Effectiveness of measures to prevent needlestick injuries among ...

4 Intervention program evaluation
recapping block [71]. Also in the category of “assistive devices” is the Suture Mate, a
small plastic device that contains an abrasive surface for cleaning needles, a sponge
used to embed needles when not in use, and a cutting slot to assist in knot tying dur-
ing surgery [72].
Goldwater et al. introduced voluntary use of a needle guard to a medical laboratory
with approximately 70 employees [69]. On a typical day, between 1,000 and 1,100
venipunctures were carried out. NSI reports during 32 months following introduction of
the guard were collected via a passive system, and comparisons were made between
the NSI rates among users (n = 47) and non-users (23) of the needle guard. The aver-
age monthly NSI rate for needle guard users was 1/16,100 venipunctures (0.006 %),
none due to recapping. Non-users were injured 1/3,739 venipunctures (0.03 %).
The major problem with this evaluation stems from voluntary use of the needle guard,
and associated potential for bias due to differences in work practices between the user
and non-user groups. Although no statistical analyses were presented by Goldwater
et al., and no attempt was made to assess or control for potential confounding, the
authors concluded that the needle guard was effective at preventing NSI among phle-
botomists [69].
Based in part on the findings of Goldwater et al., Whitby et al. adopted the needle
guard system at the Princess Alexandria Hospital of Australia. Contrary to the previous
findings, Whitby et al. observed an increased risk of needle stick following adoption of
the needle guard and associated training [70]. Injury reports were collected through a
passive surveillance system, supplemented by questionnaires from approximately 25 %
of the hospital staff that allowed for an assessment of underreporting rates. The
authors determined that the baseline rate of reporting of NSI (i.e., prior to introduction
of the needle guard) was approximately 36 %. After implementation of the interven-
tion, which included safety training, reporting rates rose to nearly 75 %. This difference
in reporting practices could have contributed to the observed increase in NSI risk asso-
ciated with use of the needle guard. In addition to changes in underlying reporting
rates, the Whitby et al. program included concurrent introduction of a new lancet that
was not compatible with the needle guard. This new lancet could have minimized any
protective effect the needle guard may have incurred, and the introduction of more
Report „Needlestick injuries“ 46