented, with strong attention to data confidentiality and anonymization. The waiver of informed consent is appropriate for retrospective, de-identified data. 4. Practical Variables Collected The study captures clinically relevant variables, including: · Time of injury · Type of instrument · Immediate post-exposure management · Serological testing and timing · These variables are directly relevant to policy and training interventions. 5. Clear Descriptive Presentation Tables and figures clearly summarize frequencies and distributions. The Results section is logically structured and easy to follow. Weak Points / Limitations 1. Major Conceptual Limitation: “Prevalence” Is Misused The study reports 100 incidents but does not define a denominator (total number of students/staff or person-years). Therefore, true prevalence or incidence rates cannot be calculated. The manuscript should be framed as a descriptive analysis of reported exposure incidents, not a prevalence study. 2. Outcome Variable Is Poorly Defined The manuscript states that the “dependent variable” is occurrence of exposure injuries, yet all included records already represent exposure injuries. This creates a logical inconsistency: there is no non-exposed comparison group. Consequently, several chi-square analyses are methodologically inappropriate. 3. Statistical Analysis Is Limited and Sometimes Misapplied Exclusive reliance on bivariate chi-square tests limits interpretability. No multivariable analysis was performed to control for confounding (e.g., gender vs. role vs. session timing). Small cell sizes (including zero counts) violate assumptions of chi-square testing in some tables. 4. Interpretation Overreaches the Data Statements such as “incidence was high” are not supported without institutional or national benchmarks. Gender differences are discussed as potential biological or psychological phenomena, yet reporting behavior bias is not adequately addressed. The manuscript occasionally implies causal relationships, which is inappropriate for a retrospective descriptive study. 5. Limited Generalizability Data were collected from a single academic institution. Institutional protocols, reporting culture, and supervision intensity may differ substantially from other settings. Findings should be interpreted as context-specific, but this is not emphasized enough. 6. Incomplete Exploration of Underreporting While underreporting is acknowledged in the Introduction and Discussion, the study design cannot assess the magnitude of underreporting. This weakens conclusions related to frequency and risk patterns. 7. Discussion Is Overly Long and Repetitive The Discussion section heavily reiterates previously published findings without sufficiently distinguishing what is novel in this study. Some cited literature is used descriptively rather than analytically. Summary Assessment Strengths Relevant topic Ethical and well-documented data source Useful descriptive insights into post-exposure practices Weaknesses Misuse of epidemiological terminology Methodological and statistical limitations Overinterpretation of descriptive data Limited external validity Final Recommendation (Reviewer Perspective) Moderate revision required The manuscript would benefit significantly from: Reframing the study as descriptive incident analysis Clarifying statistical limitations Toning down causal and prevalence claims Strengthening methodological transparency Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 12 May 2026 Balgis Gaffar, Department of Preventive Dental Sciences - College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia We thank the Reviewer for their thorough and insightful critique, which helped us improve the conceptual framing, statistical transparency, and interpretive balance of the manuscript. We agree with the reviewer that the original framing overstated epidemiological inferences. The manuscript has now been reframed as a descriptive retrospective analysis of reported exposure incidents, rather than a prevalence or incidence study. We appreciate the reviewer’s recognition of the study’s relevance, ethical rigor, use of institutional records, and practical implications for infection control and dental education. Weak Points / Limitations 1. Misuse of the term “Prevalence” Reviewer comment: True prevalence or incidence cannot be calculated without a denominator. Response: We fully agree. All references to “prevalence” and “incidence” have been removed or replaced with “number of reported exposure incidents” or “frequency of reported injuries.” The title, abstract, results, discussion, and conclusion have been revised accordingly. The study is now clearly presented as a descriptive analysis of reported exposure injuries, not a prevalence study. 2. Poorly Defined Outcome Variable Reviewer comment: All records represent exposure injuries; therefore, a dependent variable is conceptually inappropriate. Response: We agree and have revised the Methods section accordingly. The term “dependent variable” has been removed. The manuscript now clarifies that all included cases represent reported exposure incidents, and analyses are limited to patterns within these incidents (e.g., timing, role, post-exposure management), not predictors of injury occurrence. 3. Statistical Analysis Limitations Reviewer comment: Chi-square tests are sometimes inappropriate due to small cell sizes and lack of a comparison group. Response: We acknowledge this limitation. The Statistical Analysis section now explicitly states that analyses are exploratory and descriptive. We have: Clarified that chi-square tests were used only to examine associations among reported incidents. Added cautionary language regarding small cell sizes and zero counts. Avoided implying inferential or causal conclusions No multivariable analysis was attempted, and this limitation is now clearly acknowledged. 4. Overinterpretation of Results Reviewer comment: Statements such as “incidence was high” and causal interpretations are unsupported. Response: We agree. All language suggesting “high incidence,” causality, or biological explanations has been removed or toned down. Gender-related findings are now discussed primarily in terms of potential reporting behavior and institutional context, not biological susceptibility. Comparisons to external benchmarks are explicitly avoided. 5. Limited Generalizability Reviewer comment: Findings are institution-specific and should be framed as such. Response: This point has been strengthened in both the Discussion and Limitations sections, emphasizing that results reflect the reporting culture, protocols, and supervision structure of a single academic dental institution and should not be generalized beyond similar contexts. 6. Underreporting Reviewer comment: The study cannot quantify underreporting. Response: We agree and have clarified that while underreporting is discussed as a known issue in the literature, this study cannot assess its magnitude. Conclusions related to frequency and risk patterns have been revised to reflect this limitation. 7. Length and Repetition of Discussion Reviewer comment: The Discussion is overly long and repetitive. Response: We tried to summarize the discussion section and removed any redundant literature but we needed to emphasis what is novel about this institutional dataset and how findings inform post-exposure management practices rather than reiterating known risks View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Moussa SA. Peer Review Report For: Exposure Injuries in an Academic Institution: Prevalence and factors influencing post exposure management. [version 1; peer review: 2 approved with reservations] . F1000Research 2025, 14 :762 ( https://doi.org/10.5256/f1000research.184174.r444552) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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