Effectiveness of measures to prevent needlestick injuries among ...

4 Intervention program evaluation
The evaluations by Hartley et al., Rice et al., Wright et al. and Meyer et al. each used
a randomized design, but the reports were brief and lacked sufficient detail for a fair
assessment of their quality and the validity of their results [62 to 65]. For the final
report in this group the use of the intervention device was optional. Only 4 % surgeries
were undertaken using a blunt suture needle alone while 24 % were performed using
both the conventional and intervention devices and 74 % were performed using the
conventional device alone. It is unclear how it was determined which device caused
the injury when both devices were used. Therefore it is difficult to assess the effective-
ness of the device in reducing injuries [61].
4.2.2.3 Safety-engineered IV systems (not needleless)
Re-engineered, but still sharp-containing IV systems were evaluated in two papers,
which both were rated of intermediate quality [34; 66].
O’Connor et al. evaluated the use of a self-sheathing IV catheter in one emergency
medical services system, with voluntary injury reports collected retrospectively from
employee records [66]. Prior to the evaluation, employees received training in the use
of the new devices and were encouraged to report all NSI. The estimated annual
incidence of “contaminated” NSI dropped from 169/100,000 attempts at IV access
(CI: 85, 253) to none (CI: 0, 46) following introduction of the safety IV. Overall, esti-
mated annual incidence of NSI dropped from 231/100,000 attempts at IV access (CI:
132, 330) to 15/100,000 attempts (CI: 0, 40). Underreporting of NSI is likely to have
played a role in the dramatic declines noted by O’Connor et al., because they noted
similar decreases in NSI due to conventional catheters, from 176/1,000 employee-
years prior to the intervention none during the study period.
The study by Sohn et al. is described in detail in the “replacement needles” section
above [34]. While the results were presented separately for hollow-bore devices, the
results for several other replacement devices were grouped together. The mean annual
incidence of NSI decreased from 34.08 per 1,000 FTE employees before the interven-
tion to 14.25 per 1,000 FTE employees after the intervention (p < 0.001). The con-
current introduction of multiple safety devices as part of the same program and the
combined analysis does not allow for a valid assessment of the efficacy of any specific
Report „Needlestick injuries“ 44