Effectiveness of measures to prevent needlestick injuries among ...

4 Intervention program evaluation
might have influenced the number of procedures performed by particular categories of
HCW over the four year observation period. The major weaknesses were reliance on
passive surveillance and the lack of information regarding the specific devices used.
Mendelson et al. completed a similarly designed evaluation of the Safety-Lok re-
sheathable winged steel needle (Becton Dickinson Corp.) [36]. The evaluation was
conducted in a 1,190 bed acute care hospital in New York City (US). An 11-month
intervention period was followed by a 31-month post-intervention observation period,
and risk of NSI was quantified as relative risk (RR) and 95 % confidence interval (CI)
comparing the two. Overall, NSI associated with winged steel needles declined from
13.41 to 6.41 per 100,000 devices ordered (RR 0.48; 95 % CI 0.31-0.73) following
implementation of the safety device. Injuries occurring during or after disposal were
reduced most substantially (RR 0.15; 95 % CI 0.06-0.43). Because injuries were
reported directly to the area supervisor, underreporting could have inflated these esti-
mates of benefit. Overall, however, this intervention was well-planned, and included
both objective outcome measures and consideration of potential confounding by such
covariates as type of procedure, occupation, work location, timing and mechanism of
injury.
The remaining interventions employing replacement hollow-bore needles were rated
as intermediate [37 to 41] or poor quality [42 to 46]. Most employed weak study
designs, e.g. employing ecological (group-level) measurements. Other common
problems included lack of description of data collection methods, or the methods were
clearly subject to bias; information on statistical methods was lacking; and/or potential
biases were not acknowledged by the author(s). In several cases, the authors over-
interpreted the results, generalizing to populations or health care settings beyond the
scope of the paper. While the results all showed reductions in NSI with the introduction
of safety engineered hollow-bore needles, weaknesses in study design and/or analysis
did not allow for a causal interpretation of the changes in NSI rates.
� Intermediate quality
Alvarado-Ramy et al. combined NSI data from 1993 to 1995 from 10 hospitals to
evaluate the efficacy of the Safety-Lok resheathable winged steel needle (Becton
Dickinson Corp.), the Punctur-Guard bluntable vacuum tube blood-collection needle
Report „Needlestick injuries“ 36