Effectiveness of measures to prevent needlestick injuries among ...

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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 during 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 intervention, 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 associated 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
4 Intervention program evaluation than one type of equipment makes it difficult to assess the effect on injury rates of either one. Wright et al. tracked NSI during a ten-month interval following introduction of a needle recapping block [71]. There was a 60 % reduction in NSI that could have occurred after use, when a needle could have been recapped reported by nurses and housekeeping staff (OR 0.4; 95 % CI 0.18-0.82). The OR for cover-irrelevant injuries was 0.92 (95 % CI 0.40-2.03), indicating that major changes in underlying injury rates or reporting practices during the evaluation period were unlikely. However, two factors might have influenced the results, and they might have operated to either in- flate or deflate the effect estimate. Specifically: a) NSI reporting procedures were made easier during the intervention period. This would lead to an increase in the observed number of injuries, suggesting the effectiveness of the recapping block might be more protective than observed; and b) A new sharps disposal system was implemented concurrently with the introduction of the recapping block. The new system eliminated the occurrence of injuries resulting from needles protruding “through the rubbish bag”, which is among the injury types use of a recapping block would also be expected to reduce (if the disposal system had remained the same). Bebbington et al. conducted a good quality evaluation of use of the Suture Mate during obstetric surgery to repair vaginal tears [72]. Individuals performing the surgery included obstetricians, family physicians, residents, and medical students. Practitioners used the device for a three-week training period prior to the evaluation period, and the primary outcome measure was glove perforations as a surrogate for NSI risk. Perforations were detected through standard water manipulation, by study personnel blinded as to group assignment. The intervention group and the comparison group each contained 250 sets of gloves. Twenty gloves in the study group and 67 gloves in the control group were perforated. Based on stratified analyses, the authors concluded that the Suture Mate was statistically significantly protective in all groups except for medical students. The authors reported that 90 % of the practitioners reported satis- Report „Needlestick injuries“ 47
Page 1: Effectiveness of measures to preven
Page 4 and 5: Authors: Sandra I. Sulsky, Thomas B
Page 6 and 7: Wirksamkeit und Wirtschaftlichkeit
Page 8 and 9: Eficacia y rentabilidad de medidas
Page 10 and 11: 5 Cost effectiveness ..............
Page 13 and 14: Preface Preface It has long been re
Page 15 and 16: 1 Introduction 1 Introduction Altho
Page 17 and 18: 1 Introduction scientific laborator
Page 19: 1 Introduction To complete each of
Page 23 and 24: 3 Descriptive epidemiology of NSI 3
Page 25 and 26: 3 Descriptive epidemiology of NSI a
Page 27 and 28: 3 Descriptive epidemiology of NSI c
Page 29 and 30: 3 Descriptive epidemiology of NSI s
Page 31 and 32: 3 Descriptive epidemiology of NSI h
Page 33 and 34: 4 Intervention program evaluation 4
Page 35 and 36: 4 Intervention program evaluation u
Page 37 and 38: 4 Intervention program evaluation d
Page 39 and 40: 4 Intervention program evaluation (
Page 41 and 42: 4 Intervention program evaluation c
Page 43 and 44: 4 Intervention program evaluation t
Page 45 and 46: 4 Intervention program evaluation a
Page 47: 4 Intervention program evaluation d
Page 51 and 52: 4 Intervention program evaluation t
Page 53 and 54: 4 Intervention program evaluation b
Page 55 and 56: 4 Intervention program evaluation 4
Page 57 and 58: 4 Intervention program evaluation C
Page 59: 4 Intervention program evaluation a
Page 62 and 63: 5 Cost effectiveness Both costs and
Page 64 and 65: 5 Cost effectiveness 21 % by using
Page 66 and 67: 5 Cost effectiveness the high HBV v
Page 68 and 69: 5 Cost effectiveness After the impl
Page 70 and 71: 5 Cost effectiveness estimating cos
Page 73 and 74: 6 Discussion 6 Discussion This repo
Page 75: 7 Recommendations 7 Recommendations
Page 78 and 79: 8 Bibliography [12] Verordnung übe
Page 80 and 81: 8 Bibliography A retrospective stud
Page 82 and 83: 8 Bibliography [48] Gartner, K.: Im
Page 84 and 85: 8 Bibliography [66] O'Connor, R. E.
Page 86 and 87: 8 Bibliography [86] Thomas, S.; Aga
Page 89 and 90: Tables Table 1: Overview of prevent
Page 91 and 92: Tables Table 3: Distribution of cou
Page 93 and 94: Tables Table 5: Distribution of nee
Page 95 and 96: Tables Table 7: Activity during nee
Page 97 and 98: Tables Table 9: Screening Criteria
Page 99 and 100:
Tables Table 11: Quality indicators
Page 101 and 102:
Tables Table 13: Examples of estima
Page 103 and 104:
Annex 1: Glossary and abbreviations
Page 105 and 106:
Annex 1: Glossary and abbreviations
Page 107 and 108:
Annex 2: QBCR review form COMPARISO
Page 109 and 110:
Annex 2: QBCR review form Character
Page 111 and 112:
Annex 2: QBCR review form DISCUSSIO
Page 113 and 114:
Annex 3: Definitions/guidelines for
Page 115 and 116:
Annex 3: Definitions/guidelines for
Page 117 and 118:
Annex 4: Working group Needlestick
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