Objective: To estimate the prevalence and incidence of needlestick injuries associated with insulin injection among nurses working in hospitals in China and to quantify the direct healthcare costs associated with insulin injection-related needlestick injuries. Methods: We conducted a large online survey among hospital nurses from 31 provinces, municipal cities, and autonomous regions in China from October 2016 to February 2017. The survey covered a wide range of questions, including geographical location, years of experience, insulin injection practice, number of insulin injection-related needlestick injuries in the past 12 months, interventions for needlestick injuries, and treatment costs. We developed a cost estimate model and categorized costs into two major components: infection prevention and treatment of infections. Results: We received a total of 10,447 questionnaires, of which 9873 were complete and validated. 39.1% of the nurses reported at least one needlestick injury while administering diabetic injections at some point in the past. The incidence of needlestick injuries involving injection pens was 139.5 per 1000 nurses per year and, with adjustment for exposure, 10.2 needlestick injuries per 100,000 injections. Among the respondents, 3.2% reported of having hepatitis B virus infection and 0.9% having hepatitis C virus infection as a result of needlestick injuries. The total costs of one insulin injection-related needlestick injury was estimated to range from (sic)1,884 - (sic)2,389. Conclusions: Insulin injection-related needlestick injuries were common in nurses working in hospitals in China and imposed a significant economic burden. More resources should be allocated for preventive efforts for needlestick injuries, including adoption of injection devices with advanced safety features. (C) 2019 The Author( s). Published by Elsevier Ltd.