Introduction: Needlestick injuries (NSIs) are common occupational hazards against healthcare workers (HCWs). NSIs led to serious economic burden as there were high costs forhealth system and the society, as well as the psycholog-ical impact on exposed workers post injury. Methods: A retrospective cohort study was conducted to determine the incidence, contributing factors of NSIs and to estimate the cost of PEM in Sabah’s tertiary hospitals. Descriptive statis-tics were used to analyse and describe the trends of NSIs. Chi-Square test was performed to determine the association between variables, relative risk was calculated. Results: 145 cases out of 7075 employees were reported from 2017 to 2018. Results in this study showed that the highest incidence of NSIs was 2.4/100 employees in Hospital Queen Elizabeth. 1.1/100 employees in 2018, which was higher compared to year 2017. Most common among younger age group between 20-29 years old, among doctors, with median working experience of 2 years. NSIs occurred com-monly at the wards, during blood taking, disposal of devices and common device used were hypodermic needles. There was a lack of awareness on NSI precaution guidelines among the doctors (χ2=19.304, df=1, p=<0.001). The lack of awareness on NSI precaution guidelines was associated with recurrence of NSIs (χ2=9.902, df=1, p=.002). The risk of recurrent NSI was 2 times more likely to occur among those who were unaware of NSI precaution guide-lines (RR=2.094, 95% CI 1.322-3.320). The estimated PEM cost ranged from RM143,840 to RM355,830 for the total of 145 cases in this study. Conclusion: We conclude that more aggressive preventive measures should be adopted to prevent NSIs and the high burden in PEM costs. Safety engineered devices are costly but might be a preferable choice to be invested as they may counterbalance the high cost on managing NSIs. Knowledge and compliance on standard precautions among the doctors should be monitored strictly.