Hepatitis B and Sharps Safety Before Nursing Clinical Placement: A Narrative Review and Proposed Framework for Resource-Constrained Hospitals

Clinical placements expose nursing students to blood, body fluids, and sharps while procedural routines and reporting behaviors are still developing. In resource-constrained hospitals, incomplete hepatitis B virus (HBV) vaccination, limited infection prevention and control (IPC) capacity, variable supervision, and unclear post-exposure pathways may compound this risk. This structured narrative review critically synthesized evidence relevant to prelicensure nursing students and interns and used the synthesis to derive a provisional clinical-readiness framework. PubMed/MEDLINE and Google Scholar were searched through September 29, 2026, with a targeted update on October 11, 2026; backward/forward citation searching and World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidance were also used. Empirical studies from 2014 onward were prioritized, while earlier authoritative guidance and seminal education literature were retained when directly relevant. A 32-study meta-analysis estimated needlestick injury prevalence at 35% (95% CI, 28%-43%) and non-reporting at 63% (95% CI, 51%-74%), with substantial heterogeneity. Recent studies from multiple regions show marked variation in vaccination documentation and persistent gaps between knowledge and safe practice; a 2026 Egyptian study found practice and attitude, but not knowledge score alone, independently associated with injury. A single-group 2026 simulation study reported improved knowledge, practice, and observed behavior, but causal inference is limited by the absence of a control group and unequal injury recall periods. Direct evidence linking student HBV-readiness programs to patient-level outcomes remains limited; patient safety is therefore treated as a candidate downstream domain. We propose six linked domains - vaccinate, train, verify, supervise, report, and improve - supported by an evidence-to-domain matrix and a practical pilot package. The framework is evidence-informed rather than validated and requires local co-design, psychometric testing, feasibility assessment, and prospective evaluation before wider adoption.