Effectiveness of measures to prevent needlestick injuries among ...

Effectiveness of measures to prevent needlestick injuries among
employees in health professions
Abstract
The pathogens of greatest concern that may be transmitted by a needlestick injury
(NSI) are hepatitis B (HBV), hepatitis C (HCV), and human immunodeficiency virus
(HIV). The objective of the study was to critically review and summarize the published
literature on NSI, with the main focus on studies evaluating the effectiveness and cost
aspects of the implementation of safer devices and other preventive measures in
hospitals.
A comprehensive literature search on MEDLINE identified more than 2,300 publications.
A multi-stage selection process was used to identify those studies appropriate for
inclusion in the Quality Based Critical Review (QBCR), which finally included 61 publications
on intervention studies. These studies were evaluated and rated according to
quality indicators. Additionally, papers discussing the costs and benefits of the introduction
of safer device have been analyzed.
Those with the most patient contact, nurses and physicians, were the most likely to
report NSI, and NSI were most likely to occur in patient and operating rooms. However,
underreporting presents a serious problem for the development of accurate risk
estimates. The majority of the intervention programs, despite large differences in
methodological quality, showed in general that engineering controls, especially the
introduction of safety-designed devices, were effective in reducing the number of
reported NSI. There are only few studies investigating the cost-effectiveness of this
introduction and their results are suggesting that a complete substitution currently
might not be cost neutral for a hospital. However, these studies showed little methodological
consistency and therefore do not allow to draw firm conclusions. Societal as
well as intangible costs and benefits should be considered in an overall assessment.