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Objectives: Risk associated with needlestick injuries (NSI) in health care workers (HCWs) in Taiwan has not been characterized. We conducted this investigation to study 1) the prevalence and yearly incidence of NSI in HCWs in Taiwan, and the risk factors associated with NSIs; 2) reporting behavior when a NSI was sustained; and 3) seroprevalence of blood-borne pathogens among inpatients. Combination of the above information allowed for risk estimation for contracting hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in HCWs. Methodology: A cross-sectional questionnaire survey for life-time experience and frequency of NSI was conducted in a random sample from four strata of accredited hospitals according to the number of employees, from July 1996 to June 1997 in Taiwan. All full time employees, including physicians, nurses, technicians, and supporting personnel were recruited. Seroprevalence was examined for HBV, HCV and HIV among inpatients six years in age or older in one teaching hospital during July 1997 to June 1998. Results: A total of 10,469 health care workers were recruited from 16 out of 132 accredited hospitals and 82.6% (8,645) completed the survey, including nurses (61.0%), physicians (16.1%), medical technicians (14.9%), supporting personnel (7.9%). The prevalence of NSI were 93.1%, 86.6%, 78.3%, 61.0% in nurses, physicians, technicians, and supporting personnel respectively. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 times per person in the past 12 months. Of the most recent episodes of NSIs, ordinary syringe needles accounted for 80.3% (95% CI, 79.4% - 81.2%) of hollow-bore needles associated incidents, and 74.1% (95% CI, 72.8% - 75.4%) of them were contaminated. The most frequently reported circumstance was the "Breakdown of Universal Precautions", recapping-related behaviors (81.6%, 95% CI 80.3% - 82.9%) of HCWs. More than a quarter (27.8%, 2,399) of HCWs were unprotected (either not vaccinated or having an unknown serological status) against HBV. Seroconversion in stuck HCWs was reported 1.8% for HBV (135), 0.2% (18) for HCV, 0.2% (15) for both HBV and HCV, 0.1% (5) for syphilis and less than 0.1% (2) for HIV. ^M A total of 81.8% of NSIs were unreported. Similarly, high incidence of NSI and low reporting rate were also found in student nurses. Seroprevalence of HBV, HCV, and HIV among inpatients were found higher than the reported rate in source patients of this survey. Seroprevalence of HBsAg was 16.7% in hospitalized patients, 1.7% positive for HBeAg, 12.7% for Anti-HCV, and 0.8% for Anti-HIV. Different seroprevalence rates of HBsAb (+), HBsAg (+), Anti-HCV (+), Anti-HIV (+) in different seasons were also found significant (p