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To determine the frequency of needlestick injuries and barriers of reporting such injuries amongst Iranian nurses.Exposure to blood-borne pathogens because of needlestick injuries in particular is a potential risk for healthcare workers, including clinical nurses. The burden of sharp injuries sustained by healthcare workers is still unclear, primarily because of underreporting.A cross-sectional study was undertaken amongst 111 clinical nurses working in five major teaching hospitals in Tehran/Iran during 2007-2008 who were randomly selected.A validated self-reported questionnaire containing demographic characteristics and history of experiences with contaminated needlesticks as well as probably reason/s for underreporting such injuries was used.More than half of the enrolled nurses (54.1%, n = 60) had no experience of contaminated injuries, while the rest of 45.9% (n = 51) had experienced at least one contaminated needlestick injuries during their clinical performance. More than one-third (34.0%, n = 38) had experienced a mean of 58 contaminated needlestick injuries during the past 12 months (crude incidence: 0.52 NSI/nurse/year). Only 14 nurses (36.8%) with needlestick injuries experiences had officially reported their experiences. The major reasons for not reporting needlestick injuries were dissatisfaction with follow-up investigations by officials after reporting the events (33.3%) and safe/low risk considering of source patients (29.2%).Increased frequency and underreporting of needlestick injuries amongst Iranian nurses is going to be a major concern. As a preventive strategy, further interventions such as constant staff training, life-long learning and standardising postexposure procedures are recommended.Determining the prevalence, burden and reasons for underreporting needlestick injuries by clinical nurses are required for establishing a preventive strategy to decrease hospital infections.