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Breaking ampoules can cause serious injuries and a lack of self-confidence among nurses. These injuries can cause nurses to lose working hours and risk their exposure to blood-borne disease. To prevent injury, ampoule openers are recommended. However, such openers may not be available, so the most standard procedure is to open ampoules manually, requiring skill to do so safely. This comparative study evaluated manual methods for breaking ampoules and resultant injury, length of sharp edge, and identified risk factors for ampoule injury among 56 registered nurses. The participants broke ampoules using six methods with two ampoule sizes (2 ml and 10 ml). Each method used material such as a gauze pad, cotton ball or syringe bag and one hand breaking direction (breaking the ampoule tip in an outward or inward direction). The incidence of injuries, length of the sharp edge of the ampoule, and factors predicting injuries were measured. In total, 73 of 672 gloves worn by participants showed damage (glove tears). Breaking an ampoule using a syringe bag and an outward direction showed the lowest incidence of injuries and the shortest length of the sharp edge. Significant predictors of ampoule injury were the breaking method, area of nursing specialty, ampoule size, breaking direction, and length of the sharp edges. These findings suggest that breaking an ampoule in an outward direction and using material wrapping entire the ampoule neck can protect against injury. [ABSTRACT FROM AUTHOR]