Objective To explore the current status and influencing factors of occupational exposure to acupuncture needles among acupuncture practitioners in Southwest China. Methods From April 15 to April 30, 2024, medical staff engaged in acupuncture diagnosis and treatment in 98 hospitals in Southwest China were selected by convenience sampling. A self-designed questionnaire was used to investigate their general information, occupational exposure protection awareness, occupational exposure risk perception, and the occurrence of occupational exposure to acupuncture needles. Binary logistic regression was employed to analyze the factors influencing occupational exposure to acupuncture needles. Results A total of 567 questionnaires were distributed, and 564 valid questionnaires were recovered, with an effective recovery rate of 99.47%. Among the 564 practitioners surveyed, 195 experienced occupational exposure to acupuncture needles, yielding a person-based incidence rate of 34.57% (195/564). A total of 417 exposure episodes were reported, with an exposure event rate of 0.74 episodes per person (417/564). Of these exposures, 84.89% (354/417) were caused by filiform needles, and 41.73% (174/417) occurred during the needle removal process. After exposure, 78.42% (327/417) of the affected individuals managed the wounds according to standard protocols, and 53.72% (224/417) reported the incidents in a timely manner. Logistic regression analysis revealed that gender [females vs. males: odds ratio (OR)=1.755, 95% confidence interval (CI) (1.136, 2.710), P=0.011], job category [nurses vs. physicians: OR=3.252, 95%CI (1.312, 8.058), P=0.011; others vs. physicians: OR=2.774, 95%CI (1.049, 7.332), P=0.040], pre-exposure prevention awareness [OR=0.767, 95%CI (0.662, 0.890), P<0.001], perceived likelihood of occupational exposure risk [OR=1.431, 95%CI (1.222, 1.676), P<0.001], and risk response [OR=0.889, 95%CI (0.811, 0.976), P=0.013] were independent influencing factors for occupational exposure to acupuncture needles among acupuncture practitioners. Conclusions The incidence of occupational exposure to acupuncture needles among acupuncture practitioners in Southwest China is relatively high, and is influenced by multiple factors including gender, job category, pre-exposure prevention awareness, perceived likelihood of risk, and risk response. Therefore, targeted intervention measures should be taken based on the characteristics of exposure to minimize the occurrence of occupational exposure to acupuncture needles.