The present study outlined the fact, more than half of HCW had experienced an AEB during the last 12 months. This prevalence was relatively lower than that obtained at the Yaounde University Teaching Hospital (YUTH) [23]. Similarly, high levels of AEB were reported in other setting in the Fako Division District hospitals [24] and Tubah DH [25].

Almost one third of our participants had experienced percutaneous exposure to body fluids. Such observations corroborated findings in YUTH [23], elsewhere in Africa [25,26] and in a global meta - analysis [28].

Over their career, more than two third of HCW had experienced AEB. This result was close to findings in similar contexts in Africa [25,16]. Percutaneous exposures varied relatively according to the socioeconomic status of countries. Indeed, lowest prevalence were found in developed countries and highest in developing countries such as Cameroon [28].

The high variability of percutaneous exposure prevalence among health facilities of the same level of care suggests that corrective measures and possible resources should be allocated taking into account this variability for better efficiency.

Men were more affected by occupational injuries compared to women. This could be explain by the fact, men tend to take more risk than female and this negatively impacts their health status[29]. Similar results were found in Ethiopia [10]. In contrast, women were most affected in studies conducted in Laos [13] and Kenya [30]. Contextual factors specific to the different countries or to the study population could explain these differences, sex being considered as a risk factor in various studies [10,11,13,30].

HCW aged between 25 to 49 years were the most exposed to body fluid. This age group is most affected by HIV and hepatitis B as well. This arise the impact of AEB on these infections transmission among HCW [31].

Nearly half of healthcare workers who experience AEB were nurses. Due to the nature of their work, nurses spend more hours in direct contact with patients and undertake more procedures with needles or other instruments that cause percutaneous injuries. They are also called upon to work under pressure because they are at the forefront in the management of emergency cases in the DH healthcare organisation system. nurse This result was similar to those obtained in a global metanalysis [27], Ethiopia [10] and Indonesia [32]. It was higher than those obtained in China [33] and Kenya [30]. China being a developed country, the improvement of the standards of care could explain this low proportion of nurses affected by AEB compared to our study. Nurses remain nevertheless, one of the most at risk occupational groups of percutaneous exposure to blood [34].

Students were almost equally exposed than nurses which may be due to their lack of experience, anterior practical trainings and awareness of the hazards of sharp injuries at that stage of their clinical experience [33]. The risk of infection among that group lies in the fact that preventive vaccinations (Hepatitis B, Tuberculosis) are not systematically required in training institutions during admission.

Although there was a significant difference between the inter - institutional exposure levels, this difference was correlated with the lack of training. On this point, Nkoldongo DH which presented the highest prevalence of AEB was among health facilities with highest proportion of HCW with no past training on infection control and prevention.

Other studies suggest that specific safety precautions and basic infection prevention training in hospitals can improve the operational safety of HCW, thus reducing the occurrence of sharp injuries [35]. A considerable impact of training has been pointed in a European study in preventing AEB and its economic burden among HCW [36]. Public health professionals can provide educational activities to workers with the aim of improving the knowledge and skills necessary to deal with this problem by different methods such as seminars, informative educational boards, pamphlets, and workshops [33,37].

The surgery department had recorded the most cases of percutaneous exposure to blood. The often - urgent nature of the care administered in these departments and the stress that can result could explain the frequent occurrence of accidental occupational injuries. This result was in agreement with those obtained in YUTH [38], Indonesia (31.3 %) [32] and Ethiopia [10] which found, surgical department workers were the most affected by percutaneous AEB.

HCW with less than three years professional experience were the most affected in this study. The lack of skills and training could explain the more frequent occurrence of percutaneous exposure in this occupational group. In this regard, several studies have identified professional experience of less than 5 years as one of the risk factors for percutaneous exposure to blood [17,59,83].

The proportion of workers fully immunized against viral hepatitis B was less than 50 % and varied across hospitals. Moreover, a low proportion of participants were partially vaccinated reflecting the fact they started but did not complete the vaccination process. All this increases the risk and the burden of this disease that are nevertheless preventable [40]. However, this low proportion of fully vaccinated HCW was higher than that obtained at the Bamenda DH (13.9 %) [41] and lower than those obtained by some authors in Kenya [30] and in Serbia [42].

The proportion of fully vaccinated staff was significantly higher among medical staff compared to other occupational groups. Other authors have found similar results [42,43]. Indeed, the financial accessibility of the vaccine for medical personnel, their level of knowledge and perception of occupational risks related to HBV could explain these findings. In this regard, establishing mandatory vaccination against hepatitis B for public health workers could be a possible solution. In France, vaccination against HBV is governed by a law of January 18, 1991 of the Public Health Code which stipulates that any person exercising a professional activity in an establishment or a public or private prevention or care organization exposing him to risks of contamination, must be vaccinated against hepatitis. The excellent vaccination coverage of healthcare personnel against hepatitis B has led to the virtual disappearance of the risk of occupational hepatitis B in developed countries [44].

In addition, other possible solutions include training including items related to risk associated with needle stick and sharp injuries, sensitizations emphasising on the fact hepatitis B vaccination adverse events are limited to common vaccination reactions such injection site pain and redness which are self-limiting most of the time [45,46].

More than a third of healthcare personnel cited the high cost of the vaccine as the main reason for non - compliance to vaccination against HBV. Almost similar results were found at the Bamenda DH [41] and elsewhere in Africa [47].

Single health workers had a greater risk of being non - compliant to vaccination against HBV compared to married workers. Some authors have found in this regard that gender, level of study, grade and the fact of having manuals on biosafety measures at work were significantly associated with vaccination against HBV [42,48,49].

Nearly two thirds of participants who had undergone percutaneous exposure were not fully immunized against HBV. This proportion was high and worrying because in Cameroon, the seroprevalence of HBV in 2017 was high (11.2 %) [39]. So, these exposures could potentially lead to a significant proportion of seroconversion to viral hepatitis B among HCW. A study in YUTH had found that one third of percutaneous exposure victims were non - vaccinated against hepatitis B [23] ; this is probably due to the retrospection of only 3 months of the cases of AEB identified, applied in this study against 12 months for ours.